Understanding Schizophrenia: Clinical Forms and Symptoms
Schizophrenia: Clinical Forms
Hebephrenic Schizophrenia
This form typically begins between 15 and 20 years of age. It’s characterized by a progressive emotional emptiness, loss of interest in the external world, and the development of extravagant personality features. Emotional indifference, ambivalence, depersonalization, and a detachment from reality are prominent. Unmotivated agitation and aggression may occur, alongside signs of disintegrated thought and volitional processes.
Simple Schizophrenia (Heboidophrenia)
Individuals with this form exhibit a significant decline in emotion, social interaction, and overall performance. They gradually become apathetic, indifferent, and autistic, without prominent hallucinations or delusions. Starting in adolescence, this form gradually progresses over a decade or more, often leading to chronic homelessness, unstable employment, and involvement in criminal activities.
Catatonic Schizophrenia
This form is marked by distinct psychomotor symptoms: rigid postures, waxy flexibility, negativism, automatic obedience, catalepsy, stereotypy, inappropriate gestures, mutism, absurd posturing, hyperkinesia, and immobility. It oscillates between two extremes: catatonic stupor and hyperkinetic catatonia. Hallucinations, delusions, and mood disturbances (depressive or hypomanic) may also be present. Physical signs like facial seborrhea, constipation, fever, weight fluctuations, and changes in blood counts can occur.
Paranoid Schizophrenia
This distinct form is characterized by disordered thought content, including primary or secondary delusional experiences (often unsystematized) and hallucinations (primarily auditory). Thought process disorders may also be present. Affective and volitional signs are often less prominent. Onset typically occurs between 22 and 30 years of age, with a higher risk of antisocial acts due to violent reactions.
Pseudoneurotic Schizophrenia
This form presents as a constellation of symptoms, including social withdrawal, autistic behavior, ambivalence, and anxiety. Individuals may be overwhelmed by multiple neurotic mechanisms (phobic, hysterical, obsessive, and depressive).
Schizoaffective Disorder
This type can manifest as significant inhibition and depression, accompanied by suicidal ideation, persecutory delusions, disordered thinking, and complaints of external control. Schizophrenic and mood disorders are prominent.
Latent Schizophrenia
This form involves primary symptoms like disordered thinking and behavior, without secondary symptoms like hallucinations or delusions.
Residual Schizophrenia
This represents the final state after an active phase of the illness.
Chronic Undifferentiated Schizophrenia
This form encompasses disordered thinking, emotions, and behavior without fitting neatly into other categories.
Criminality and Schizophrenia
Schizophrenia has significant forensic implications. Affected individuals may commit crimes, sometimes of extreme severity. The genesis of criminal behavior is twofold: automatism (characteristic of simple and catatonic forms) and delusion-driven acts (typical of other forms, especially paranoid schizophrenia). Crimes against physical integrity and property are common. Due to their detachment from reality, patients may also commit crimes of contempt and resistance against authority. Homicide is often an absurd and psychologically incomprehensible act. Property crimes are often marked by confusion and absurdity. Depending on the specific form and personality of the individual, other crimes like armed robbery and fraud may occur.
Primary Symptoms of Schizophrenia
Dissociation of Personality
The core alteration in schizophrenia is a dissociation of thought and brain function. This affects all basic psychic functions: thinking, emotions, intelligence, and motor behavior. The normal sense of unity and personality is disrupted, leading to a progressive breakdown in the patient’s relationship with the external world. Feelings of annihilation, depersonalization, loss of identity, and a sense of being controlled by external forces are common.
Affective Disorders
Affective rigidity, indifference, emotional hypersensitivity (often expressed as anger), and lability are common. Paratimia, where emotional reactions are contrary to normal expectations, can also occur. Feelings of malaise, anxiety, terror, and a lack of social tact are frequently observed.
Disorders of Consciousness, Perception, and Motor Behavior
Loss of consciousness is less common, but disorders of sensory perception and attention are frequent. Decreased volition, thought insertion, thought withdrawal, and thought broadcasting can occur. Neologisms (creation of new words) and paraphasias (incorrect word substitutions) are common. Motor behavior disorders include mutism, echolalia, echopraxia, active and passive negativism, stereotypies, and automatic obedience.
Secondary Symptoms of Schizophrenia
Hallucinations
Hallucinations are frequent, especially at the onset of the illness, and can significantly influence behavior. Auditory hallucinations (whispers, bells, voices) are most common, followed by kinesthetic and tactile hallucinations. Olfactory, visual, and gustatory hallucinations are less frequent.
Delusions
Delusions of reference, significance, and influence are common. Delusions of reference involve ascribing personal meaning to unrelated events. Delusions of significance involve self-referential experiences. Delusions of influence involve the belief that one’s thoughts, feelings, or actions are controlled by external forces. These delusions often have a persecutory or harmful content.