schizophrenia - clinical types of schizophrenia


Stress factors precipitation the disease

written by DR/Fathy Khodier

PHYSIOLOGICAL :

  • Adolescence - change from home and school to work 
  • Pregnancy and delivery 
  • Menopause

PSYCHOLOGICAL

  • Rearing of children 
  • Examinations
  • Separation situations 
  • Travel - Politics - Religion
  • T.V and Radio

PHYSICAL

  • Sever sunburns

CLINICAL PICTURE

  • Prodromal symptoms
    the patients become unsettled , restless , a social shy or remote
    eg. they stay most of the time in their bed rooms
    they find difficulty with education , work or failure to get work
    they find difficulty with their thought and lose their friendships 

CLINICAL TYPES OF SCHIZOPHRENIA 

  1. SIMPLE SCHIZOPHRENIA- Occurs early in life between 15-25 years with gradual onset.
    - Inability to accept the usual discipline of school or the change to work.
    - Failure to meet the demands of society.
    - Decline in performance.
    - General change in personality with odd behavior.
    - Classically delusions and hallucinations are not present but occasionally they may be present.
    - The patient becomes aimless with lack of ambitions.
    - The patient is not obviously psychotic so they became drop outs.
    - Absence of feeling (apathy) , will and drive which determine the illness.
  2. HEBEPHRENIC SCHIZOPHRENIA - Appears between the age of 15-25.
    - It coincides with the development of sexual maturation.
    - This form is dominated by changes of affect with shallow feeling or silly or incongruous.
    - There may be withdrawal of affect and self adsorbed smiling.
    - Thoughts are inappropriate and disorganized.
    - There are frequently hypochondrical  delusions , preservation and preoccupations.
    - There are frequently delusions and hallucinations which are bizarre , fleeting and fragmented.
    - The patient behavior is irresponsible , unpredictable and studded with mannerisms and tics and the patient become solitary.
  3. PARANOID SCHIZOPHRENIA- Appears in persons over 35 years of age.
    - The general personality change is less severe in this form than the other types but it is more obvious because the patient has previously established life.
    - The illness is dominated by thought disorder including fixed often bizarre delusions - the patient may believe that he is a prophet , that he is crist or devil , that he is some famous person like Hitler , Ceasur or Napoleon and that he has special mission in life.
    - Auditory hallucinations are common.
    - The patient may be delusioned  that he is persecuted.
    - The patient may begin to dress oddly or try to produce new invention and showing mannerisms eg. Hitler saluting or Napoleon attitude.
  4. CATATONIC SCHIZOPHRENIA- Appears between 25-35 years of age.
    - Motor Symptoms predominate in this thye and the illness may vary from unpredictable complete retardation (stupor) to unexplained excitement.
    - there may be automatic obedience - flexibilities  cera eccho - praxia or resistance ( negativism).
    - With the interruption of motor activity the patient appears to refuse work or to obey orders.
    - In severe cases the patient's normal domestic behavior may become involved - he may become incontinent , eat from another person's plate or remain for long periods in a fixed attitude , further deterioration leads to postural stereotypes or repetitive mannerisms.
    - The acute onset of catatonic excitement is very disturbing and the psychotic intensity of the illness is out of proportions to any apparent precipitating factors.
    - the patient may refuse food and fluids and his uncontrolled motor behavior produce a real risk to life.
  5. LATENT SCHIZOPHRENIA- Here the disease is normally dormant but it may became manifest when special demands are made of patient.
    - These patient have adopted to their lives , incorporating restrictions to protect themselves from stress.
    - some may appear to have neurotic fixations which are really delusions . Others are involved in a life of unnecessary and irrelevant crimes.
  6. RESIDUAL SCHIZOPHRENIA-It is considered to be a chronic form of the illness with gross personality deterioration. The acute symptoms are blunted but they persist and are passive.
    - Residual type is the official term for patient who no longer normally show active schizophrenia and who do not appear to be controlled by illness or motivated by the environment i.e., he become oriented to his symptoms and not affected by them and also lack the ambitions in the surrounding environment . The patient come to accept his illness .
  7. CHRONIC SCHIZOPHRENIA- Severe deterioration of the personality.
    - All the signs of schizophrenic though can be elicited ( Vagueness , Blocking , Repetitions ) also show limited conversational power with lack of initiation.
    - Have little contact with others and frequently incoherent.
    - Feeling processes are flat and occasionally patient retain a chronic cheerfulness.
    - His habits deteriorate further , he lack his self hygiene ,  hoarding useless objects , grab food and finally appears insensitive to temperature pain or taste.
    - Cannot organize his life or even meet the simple demands of the social services.
  8. GRAFTED SCHIZOPHRENIA- When schizophrenic symptoms are associated with mental retardation.
  9. SCHIZO EFFECTIVE SCHIZOPHRENIA- When SCHIZOPHRENIA is associated with on apparent effective element mania or depression.