Types and Management of Schizophrenia

 Definition

          The functional psychosis in which individual loses connectivity with reality.

    Schizophrenia is a descriptive term for a group of psychotic disorders characterized by gross distortions of reality; withdrawal from social interaction, and the disorganization and fragmentation of perception, thought, and emotion (Coleman, 1988).

Distortions in

(i)       Thinking,

(ii)      Perception,

(iii)     Language,

(iv)     Sense of self and behaviour.

Important Note

          ICD-11 and DSM V both classification systems have done away with Sub-type of Schizophrenia. However, ICD-10 discussed 9 sub-types and DSM IV 5 sub-types.

Certain Diagnostical Features

          The diagnosis is based on disorders in

(i)       thought,

(ii)      perception,

(iii)     experience of self,

(iv)     cognition, volition,

(v)      affect and behaviour,

for a time for at least 1 month.

          Experiences of passivity and control along with psychomotor disturbances (catatonia). These symptoms must not due to another health condition or of substance or medication use or abuse.

Types of Schizophrenia

Sr. No.	ICD – 10	DSM-IV	Coleman (1988)
1	Paranoid Schizophrenia	Paranoid type	Acute type
2	Hebephrenic Schizophrenia	Disorganized type	Paranoid type
3	Catatonic Schizophrenia	Catatonic type	Catatonic type
4	Undifferentiated Schizophrenia	Undifferentiated type	Hebephrenic type
5	Post-schizophrenic Depression	Residual type	Simple type
6	Residual Schizophrenia		Schizo-affective type
7	Simple Schizophrenia		Latent type
8	Other Schizophrenia		Residual type
9	Non-specific Schizophrenia		Chronic-undifferentiated
10	---------	-----------	Childhood type

 

(i)      Paranoid Schizophrenia – Dominated by absurd, illogical, and changeable delusions along with hallucinations, impairment of judgment, dangerous behaviour. Lesser disorganization of behaviour and withdrawal from social environment.

(ii)     Hebephrenic Schizophrenia – At earlier age than other types of schizophrenia. Disintegration of personality. Emotional distortion & blunting typically are expressed by inappropriate laughter, silliness, manners and bizzare behaviour.

(iii)    Catatonic Schizophrenia – Alternating episodes of extreme withdrawal and excitement. During withdrawal the individual remains motionless (hours and even days together). Sudden excitement, talk or shout incoherently, pace rapidly, engage in impulsive and dangerous behaviour.

(iv)    Undifferentiated Schizophrenia – Manifesting schizophrenic symptoms that do not match with other types.

(v)     Post-schizophrenic Depression – The individual tends to withdraw and fall into severe depression (at least for 2 weeks) with           occasional manifestation of mild schizophrenic symptoms. After the patient has met general criteria for schizophrenia within past 12 months.

(vi)    Residual Schizophrenia – The manifestation of mild symptoms post-schizophrenic episode. A kind of schizophrenic hang over.

(vii)   Simple Schizophrenia –Expression of low intensity symptoms of disorganization of thoughts, perception and behaviour. It generally occurs during early age. A kind of initial stage of onset of schizophrenia. The contact with reality is not severed completely but not intact either.

(viii)  Other Schizophrenia – Expression of various symptoms of schizophrenia without any significant previous episodes or hospitalization.

(vii)   Non-specific Schizophrenia –         Symptoms which resembles schizophrenic type but not covered in any of the types discussed above.

 

Pharmacological Treatment

          Common antipsychotic drugs are haloperidol (Haldol) and risperidone (Risperdal). Research has shown that these drugs are more effective than any other single form of treatment for schizophrenia and other psychotic disorders, reducing symptoms in at least 65 percent of patients Breier, 2001).

 

Management of Schizophrenia

          The therapeutic goal is significantly to reduce the excess morbidity and mortality associated with depressive symptoms.

(i)       Psycho-social support

(ii)      Community and after care treatment

(iii)     Family therapy

(iv)     Yoga and relaxation techniques in association with pharmacological treatment

(v)      Social skills training

(vi)     Cognitive Behaviour Therapy

 

सन्दर्भ:

1.       Coleman, C. J. (1988). Abnormal psychology and modern life. Bombay, India: D. B. Taraporevala Sons & Co.

2.       NCERT. (XII). Psychology Book.

3.       DSM V Manual. Published by APA.

 

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