Mental disorders are the subject of studies in clinical psychology. One of the most disabling is schizophrenia, a chronic and serious disease with a lifetime prevalence between 0.7 and 1.5%.
In this concept, several subtypes have been proposed. In this article we will talk about one of them, simple schizophrenia. This diagnosis has given rise to some controversy over the advisability of not including it as an independent diagnosis in the various mental health reference manuals (DSM, CIE, etc.)
Currently, it only exists as a diagnostic category in ICD-10, as we will see later. This controversy arose out of the questioning of the descriptive validity and reliability of the concept, as well as its infrequent use.
Symptoms of schizophrenia
To learn more about simple schizophrenia, let’s first look at the three most characteristic symptom types of schizophrenia, which are as follows.
Appearance or exacerbation of certain psychological functions. For example, hallucinations, delusions, disorganized language, and disorganized behavior.
They are generally known as psychotic behavior. The patient can “lose touch” with reality.
Absence or reduction of a function, for example affective flattening, decreased fluency and thinking, Apathy, bullying, reduced speech, etc. Thus, they are associated with the interruption of behavior and emotions considered normal.
It is important to make a differential diagnosis for depression or other mood problems.
Reduction or impairment of certain cognitive processes such as attention, memory and executive functions (Working memory, speed of thought, …).
Thus, the patient may have difficulty in attention and concentration, difficulty understanding information and making decisions, etc. A lack of awareness of the disease (anosognosia) may also appear.
What characterizes simple schizophrenia?
Simple schizophrenia is a classic category that remains only in ICD-10 (WHO International Classification of Diseases). The ICD-6 first included it in 1948, as did the DSM-I in 1952.
The DSM-III has eliminated this subtype, and the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) includes it in the section Criteria and axes proposed for further studies, with the name of simple deterioration disorderWhereas this is a disorder which requires more studies for possible inclusion. In the DSM-5, however, it does not appear.
Its characteristics consist of an insidious and gradual onset of extravagant behavior, a decrease in overall performance and an inability to respond to social demands. There is no evidence, at any time, of the presence of hallucinations or delusions.
In other words, the symptoms are only negative, without a psychotic episode appearing at any time, which is the element that would make the difference with the residual type (in which there was a psychotic episode, but at the at the time of diagnosis, there are no positive symptoms, but continuous manifestations in the form of negative symptoms).
Symptoms involve alterations in personal relationships, as well as a significant worsening of work or academic activity. Fleeting episodes of self-referential delirium, depressed mood, and social isolation may be associated.
Symptoms should be present for a period of at least 1 year. His prognosis is very bad; in fact it is the schizophrenia subtype with the worst prognosis, alongside hebephrenic or disorganized schizophrenia.
Origin of the term: Eugen Bleuler
Simple schizophrenia was raised by Eugen Bleuler. This author raised five clinical forms of schizophrenia. Three of them corresponded to the Kraepelin subtypes: paranoid, catatonic, and hebephrenic. The latter was “latent”, compensated or asymptomatic schizophrenia.
Bleuler introduced the term “schizophrenia” (divided mind) and characterized the image with its most important psychopathological trait, which was the division of the ego. like that, unlike Kraepelin, he focused on nuclear psychopathology, And not so much in symptomatology and evolution.
This author distinguishes the essential symptoms (fundamental and common to all schizophrenic disorders) from the accessory symptoms (more striking but less important).
Differential diagnosis with residual schizophrenia
The differential diagnosis should be made with other subtypes of schizophrenia, as well as with other affective disorders, personality disorders, organic mental disorders, etc. However, we will focus on residual schizophrenia, as it can make us doubt the diagnosis, due to its similarity.
As we saw above, residual schizophrenia is characterized by negative symptoms and attenuated positive symptoms. Significant positive symptoms may have appeared in the past, but at the time of the examination the patient has only negative symptoms. In simple schizophrenia, on the other hand, there have never been any positive symptoms.
The treatment of uncomplicated schizophrenia consists of an interdisciplinary approach between doctors and clinical psychologists. It is usually based on psychotherapy and the use of psychotropic drugs as a support.
- To see the intervention in these cases in more detail, access this article: What is schizophrenia? Symptoms and treatments “
- Jiménez, M., Ramos, F., Sanchís, M. Schizophrenias: clinical aspects. In Belloch, A., Sandín, B., Ramos, F. (1996). Manual of the psychopathologist. McGraw-Hill, Madrid.
- Novella, E. and Huertas, R. (2010). Kraepelin-Bleuler-Schneider syndrome and modern consciousness: an approach to the history of schizophrenia. Clinic and Health, 21 (3), 205-219.
- National Institute of Mental Health (2015). Schizophrenia.