Types of Schizophrenia
The word comes from the Greek, ‘split mind’, hence arises a common misconception that schizophrenia refers to a Jekyll and Hyde character, or the ‘Multiple Personality Disorder’. This is not so. It was Bleuler, a German psychiatrist, who coined the term. He was not referring to the splitting of the personality into two or more parts, but to the splitting from reality that he commonly observed in the illness and to the inconsistency between behaviour and emotion in the schizophrenic patient e.g., ‘Napoleon’ will happily wait on tables in a hospital dining area!
There are five main types of schizophrenia:
- Simple Schizophrenia
Tends to develop gradually, almost unnoticed, often in a young person, late teens or early twenties. Such a person becomes increasingly withdrawn and may neglect hygiene and appearance. The person may ‘drop-out’ from society and become homeless. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), classification system does not include this category as there is some disagreement about its existence amongst psychiatrists.
- Acute Schizophrenic Episode
This is a sudden, severe psychosis that runs a short, yet stormy course. The individual may experience extremely agitated panic, accompanied by delusions and hallucinations. This psychosis accounts for many so-called ‘nervous breakdowns’ (also referred to as ‘Brief Reactive Psychosis’).
- Catatonic Schizophrenia
This type of schizophrenia is becoming very rare in Europe and North America, although it was common several decades ago. Individuals show either a general inhibition of all movement or, conversely, excessive and excited aggression. Close supervision is essential to prevent self-harm or harm to others. Aggressive catatonics can become agitated, unpredictable and dangerous.
- Hebephrenic Schizophrenia
The hebephrenic has not only withdrawn from reality, but has substituted a synthetic reality for it. The onset of the illness is usually quite sudden, with bizarre symptoms, including meaningless grimaces and gesture, peculiar delusions and hallucinations and symbolic actions, difficult to understand. Mood may be flattened or inappropriate.
- Paranoid Schizophrenia
In this form of the illness, the individual suffers from persecutory delusions which are experienced as very frightening. It tends to appear later in life.
Several other types of schizophrenia have been distinguished including undifferentiated or atypical schizophrenia. This is a category in which people fit one or more of the other categories but may not exhibit all of the symptoms peculiar to one category alone. Because of the number of symptoms which can be classified as schizophrenic (over thirty) some psychologists disagree with the use of one label to encompass such a wide range of disorders.
The aetiology of schizophrenia is not fully known and different theories abound, hereditary/biological, psychological/familial. In the 1920’s and 1930’s, psychoanalysts were claiming that schizophrenia was the result of traumas and early childhood experiences no longer remembered or acknowledged, although Freud himself has warned that psychosis would probably turn out to have a physical origin.
In 1948, Fromm-Reichmann coined the term ‘schizophrenogenic’ meaning causing schizophrenia, to describe a cold, hostile, domineering, over-protective or over-involved mother. Thus we had a decade or two of mother-blaming, or family-blaming. Then the discovery of neuroleptic drug treatment, with its dramatic ability to alleviate the more florid symptoms of schizophrenia led towards the possibility of a more biological basis to the disease. Research showed that the drugs acted as dopamine receptor-blockers. The brain cells of schizophrenic patients either produced too much dopamine or they cannot mop up the surplus.
Later it was mooted that in schizophrenia there may be a dominant gene affecting mono-amine oxidase activity, with a recessive gene affecting dopamine beta-hydroxylase. Adoption and fostering studies have confirmed that there is probably an important genetic component in this disease.
The treatment for schizophrenia is pharmacological, i.e., drug therapy. The drugs used, anti-psychotic or neuroleptic are often referred to as major tranquillisers, as opposed to minor tranquillisers. They can be very effective and include Chlorpromazine, Flupenthixol, Haloperidol and Clozapine.
