What Are the 4 Types of

Schizophrenia and How

Do They Affect You?
Discover how each type is
diagnosed and treated
November 7, 2018 / Brain & Spine

Schizophrenia is a mental health disorder

that disturbs your thinking and
perceptions of life. This affects your
interactions with the world.

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“People with schizophrenia may hear

voices or noises; become very paranoid;
believe they have unusual powers; think
others control their thoughts, or vice-
versa; or believe world events are
connected to them,” explains psychiatrist
Minnie Bowers-Smith, MD.

It can be a long road to diagnosis,

however. Patients — and families — are
often in denial. After all, it’s a tough
diagnosis to accept.

Psychiatrists may not see all the person’s

symptoms right away. And substance
abuse may be a factor.

“We don’t label it schizophrenia right

away; the diagnosis can follow a person
throughout life once it’s in their chart,”
says Dr. Bowers.

What are the 4 main types of

schizophrenia?

Schizophrenia looks different from one

person to the next. But there are four
main categories into which patients fall:

1. Paranoid schizophrenia: The

person’s paranoia may be extreme,
and they may act on it. “They may
show up at the door of the FBI and
ask, ‘Why are you following me?’”
says Dr. Bowers. They may also
behave oddly, have inappropriate
emotional responses and show little
pleasure in life.
2. Catatonic schizophrenia: The
person shuts down emotionally,
mentally and physically. “People
appear to be paralyzed. They have no
facial expression and may stand still
for long periods of time,” she says.
There is no drive to eat, drink or
urinate. When catatonia lasts for
hours, it becomes a medical
emergency.
3. Undifferentiated schizophrenia:
The person has various vague
symptoms. “They may not talk or
express themselves much. They can
be confused and paranoid,” says Dr.
Bowers. The person may not bother
to change clothes or take a shower.
4. Schizoaffective disorder: The
person has delusional thinking and
other symptoms of schizophrenia.
“But they also present with one or
more symptoms of a mood disorder:
depression, mania and/or
hypomania,” says Dr. Bowers.

What happens at the hospital?

About one-third of people with

schizophrenia don’t believe anything is
wrong with them. Many more don’t seek
help on their own, for cultural reasons or
because they lack resources.

So problems often come to light only

when their erratic behavior or other
troubles trigger a crisis. “Patients are
often brought to the hospital by family,
teachers or the police,” says Dr. Bowers.

To decide whether to admit someone,

psychiatrists consider whether patients
pose a risk to themselves or others;
whether they can take care of
themselves; and whether they could
benefit from hospital treatment.

How do doctors diagnose the type

of schizophrenia?

If the patient is admitted, the psychiatrist

talks to them and evaluates their
behavior, considers whether any
symptoms were triggered by alcohol or
drugs, reviews any records from prior
admissions, and talks to the family.

“Initially, we may only see that the

patient is losing track of reality,” says Dr.
Bowers. “We may need more time to see
all the symptoms of
schizophrenia.” These symptoms include:

Fixed, false beliefs.

Hearing voices.
Seeing visions or shadows.
Suspicion and distrust.

Government regulations require

psychiatrists to diagnose a specific type of
schizophrenia so that insurance
companies get the green light to pay for
care.

“We hope to see enough symptoms

during a three-, five- or 10-day hospital
stay to clarify the type of schizophrenia,”
she says. “But we may not see all of them,
so the initial diagnosis may not be exactly
right.”

What are the treatments for

schizophrenia?

Ninety-nine percent of patients with

schizophrenia need lifelong treatment
with antipsychotic drugs, counseling and
social rehabilitation, says Dr. Bowers.

“This will reduce their symptoms and

help them get to a place of stability in
their lives,” she says.

Antipsychotics are given orally or by

injection. Depending on the type of
schizophrenia, other medications may be
needed as well:

People with paranoid schizophrenia

usually respond well to
antipsychotics, which decrease
paranoid thinking and help them
readjust to their environment.
People with catatonic schizophrenia
require benzodiazepines to relax
their muscles, allowing them to
become more active and to react to
the environment.
People with undifferentiated
schizophrenia are slower to respond
to antipsychotics because thinking is
disturbed across the board. “The
medication makes them more alert
and able to care for themselves, but
it doesn’t always clear their
thinking,” she says.
People with schizoaffective disorder
require a combination of
antipsychotics and antidepressants
or mood stabilizers.

Despite significant side effects, it’s

important to keep taking these
medications.

“When people go on and off their meds,

their symptoms return, and they often
end up back in the hospital,” says Dr.
Bowers. “Also, the more episodes you
have, the further you get from your
healthy baseline.”

What is the long-term outlook?

Without ongoing care, people with

schizophrenia can be hospitalized
multiple times, lose jobs and fall out of
touch with their families.

“Early treatment in whatever setting

works best for the patient is important,”
says Dr. Bowers. “If they are in the
hospital, we want to be sure they have a
good aftercare plan.

“Patients need to have a clear idea about

how to maintain their health by taking
their meds, staying sober and getting
community support.”

This will help them maintain their

independence and function better in
society.

The road to diagnosis, treatment and

stability is a challenging one. Along the
way, she recommends getting education
and support from national organizations
like the National Alliance on Mental
Illness (NAMI), Recovery International
and Emotions Anonymous.

To learn about local services, families can

reach out to their county mental health
board, local hospital or mental health
center.