Schizophrenia is the quintessential psychotic disorder, although we can actually talk about a group of disorders. This psychiatric disorder can be truly disabling, affecting all areas of a person’s life.

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

Undifferentiated schizophrenia: inclusion in manuals

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”.

This is because in DSM-5 the schizophrenia subtypes of DSM-IV-TR were eliminated. The reason was its poor diagnostic stability, low reliability, poor validity and poor clinical utility. Furthermore, with the exception of the paranoid and undifferentiated subtypes, the other subtypes were rarely used in most parts of the world. However, their elimination 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.

General characteristics

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

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The ICD-10, on the other hand, establishes that they are a group of disorders that satisfy the general guidelines for the diagnosis of schizophrenia but that do not fit into 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 particular.

Following the ICD-10, this category should be used only for psychotic pictures, excluding residual schizophrenia and post-schizophrenic depression , and only after having tried to classify the clinical picture in 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. Criteria for schizophrenia

Guidelines for diagnosing schizophrenia must be followed. 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. Abulia or emotional flattening).

2. Does not correspond to another subtype

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

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

The guidelines for residual schizophrenia or post-schizophrenic depression are not met, although you may have features of one.

Causes

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

1. Stress-Diathesis Model

This model proposes that there are people with a previous vulnerability (diathesis) who end up developing schizophrenic symptoms due to stressing factors (biological or environmental).

2. Biological models

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

3. Genetic models

They propose a heritability component, following research with adopted monozygotic twins, which indicate similar morbidity proportions regardless of the breeding environment .

4. Psychosocial models

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

Treatment

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

An integrative treatment will be the best therapeutic option, combining 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 his/her environment and the dynamics that occur in his/her family environment, which are usually dysfunctional.

On the other hand, a psychosocial approach that includes psycho-educational guidelines, labor rehabilitation and activation of family and social support networks, among others, will be fundamental.

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 (4thEdition Reviewed). Washington, DC: Author.
  • Kaplan, Sadock B.J., Sadock V.A. (2003). Clinical psychiatry. Pocketbook. Editorial Waverly Hispánica, Madrid