Undifferentiated Schizophrenia – What is it?

Paranoid, disorganized, catatonic, residual, and undifferentiated schizophrenia were listed in the previous version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as the five diagnosable subtypes of schizophrenia ^[1]. However, these five subtypes have been removed from the most recent publication, the DSM-5 ^[2], as they are no longer considered valid as individual diagnoses ^[3].

Now, undifferentiated schizophrenia is not a specific diagnosis. However, when making a diagnosis of schizophrenia, physicians can compare presenting symptoms with previously listed criteria to help form a diagnosis.

What is undifferentiated schizophrenia?

Symptoms of Schizophrenia can include:

• Positive symptoms: such as hallucinations, delusions, and thought disorders
• Negative symptoms: such as a lack of motivation, blunted affect, catatonia, and social withdrawal
• Cognitive symptoms: such as disorganized speech and behavior, including odd or repeated movements, incoherent sentences, and jumping between thoughts and ideas

According to the DSM-IV, for a diagnosis of undifferentiated schizophrenia, any of the above symptoms can be present, but the symptoms do not clearly meet the criteria of the other types, which state that a particular symptom is prominent and that there is an absence of other symptoms.^[1]

Symptoms of undifferentiated schizophrenia

People diagnosed with undifferentiated schizophrenia may experience any combination of symptoms, including positive, negative, and cognitive symptoms.

Negative symptoms

Negative symptoms of schizophrenia include lack of emotional response, social withdrawal and isolation, low mood, and decrease in communication.

Negative symptoms may be difficult to notice, as they typically result in fewer social interactions and less societal disturbances, and thus, may take longer to be diagnosed than positive symptoms, or mistaken for symptoms of depression ^[4].

Positive symptoms

Although visual and auditory hallucinations are most common, hallucinations can involve any of the five senses, meaning that you may experience hearing, seeing, touching, smelling, or tasting things that are not there ^[5].

Delusions involve having a strong belief in something with no evidence, or that is clearly incorrect to other people. Examples of delusions may include ^[5]:

• Perception: a normal occurrence is given an abnormal meaning, for example, a bird flies overhead and this means that an alien spaceship is going to land. Or a song comes on the radio and that means the radio is communicating a special message to you.
• Idea: a current belief, such as the idea that the CIA are listening to your phone calls, or that someone is trying to kill you.
• Thoughts: thought insertion, broadcast, or withdrawal, which means that you feel you are not in control of your thoughts in some way. You may believe that other people can hear your thoughts, put thoughts into your head, or take them out.

Delusions may be based on certain themes, such as:

• Love: believing that a certain person is in love with you, such as a boss, a celebrity, or a fictional character.
• Persecution: believing that someone is trying to harm or kill you, or you are to blame for a terrible occurrence.
• Illness: being convinced you have a certain disease or condition.
• Jealousy: believing that your partner is cheating on you.
• Grandiose: feeling especially important, such as believing you are a celebrity or superhero.

Cognitive symptoms

Cognitive symptoms may include ^[4]:

• Disorganized speech: such as speaking in jumbled, incoherent sentences, using made up words, or repeating words or phrases.
• Disorganized behavior: such as unusual or inappropriate responses, including laughing at bad news, or responding to a question with an unrelated answer, difficulty concentrating or remembering, losing things, or making unusual facial expressions or body movements.

Causes of undifferentiated schizophrenia

The exact cause of schizophrenia is not clear, but is believed to be influenced by several factors, including:

Brain structure and function

Studies show that people with schizophrenia have abnormal levels of neurotransmitters, particularly dopamine and glutamate, indicating that these chemicals may impact the development of the condition ^[6].

Furthermore, brain scans of individuals with schizophrenia show changes in the structure of the brain, including less gray matter, which suggests that schizophrenia may be influenced by impaired brain development ^[7].

Additionally, research shows that traumatic brain injuries can lead to the onset of schizophrenia or an episode of psychosis, which also implies that the structure of the brain plays a part in the development of schizophrenia ^[8].

Genetics

Schizophrenia is significantly more common in people with a family history of the condition, than in those without. It is estimated that people with a parent or sibling with schizophrenia are six times more likely to develop the condition ^[6]. However, having a family member with schizophrenia does not always mean that the condition will develop.

Social and environmental influences

The risk of developing schizophrenia has been found to be influenced by several social and environmental factors, such as childhood trauma and abuse, stress, low socioeconomic status, social isolation, and complications during pregnancy and childbirth ^[4][9].

Alcohol and drugs

Studies show that substance use can increase the risk of developing a psychotic episode or illness, especially cannabis use. Research indicates that people who use large and frequent doses of cannabis from a young age could be at a significantly increased risk of developing schizophrenia ^[9][10].

Furthermore, there is also research to suggest that the use of other substances, such as cocaine, amphetamines, and alcohol, may also contribute to an increased risk of developing psychotic symptoms with schizophrenia ^[9].

Treatment of undifferentiated schizophrenia

Medication

Antipsychotic medications are usually prescribed to treat all types of schizophrenia and manage psychotic symptoms. Usually, a second-generation antipsychotic (also known as atypical antipsychotic) will be prescribed, which may include aripiprazole, olanzapine, or risperidone.

Medications can affect people differently, so while one person may have a positive effect from a certain medication, another may not find it useful. Therefore, it may be necessary to try several different medications before finding the most effective treatment. Antidepressants and mood stabilizers may also be used to treat certain symptoms of schizophrenia.

If two or more antipsychotic medications have been tried and are not successful, clozapine may be prescribed, which is a very effective treatment for schizophrenia, but is associated with certain severe side effects and risks. As such, it is not prescribed as a first choice of medication, and it is necessary to carefully monitor physical health during clozapine treatment ^[7].

It is important to always take your medication exactly as it has been prescribed, as taking too much, regularly missing doses, or abruptly stopping your medication is likely to cause adverse effects and a worsening of your condition. Medication noncompliance can lead to an increase in symptom severity and relapse ^[11].

Therapy

People with schizophrenia may find therapeutic interventions helpful, which could include:

• Cognitive behavioral therapy (CBT): CBT can provide the skills needed to adapt negative thoughts and behaviors, gain a better understanding of how to manage schizophrenia symptoms, and prevent the occurrence of a relapse ^[7].
• Family therapy: Some might find family therapy useful, as it can add to the family members’ understanding of their loved one’s condition, helping to provide skills to communicate effectively and manage symptoms ^[12].
• Psychosocial treatments: There are various psychosocial interventions available that can help individuals with schizophrenia to learn new professional and social skills, manage their condition, and recognize the importance of medication compliance ^[6].

Self-care

• Avoid drugs and alcohol: The use of alcohol and illicit substances can negatively impact mental health and may cause a relapse. There is also a risk that these substances could interact with medication, potentially leading to ineffective treatment or serious side effects ^[4].
• Attend all appointments: It is vital for your recovery process to attend all arranged appointments relating to your treatment, to monitor your mental and physical wellbeing, receive necessary care, and discuss any changes in your mental state.
• Get plenty of sleep: Sleep can have a significant impact on mental wellbeing, with poor quality or reduced sleep contributing to a worsening in symptoms, and good quality sleep helping to improve mental health. Utilizing good sleep hygiene techniques can help with this, such as going to bed at the same time each night and avoiding screens and caffeine before bed.
• Physical activity: Engaging in activities can help to prevent symptoms from worsening, by being active and engaged, such as yoga, meditation, running, walking, listening to music, and spending time with friends.

Other types of schizophrenia

Currently, schizophrenia is not diagnosed using five specific subtypes, although the symptoms of each subtype might still be recognized within a diagnosis. Along with undifferentiated schizophrenia, the other four previously used subtypes were ^[1]:

Paranoid schizophrenia

For a diagnosis of paranoid schizophrenia, an individual would experience symptoms such as delusions and/or hallucinations. It would be likely that this person becomes intensely focused on at least one persecutory delusion, resulting in a strongly held belief that they are in danger of harm from someone or something.

An individual with paranoid schizophrenia might hear a voice, or voices, that tells them they are being poisoned, followed, or watched, or they might believe that they see or hear worrying messages. Typically, individuals with paranoid schizophrenia become untrusting and suspicious of others, and this can cause them to become withdrawn, angry, or afraid.

Catatonic schizophrenia

Abnormal psychomotor function is a common aspect of catatonic schizophrenia. This might cause excessive or hyperactive moments, an inability to move, or abnormal movements or postures.

A commonly seen symptom of catatonic schizophrenia is stupor, or immobility, which causes the individual to hold unusual positions for extended periods of time, or to appear frozen in place, sometimes for hours or days ^[13].

Someone with catatonic schizophrenia may also experience symptoms such as echolalia and echopraxia, respectively meaning the mimicking of other people’s words or the mimicking of other people’s actions.

Disorganized schizophrenia

If someone is diagnosed with disorganized schizophrenia, they might be experiencing symptoms such as hallucinations and delusions, but the clearest and most persistent symptoms are disorganized speech and behavior, such as jumping between topics, saying bizarre or unusual things, feeling confused, or repeating certain words.

It is also common for someone with disorganized schizophrenia to experience flat affect, which means that they will show expressionless, inappropriate, or unusual responses.

Residual schizophrenia

For a diagnosis of residual schizophrenia, no prominent positive symptoms, such as hallucinations, delusions, and disorganized speech, would be present. However, there would still be clear disturbances in cognition, such as odd beliefs, and potentially the presence of negative symptoms.