Schizophrenia is the quintessential psychotic disorder, although we can really speak of a group of disorders. This psychiatric disorder can be very disabling and affects all areas of a person’s life.
We know here a “subtype” of schizophrenia, which appeared in the DSM-IV-TR: undifferentiated schizophrenia, A category for classifying cases that do not meet the diagnostic criteria for other specific types of schizophrenia.
Undifferentiated schizophrenia: inclusion in textbooks
The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) was the last edition where undifferentiated schizophrenia was collected, under the name “undifferentiated type of schizophrenia”.
This is so because in DSM-5, schizophrenia subtypes were removed from DSM-IV-TR. The reason for this was its low diagnostic stability, low reliability, low validity, and low clinical utility. Additionally, with the exception of the paranoid and undifferentiated subtypes, the other subtypes were rarely used in most countries of the world. However, its elimination from DSM-5 has not been accepted by all mental health professionals.
In contrast, undifferentiated schizophrenia also appears in the ICD-10 (International Classification of Diseases), as we will see later.
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 paranoid, disorganized, or catatonic criteria.
The ICD-10, for its part, states that it is a set of disorders that meet the general guidelines for the diagnosis of schizophrenia but which do not conform to any of the existing types of schizophrenia, or exhibit characteristics of several of them, without a clear predominance of one in particular.
Following ICD-10, this category should only be used in psychotic conditions, excluding residual schizophrenia and post-schizophrenic depression, And only after attempting to classify the clinical picture into one of the other categories or subtypes. In addition, the diagnosis is compatible with atypical schizophrenia.
The symptoms of undifferentiated schizophrenia are as follows.
1. Criteria for schizophrenia
Guidelines for the diagnosis of schizophrenia should be followed. This involves criterion A (two or more, for a month or less if treatment is successful):
- Crazy ideas.
- Disorganized language.
- Catatonic or disorganized behavior.
- negative symptoms (For example abulia or emotional flattening).
2. It does not correspond to another subtype
These are not other subtypes of schizophrenia (catatonic, hebephrenic or paranoid) and, therefore, their diagnostic guidelines are not followed.
3. It is not residual schizophrenia or post-schizophrenic depression.
They do not meet recommendations for residual schizophrenia or post-schizophrenic depression, although it may exhibit characteristics of some of them.
Research suggests a variety of explanatory theories regarding the etiology or origin of schizophrenia itself, extending, broadly defined, to undifferentiated schizophrenia. Some of the models or hypotheses involved in the onset of schizophrenia son:
1. Stress diathesis model
This model proposes that there are people with a previous vulnerability (Diastesis) who eventually develop schizophrenic symptoms due to stressors (biological or environmental).
2. Biological models
Much research, especially in recent years, highlights the presence of certain dysfunctions in specific areas of the brain (Limbic system, frontal cortex and basal ganglia) as the causes of the pathological process.
3. Genetic models
They offer a component of heritability, following research with adopted monozygotic twins, which indicate Similar morbidity reports regardless of the rearing environment.
4. Psychosocial models
They raise psychosocial factors underlying the development of schizophrenia, such as some stressors, stressful life events, dysfunctional family dynamics, etc.
The treatment must be adapted as always to the needs and particularities of the patient, especially since it is not a “classic” or common schizophrenia, but a type of schizophrenia that does not meet the criteria for classification into no specific subtype. Therefore, the characteristics or symptoms will depend more than ever on the patient himself.
Integrative treatment will be the best therapeutic option, combining pharmacological treatment (neuroleptics, antidepressants, etc.) with psychological treatment.
Psychological intervention can be a cognitive-behavioral, systemic or other approach; it will be a priority to treat the patient always taking into account his environment and the dynamics that occur in their family environment, which are usually dysfunctional.
On the other hand, a psychosocial approach including psycho-educational guidelines, vocational rehabilitation and activation of family and social support networks, among others, will be essential.
- WHO: CIE-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 of the journal). Washington, DC: author.
- Kaplan, Sadock BJ, Sadock VA (2003). Clinical psychiatry. Pocket manual. Editorial Waverly Hispanica, Madrid