02.09 Types of Schizophrenia

In this lesson I just want to quickly review the 5 different types of schizophrenia. They all have very similar characteristics like we talked about in the last lesson, but we want to help you differentiate the unique aspects of each one of these.

The first type is Catatonic Schizophrenia, which is characterized by psychomotor and behavioral abnormalities. It’s the only one where you really see the movement abnormalities like this. They will experience Stupor, which, if you remember from neuro - is a state where they’re completely unresponsive to stimuli, but they’re awake. So they may just sit and stare off at nothing. They may be fully immobile as well, as if they’re paralyzed. They may also experience something called Waxy flexibility - think of this like a wax figure or a gumby doll (I think I’m dating myself with that one!) - when you move their arm to one position, they will hold it there. If you turn their head or twist their hand a certain way - they hold it there - so you may see them holding these weird positions for a long period of time. And, finally they may also exhibit mutism or the inability to speak. So that’s catatonic schizophrenia. It’s very interesting.

The next one is disorganized schizophrenia - we see this a lot in adolescents with schizophrenia. Their thought processes and behaviors are just all over the place and never seem to be appropriate for the situation. Their thoughts and speech are disorganized - sometimes we call it “Word Salad”. They’ll say something like “Peanuts basketball jumping sharks blue yesterday” and fully expect you to get what they’re trying to say. They may have an inappropriate affect where their expression isn’t appropriate to the situation. Some people even say they are acting “silly” because they’re laughing randomly or at weird time. They may also struggle to even complete ADL’s because they can’t get their thoughts organized enough to complete tasks - this often leads to social withdrawal. One way I found to kind of depict what’s going on is this little animation. This is an example of a chaotic pattern - it never repeats, it’s not predictable, and if you continue to let it swing wildly you won’t really be able to accomplish what you want. It’s also interesting because if you were to start the swing at a slightly different place, you’d get a completely different result. So you can see how difficult it is to have a normal life and that every patient would be different.

The third type is Paranoid Schizophrenia. We will talk more about paranoia in the next lesson, but just recognize that paranoid schizophrenia is more intense and longer lasting than just a simple feeling of paranoia. They’re anxious, may be angry, and may have delusion of persecution - like everyone is out to get them. They’re suspicious and on alert all the time and may be prone to violence when their anxiety or anger is too high. Again, we’ll talk about this in the next lesson - but I want to say it here, too - NEVER whisper around these clients - even if you’re whispering about what to get for lunch. This is a big safety concern, okay?

The last two types are residual and undifferentiated. Residual is exactly what it sounds like - it’s leftover schizophrenia - they received the diagnosis in the past and they may still have some of those positive symptoms we talked about, but only at a low intensity and usually managed well. Undifferentiated schizophrenia is a patient who meets criteria for schizophrenia but doesn’t fall into any of the other subtypes we just talked about.

So a quick way to remember each one - Catatonic schizophrenia has psychomotor symptoms, disorganized is all over the place or chaotic, paranoid has paranoia and delusions, residual is leftover and low intensity, and undifferentiated is everyone else with schizophrenia.

Okay, so those are the types of schizophrenia - keep working your way through this module to learn more. Now, go out and be your best self today. And, as always, happy nursing!