264 Schizophrenia, Disorganized Type (295.10)

DSM-IV-TR criteria

• Schizophrenia in which the following criteria are meet:
• All of the following are prominent for a diagnosis to be made:
  • Disorganized speech
  • Disorganized behavior
  • Flat or inappropriate affect
• The criteria are not met for Catatonic Type

Associated features

The essential features of the Disorganized Type of Schizophrenia are:

• Disorganized speech, disorganized behavior, and flat or inappropriate affect.
• Having disorganized speech may be accompanied by madness and laughter that are not closely related to the content of the speech.
• The behavioral disorganization (i.e., the lack of goal orientation) may lead to severe disruption in the ability to perform activities of daily living (i.e., showering, dressing, or preparing meals).
• Those individuals suffering from the Disorganized Type of schizophrenia may also demonstrate improper “normal behaviors” including masturbating or defecating in public.
• Criteria for the Catatonic Type of Schizophrenia are not met, and delusions or hallucinations, if present, are fragmentary and not organized into a coherent theme. Associated features include grimacing, mannerisms, and other oddities of behavior. Impaired performance may be noted on a variety of neuropsychological and cognitive test.
• This subtype is also usually associated with poor pre-morbid personality, early and insidious onset, and a continuous course without significant remissions.
• Historically, and in other classification systems, this type is termed hebephrenic, which is characterized by foolish mannerisms, senseless laughter, delusions, hallucinations, and regressive behavior.

Individuals with Disorganized Type of Schizophrenia might suffer from social deficits, which is an impaired ability to understand and solve social problems. They behave “silly” or seem weird to most people. For example, individuals suffering from Disorganized type laugh or giggle at inappropriate times.

Individuals might also suffer from emotional deficits, which some Schizophrenics might show abnormal expressions of emotions, or an impaired ability to recognize emotion in others. Sufferers of Disorganized type schizophrenia also have problems showing the correct emotion for example they might be the ones to laugh at a funeral.

Substance abuse is very prevalent in Schizophrenia cases. 80-90% use nicotine heavily. In many cases many are polysubstance abusers.

Most Schizophrenics are at a high suicide risk. (10% succeed)

Also if these individuals display hallucinations and delusions, their behavior tends to be bizzare and poorly organized.

Individuals do not respond well to treatment.

Child vs. adult presentation

In recent research it has been shown that signs of schizophrenia may be present before clincal symptoms of psychosis appear. Normally schizophrenia develops in individuals sometime between adolescence and early adulthood. During childhood, symptoms can be minimal and discrete, however through adolescence and into adulthood these symptoms will gradually increase in number and severity. It is extremely rare for the onset of schizophrenia to occur before adolescence (before the age of 12). Studies suggest that adult onset schizophrenia and childhood development of the disorder both lead to similar, if not identical, symptoms and complications. The life of the symptoms reported is similar to that seen in adult cases with the predictable developmental variations. For example, delusions are less complex in children and reflect childhood themes.

Gender and cultural differences in presentation

Women often have a milder overall course and later onset of schizophrenia than men. Men are more likely to receive treatment for the disorder. Some research suggests that social skills training may be more helpful to men than to women. Because treatment studies usually sample persons with schizophrenia who are currently receiving treatment it leads to more information gathered on males than in females. The prevalence of schizophrenia is comparable across different cultures. Several studies have shown that the course of the illness is more benevolent in developing countries compared to industrialized nations. Certain cultural interpretations of schizophrenia may promote more acceptance of people who display the symptoms. Without a clear understanding of the religious and cultural background, patients may be misdiagnosed. Knowledge of cultural norms appears critical to avoid the possible misinterpretation of culturally bound beliefs, experiences, and practices when arriving at a diagnosis. Stigma also plays an important role for cultural factors; this can greatly undermine the person’s ability to recover from the effects of schizophrenia. Also, this can cause difficulties in integrating into society.

Epidemiology

• It is estimated that approximately 2.2 million persons in the United States have Schizophrenia at any given time.
• The annual incident rate of new cases of Schizophrenia has ranged from 16 to 40 per 100,000 persons.
• One- year prevalence rates of Schizophrenia have ranged from 1% to 4.6% per 1,000 persons.
• The lifetime prevalence of Schizophrenia lies between 0.55% and 1% per 100 persons worldwide.
• The prevalence is believed to be remarkably stable across a wide range of: different populations, cultures, genders, races, and religions.
• People with the illness are especially affected in that they are less likely to marry or remain married, particularly males.
• Also people with Schizophrenia are less likely to complete higher levels of education.
• Only 14% to 20% of persons with Schizophrenia hold competitive employment.

Etiology

• Studies that have been done in the past 30 years are indicating that the risk of developing Schizophrenia in biological relatives of persons with Schizophrenia is greater than in the general population, even in the absence of any contact between relatives.
• The odds of developing Schizophrenia if one parent has the disorder is 13% and rises to 50% if both parents have the disorder, compared to only 1% risk in the general population.
• The rate of one identical twin developing Schizophrenia if his or her twin also has Schizophrenia is between 25% and 50%, compared to about 6% and 15% for fraternal twins.
• It also appears that the risk of developing Schizophrenia is greater in more severe types of Schizophrenia.
• It is more likely that Schizophrenia is a polygenetic condition or arises from an interaction of multiple genes, which increase the receptiveness to the disorder. Chromosome 1 has been implicated in recent research (Hodge et al., 2009). Several studies have shown that single nucleotide polymorphisms associated with chromosome 1 are present in many varieties of schizophrenia. Future research conducted will need to focus on determining which single nucleotide polymorphisms in a person’s DNA might alter genetic function and facilitate the development of schizophrenia.

Empirically supported treatments

Although no cures have been found yet for Schizophrenia, there are many treatment options to help a person with Schizophrenia cope with this disorder. Antipsychotic medication is the main biological treatment used in Schizophrenic cases. Antipsychotic medications block an excess of dopamine in the brain, but also effect other neurotransmitters as well as serotonin levels. Antipsychotic medications are usually grouped with psychosocial therapy treatments in order to treat the patient as effectively as possible. Although antipsychotic medications are useful, they can be dangerous and lead to major side effects.

Another treatment option is Psychosocial Therapy which includes family therapy, social skills training, and cognitive therapy. The most widely used type of therapy for schizophrenics is family therapy. In family therapy, the patient’s family is educated about what is happening to their loved one and are taught ways to help communicate and deal with the situations that arise. Social skills training and Cognitive therapy are also popular ways in trying to treat schizophrenia. In social skills training, the patient is taught basic social skills such as maintaining eye contact and engaging in small talk to help build relationships with those around them. This type of therapy is helpful because Schizophrenics tend to push people away, and become isolated. This type of therapy can greatly help disorganized schizophrenics since they mostly struggle with showing emotions, as well as not knowing how to behave properly in public. Cognitive therapy is also a popular therapy choice in treating persons with Schizophrenia because it aims to reverse how they perceive themselves, others, and the world around them.