What Is Undifferentiated Schizophrenia?

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Various presentations of schizophrenia were categorized into subtypes in previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the most recent edition, the DSM-5, eliminates these subtypes, including paranoid, disorganized, catatonic, and residual schizophrenia, as well as undifferentiated schizophrenia, which involved having features of more than one subtype.

undifferentiated schizophrenia hallucination
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Signs and Symptoms

A diagnosis of schizophrenia must comply with the DSM-5 criteria for a diagnosis of schizophrenia by having at least two of the following symptoms:

  • Hallucinations
  • Delusions
  • Disorganized thinking (speech)
  • Grossly disorganized or catatonic behavior
  • Negative symptoms such as showing no emotion or a total lack of motivation or interest in activities

At least one of the symptoms must be hallucinations, delusions, or disorganized speech.

According to the DSM-5 criteria for schizophrenia, a person must have experienced these symptoms for at least a month, with the overall course lasting at least six months. Additionally, the symptoms must interfere with at least one major area of functioning—including work, school, personal relationships, or self-care.

Symptoms May Shift

A person with schizophrenia with undifferentiated features has a range of symptoms that could be from any or all the other previous symptom subtypes including:

  • Disorganized schizophrenia
  • Catatonic schizophrenia
  • Paranoid schizophrenia

Symptoms of schizophrenia categorized as undifferentiated can be variable.

Symptoms of schizophrenia that might have been categorized as undifferentiated include all of the following diagnostic criteria of schizophrenia:

  • Feeling void of emotion
  • Lack of motivation or desire
  • Auditory hallucinations
  • Delusions
  • Movement disturbances
  • Disorganized speech
  • Behavior and speech that is difficult to understand

Causes

It is thought that alterations in brain chemistry and structure may be an underlying contributing or causal factor in schizophrenia.

These brain abnormalities may develop before birth but can progress later in life. The changes that have been observed in the brain of those with schizophrenia suggest that schizophrenia may be a brain disorder.

Risk Factors

The exact cause of schizophrenia (including undifferentiated type schizophrenia) is not well understood, but some things pose a higher risk associated with getting the disorder, including:

  • A person’s age: Schizophrenia is often diagnosed during the late teen years to the early thirties. In males, schizophrenia usually occurs at a younger age than it does in females. The average age for males to be diagnosed with schizophrenia is late adolescence to the early twenties. For females, that number is the early twenties to early thirties.
  • Genetics: Although no specific gene has been definitively linked with schizophrenia, scientists know that the condition sometimes runs in the family. According to the National Institutes of Health, genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder by itself. More research is required before it will be possible to utilize genetic information to predict who will get schizophrenia.
  • Environmental Factors: Some experts feel that a combination of genetic and environmental factors may play into whether a person develops schizophrenia.

Diagnosis

Although there is no specific lab test to diagnose schizophrenia, many types of medical tests are performed to help evaluate signs and symptoms of schizophrenia, while ruling out other disorders.

A diagnosis of schizophrenia may include many different forms of screening tools and examination measures, including:

  • A thorough history and physical examination: These will help rule out any physical causes of symptoms.
  • Lab tests: There is no specific lab test to diagnose schizophrenia, but other types of lab tests may be done that could point to a physical contribution to the symptoms. Also, a drug screen could be ordered to test for any type of substance use.
  • Imaging Tests: Magnetic resonance imaging (MRI) or computerized tomography (CT) may be performed to check for any type of brain disorder (such as a tumor) that could be causing symptoms.
  • A psychosocial evaluation: A test that is given to help evaluate a person’s mental health and social well-being, this evaluation includes a thorough history of psychiatric issues, medical history, drug and alcohol use, and more.   
  • A safety assessment: This assesses factors such as whether the person is a suicide risk. 
  • Cognitive tests: This evaluates problems in cognitive functioning that are often present in people with schizophrenia. Cognitive impairment may include problems with a person’s judgment, memory, language, and ability to learn new things. 
  • A diagnostic assessment: After the medical causes of the symptoms are ruled out, the healthcare provider may refer a person with symptoms of schizophrenia to a mental health professional for a diagnostic assessment.

Treatment

The range of treatment options for schizophrenia varies according to many different factors. The most influential factor regarding the treatment modality is the symptoms one experiences.

Medication

Treatment often involves medication—such as antipsychotic medication for the treatment of hallucinations and delusions. Examples of antipsychotic drugs include:

  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)

One of the biggest concerns with many antipsychotic medications is non-compliance on a person's behalf. This can relate to side effects that can be troubling for some people with schizophrenia. Common side effects include:

  • Increased appetite
  • Severe dry mouth
  • Severe weight gain
  • Drowsiness
  • Sleepiness
  • Constipation
  • Increased lipid (fat) levels in the blood
  • An increase in blood sugar levels
  • Sexual problems
  • Dizziness
  • Abnormal movements
  • Restlessness

In addition to antipsychotic medications, other drugs that may be prescribed (depending on symptoms) to a person with schizophrenia may include:

  • Antidepressant medications
  • Anti-anxiety medications
  • Mood stabilizers
  • Sleeping medication
  • Drugs to combat side effects of antipsychotic medications

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychological treatment shown to be effective for a wide range of mental health problems, including:

  • Depression
  • Anxiety disorder
  • Substance use disorder
  • Eating disorders
  • Severe mental illness

CBT is a type of treatment modality that can help people who have schizophrenia in many ways, including helping a person:

  • Identify unhealthy patterns of thought
  • Change troublesome thoughts
  • Employ a variety of various coping tools (such as journaling, mindfulness, and more)
  • Utilize role-play to practice skills learned

Family Education and Support

Family education and support are aimed at helping family members and close friends of those with schizophrenia cope with the many issues involved in living with or interacting with a person with severe mental illness. This type of treatment can include many different types of modalities including:

  • Marital counseling
  • Group therapy
  • Educational groups
  • Individual therapy
  • Support groups

Coordinated Specialty Care (CSC)

Coordinated specialty care (CSC) is a type of treatment that offers a multidisciplinary approach to supporting those in the early stage of schizophrenia.

Treatment modalities that may be offered as part of a CSC program include:

  • Employment support
  • Education (for school or job training)
  • Medication management
  • Case management
  • Family education
  • Family support

Substance Use Treatment

Because a large number of people with schizophrenia have been found to have a substance use disorder, a program that addresses both the mental illness and the substance use may be recommended.

This is often referred to as mental illness chemical dependency (MICD) or dual diagnosis treatment. Using substances or drinking alcohol can worsen symptoms of differentiated types of schizophrenia, so it’s vital to address any problems a person has with substance use.

When to Call a Doctor

If a person with schizophrenia begins experiencing symptoms that worsen and/or starts having very active hallucinations or delusions, it’s important to reach out to a mental health professional or another healthcare provider.

Call 911 or seek emergency medical intervention if the person is talking about suicide or homicide, or has had a suicide attempt.

Seek Help

If you or a loved one is struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Coping

Helping a loved one who has been diagnosed with schizophrenia is no small undertaking. Keep in mind that there are many sources of support available. If your loved one has substance abuse and schizophrenia, you can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357.

Other support networks include:

  • National Alliance on Mental Illness (NAMI): 1-800-950-6264
  • Schizophrenia and Related Disorders Alliance of America: 1-800-493-2094
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Article Sources
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