Undifferentiated schizophrenia: symptoms, causes and treatment

Schizophrenia is the psychotic disorder par excellence, although we can really speak of a group of disorders. This psychiatric disorder can become truly disabling, and affects all areas of the person's life.

Here we will know a "subtype" of schizophrenia, which appeared in the DSM-IV-TR: undifferentiated schizophrenia, a category in which to classify those cases that do not fit the diagnostic criteria of the other specific types of schizophrenia.

• Related article: "What is psychosis? Causes, symptoms and treatment"

The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) was the last edition where undifferentiated schizophrenia was collected, with the name “undifferentiated type of schizophrenia”.

That is so because in the DSM-5 the subtypes of schizophrenia of the DSM-IV-TR were eliminated. The reason was its poor diagnostic stability, low reliability, poor validity, and limited clinical utility. Furthermore, with the exception of the paranoid and undifferentiated subtypes, the other subtypes were rarely used in most of the world. However, its removal from the DSM-5 was not accepted by all mental health professionals.

On the other hand, undifferentiated schizophrenia also appears in the ICD-10 (International Classification of Diseases), as we will see later.

• You may be interested in: "Residual schizophrenia: symptoms, causes and treatment"

According to the DSM-IV-TR, undifferentiated schizophrenia is a type of schizophrenia in which the symptoms of Criterion A of schizophrenia are present, but which does not meet criteria for paranoid, disorganized, or catatonic type.

The ICD-10, for its part, establishes that it is a group of disorders that satisfy the general guidelines for the diagnosis of schizophrenia but that do not conform to any of the existing types of schizophrenia, or present features of more than one of them, without there being a clear predominance of one in each particular.

Following the ICD-10, this category should be used only in psychotic pictures, excluding residual schizophrenia and post-schizophrenic depression, and only after trying to classify the clinical picture into one of the other categories or subtypes. Furthermore, the diagnosis is compatible with atypical schizophrenia.

Symptoms

The symptoms of undifferentiated schizophrenia are as follows.

1. Schizophrenia criteria

Guidelines for the diagnosis of schizophrenia must be met. This involves criterion A (two or more, for one month or less if successfully treated):

• Delusional ideas.
• hallucinations.
• disorganized language.
• Catatonic or disorganized behavior.
• negative symptoms (e.g. Avolition or affective flattening).

2. Does not correspond to another subtype

It is not a question of any other subtype of schizophrenia (catatonic, hebephrenic, or paranoid), and therefore its diagnostic guidelines are not met.

3. It is not residual schizophrenia or post-schizophrenic depression.

He does not meet the guidelines for residual schizophrenia or post-schizophrenic depression, although he may have features of either.

Causes

Research suggests a variety of explanatory theories in relation to the etiology or origin of schizophrenia itself, broadly extensible to undifferentiated schizophrenia. Some of the models or hypotheses involved in the appearance of schizophrenia are:

1. Stress-diathesis model

This model suggests that there are people with a previous vulnerability (diasthesis) that end up developing schizophrenic symptoms due to stressful factors (biological or environmental).

2. biological models

Many investigations, especially in recent years, suggest the presence of some dysfunctions in specific areas of the brain (limbic system, frontal cortex and basal ganglia) as causes of the pathological process.

3. genetic models

They propose a heritability component, as a result of investigations with adopted monozygotic twins, which indicate Similar morbidity rates regardless of rearing environment.

4. psychosocial models

They suggest psychosocial factors at the base of the development of schizophrenia, such as certain stressors, stressful life events, dysfunctional family dynamics, etc.

Treatment

The treatment must be adapted as always to the needs and particularities of the patient, and more taking into account that it is not about not a “classic” or common schizophrenia, but a type of schizophrenia that does not meet the criteria for classification into any subtype concrete. Therefore, the characteristics or symptoms will depend more than ever on the patient himself.

An integrative treatment will be the best therapeutic option, which combines pharmacological treatment (neuroleptics, antidepressants,...) together with psychological treatment.

The psychological intervention may be cognitive-behavioral, systemic or other approaches; it will be a priority to treat the patient always considering their environment and the dynamics that occur in their family environment, which are usually dysfunctional.

On the other hand, a psychosocial approach that includes psychoeducational guidelines, occupational rehabilitation and activation of family and social support networks, among others, will be essential.

Bibliographic references:

• WHO: ICD-10. (1992). Mental and Behavioral Disorders. Tenth Revision of the International Classification of Diseases. Clinical descriptions and diagnostic guidelines. World Health Organization, Geneva.
• American Psychiatric Association (2000). DSM-IV-TR. Diagnostic and statistical manual of mental disorders (4th Edition Reviewed). Washington, DC: Author.
• Kaplan, Sadock B.J., Sadock V.A. (2003). clinical psychiatry. pocket handbook. Editorial Waverly Hispánica, Madrid