What Is Undifferentiated Schizophrenia?

Medically Reviewed By Nicole Washington, DO, MPH
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Some cases of schizophrenia were once categorized as undifferentiated. Here is an overview of what was formerly known as undifferentiated schizophrenia. Schizophrenia is a chronic mental health condition that affects the way a person thinks, feels, and behaves.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) formerly categorized schizophrenia into four different subtypes: paranoid, catatonic, hebephrenic, and simple. When the symptoms did not appear to fit into any of these subtypes, it was categorized as undifferentiated.

Schizophrenia categories disclaimer

The DSM-5 no longer uses these categories in the diagnosis of schizophrenia. Diagnoses are now made based on the appearance of certain symptoms over a period of time. This article refers to undifferentiated schizophrenia as it was originally described.

This article covers what undifferentiated schizophrenia was considered to be, as well as its symptoms and treatment options.

What was undifferentiated schizophrenia?

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Schizophrenia is a mental health condition that used to be grouped into subtypes. These were paranoid, catatonic, hebephrenic (or disorganized), and simple. When schizophrenia did not fit in with one of these subtypes, it was instead categorized as undifferentiated schizophrenia.

On occasion, the clinical presentation of schizophrenia fit a subtype description but then gradually changed so that it no longer fit into one subtype. This was more common with the catatonic and hebephrenic subtypes.

The lifetime prevalence of schizophrenia is less than 1%. It occurs almost equally in males and females, though males tend to have an earlier onset than females. People usually receive their diagnosis between the ages of 16 and 30 years and after their first episode of psychosis.

The onset of symptoms can be acute or insidious, occurring over a period of weeks to months or many years. Symptoms vary among individuals but primarily include hallucinations, delusions, disorganized speech, and catatonic or bizarre behaviors.

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What were the symptoms of undifferentiated schizophrenia?

The symptoms of undifferentiated schizophrenia fell into three main categories: psychotic, negative, and cognitive.

Psychotic symptoms

Psychotic symptoms have to do with the way a person perceives reality. People with psychosis may experience the world in a distorted way and lose touch with a shared sense of reality.

Some psychotic symptoms include:

  • Hallucinations: This is when you see, hear, smell, taste, or feel things that are not actually there. One example is hearing voices.
  • Delusions: This is when you have strong beliefs that often seem irrational to others. One example is believing that someone on the television is sending you messages.
  • Thought disorder: This is when you think in a way that is unusual or illogical. One example is making up words that have no meaning.
  • Movement disorder: This is when you exhibit unusual body movements. One example is repeating certain motions.

Negative symptoms

Negative symptoms happen when you lose motivation or interest in things you used to enjoy, have difficulty showing emotions, or suddenly withdraw from your family and friends.

Some other examples include:

  • having difficulty feeling pleasure in everyday life
  • having difficulty planning things, such as grocery shopping
  • talking in a dull voice
  • showing limited facial expressions
  • avoiding social interaction
  • having very low energy

Cognitive symptoms

Cognitive symptoms have to do with difficulty with attention, concentration, and memory. People with cognitive symptoms may have difficulty processing information or focusing and paying attention.

Some examples include:

  • having difficulty following a conversation
  • having difficulty learning new things
  • having difficulty remembering appointments
  • having difficulty making decisions

How did doctors diagnose undifferentiated schizophrenia?

To diagnose schizophrenia, a doctor will perform a physical exam and ask about your medical, psychiatric, and family history. They will typically make a diagnosis after clear symptoms of psychosis have emerged and other causes have been ruled out.

In order to receive a diagnosis, you must be experiencing two of the following symptoms most of the time during a 1-month period, with at least some disturbance for 6 months:

  • delusions
  • hallucinations
  • disorganized speech
  • catatonic behaviors
  • negative symptoms

For an accurate diagnosis, at least one of the symptoms must be delusions, hallucinations, or disorganized speech. A doctor may order other tests, such as an MRI scan or a blood test, to rule out other things that could be causing schizophrenia-like symptoms.

For a doctor to have categorized schizophrenia as undifferentiated, the symptoms must not have fit into any of the other subtypes of schizophrenia.

The characteristics of the other subtypes were as follows:

  • Paranoid: This tended to have a later onset than the other subtypes and was characterized mainly by delusions and hallucinations.
  • Catatonic: This type manifested as stuporous catatonia or excited catatonia. In the stuporous form, there were varying degrees of immobility, posturing, and lack of speech. In the excited form, there were periods of frenzied activity and extreme impulsivity.
  • Hebephrenic: This subtype tended to have an earlier onset than the others and developed insidiously. This type was characterized by bizarre behaviors and inappropriate affect.
  • Simple: This had the earliest age of onset, often beginning in childhood. It was characterized by a lack of will and flattening of affect.

How did doctors treat undifferentiated schizophrenia?

Treatment for undifferentiated schizophrenia included a combination of medication, therapy, and psychosocial support.

The earlier treatment starts, the better the outcome. Recovery from schizophrenia often occurs over time.

Medication

Medication is often the first step in the treatment of schizophrenia. Antipsychotics are used to help relieve symptoms of psychosis. Antipsychotics may be first-generation or second-generation.

First-generation (typical) antipsychotics

  • chlorpromazine (Thorazine)
  • haloperidol (Haldol)
  • perphenazine (Trilafon)

Second-generation (atypical) antipsychotics

  • aripiprazole (Abilify)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • risperidone (Risperdal)
  • quetiapine (Seroquel)
  • ziprasidone (Geodon)

Therapy

Cognitive behavioral therapy (CBT) helps a person uncover unhealthy ways of thinking and how that affects their behaviors and beliefs. The core principle is identifying negative beliefs and restructuring them. A CBT therapist will work with a person to develop constructive ways of thinking that lead to healthier behaviors and beliefs.

Psychosocial treatments

People who participate in psychosocial rehabilitation are more likely to be compliant with their medication and less likely to have a relapse of symptoms. One example is peer-to-peer support groups. These groups may meet in person or online and can help someone with schizophrenia feel less alone.

Read more about psychotherapy and what it involves.

What are similar conditions to undifferentiated schizophrenia?

Some conditions share similar symptoms with schizophrenia. These include:

  • Schizotypal personality disorder: A person with this condition may have unusual behaviors and learning difficulties. They may also hold beliefs that are not shared by other people.
  • Schizoid personality disorder: A person with this condition is often aloof and does not show emotions.
  • Delusional disorder: People with this condition are able to function in daily life but hold persistent beliefs that could happen but are unlikely to happen. They have no other psychotic symptoms besides delusions.
  • Schizoaffective disorder: People with this condition have the same symptoms as someone with schizophrenia, but they also have symptoms of bipolar disorder, including periods of depression and mania. Alternatively, they may only have depressive symptoms.
  • Schizophreniform disorder: People with this condition have the same symptoms as someone with schizophrenia, but the symptoms do not last as long. They only last about 1–6 months.

Summary

A diagnosis of undifferentiated schizophrenia was made when the symptoms did not fit in with any of the other former subtypes of schizophrenia.

Among other symptoms, a person must have delusions, hallucinations, or disorganized speech to receive a diagnosis of schizophrenia. Treatment focuses on medication compliance, psychotherapy, and psychosocial support. Recovery is often gradual and focuses on minimizing relapses of symptoms.

The DSM-5 no longer supports the former subtypes of schizophrenia. You should discuss all diagnoses and treatment options with your doctor.

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Medical Reviewer: Nicole Washington, DO, MPH
Last Review Date: 2022 Apr 22
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