Discover how each type is diagnosed and treated

Schizophrenia is a mental health disorder that disturbs your thinking and perceptions of life. This affects your interactions with the world.

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“People with schizophrenia may hear voices or noises; become very paranoid; believe they have unusual powers; think others control their thoughts, or vice-versa; or believe world events are connected to them,” explains psychiatrist Minnie Bowers-Smith, MD.

It can be a long road to diagnosis, however. Patients — and families — are often in denial. After all, it’s a tough diagnosis to accept.

Psychiatrists may not see all the person’s symptoms right away. And substance abuse may be a factor.

“We don’t label it schizophrenia right away; the diagnosis can follow a person throughout life once it’s in their chart,” says Dr. Bowers.

What are the 4 main types of schizophrenia?

Schizophrenia looks different from one person to the next. But there are four main categories into which patients fall:

Paranoid schizophrenia: The person’s paranoia may be extreme, and they may act on it. “They may show up at the door of the FBI and ask, ‘Why are you following me?’” says Dr. Bowers. They may also behave oddly, have inappropriate emotional responses and show little pleasure in life. Catatonic schizophrenia: The person shuts down emotionally, mentally and physically. “People appear to be paralyzed. They have no facial expression and may stand still for long periods of time,” she says. There is no drive to eat, drink or urinate. When catatonia lasts for hours, it becomes a medical emergency. Undifferentiated schizophrenia: The person has various vague symptoms. “They may not talk or express themselves much. They can be confused and paranoid,” says Dr. Bowers. The person may not bother to change clothes or take a shower. Schizoaffective disorder: The person has delusional thinking and other symptoms of schizophrenia. “But they also present with one or more symptoms of a mood disorder: depression, mania and/or hypomania,” says Dr. Bowers.

What happens at the hospital?

About one-third of people with schizophrenia don’t believe anything is wrong with them. Many more don’t seek help on their own, for cultural reasons or because they lack resources.

So problems often come to light only when their erratic behavior or other troubles trigger a crisis. “Patients are often brought to the hospital by family, teachers or the police,” says Dr. Bowers.

To decide whether to admit someone, psychiatrists consider whether patients pose a risk to themselves or others; whether they can take care of themselves; and whether they could benefit from hospital treatment.

How do doctors diagnose the type of schizophrenia?

If the patient is admitted, the psychiatrist talks to them and evaluates their behavior, considers whether any symptoms were triggered by alcohol or drugs, reviews any records from prior admissions, and talks to the family.

“Initially, we may only see that the patient is losing track of reality,” says Dr. Bowers. “We may need more time to see all the symptoms of schizophrenia.” These symptoms include:

Fixed, false beliefs.

Hearing voices.

Seeing visions or shadows.

Suspicion and distrust.

Government regulations require psychiatrists to diagnose a specific type of schizophrenia so that insurance companies get the green light to pay for care.

“We hope to see enough symptoms during a three-, five- or 10-day hospital stay to clarify the type of schizophrenia,” she says. “But we may not see all of them, so the initial diagnosis may not be exactly right.”

What are the treatments for schizophrenia?

Ninety-nine percent of patients with schizophrenia need lifelong treatment with antipsychotic drugs, counseling and social rehabilitation, says Dr. Bowers.

“This will reduce their symptoms and help them get to a place of stability in their lives,” she says.

Antipsychotics are given orally or by injection. Depending on the type of schizophrenia, other medications may be needed as well:

People with paranoid schizophrenia usually respond well to antipsychotics, which decrease paranoid thinking and help them readjust to their environment.

People with catatonic schizophrenia require benzodiazepines to relax their muscles, allowing them to become more active and to react to the environment.

People with undifferentiated schizophrenia are slower to respond to antipsychotics because thinking is disturbed across the board. “The medication makes them more alert and able to care for themselves, but it doesn’t always clear their thinking,” she says.

People with schizoaffective disorder require a combination of antipsychotics and antidepressants or mood stabilizers.

Despite significant side effects, it’s important to keep taking these medications.

“When people go on and off their meds, their symptoms return, and they often end up back in the hospital,” says Dr. Bowers. “Also, the more episodes you have, the further you get from your healthy baseline.”

What is the long-term outlook?

Without ongoing care, people with schizophrenia can be hospitalized multiple times, lose jobs and fall out of touch with their families.

“Early treatment in whatever setting works best for the patient is important,” says Dr. Bowers. “If they are in the hospital, we want to be sure they have a good aftercare plan.

“Patients need to have a clear idea about how to maintain their health by taking their meds, staying sober and getting community support.”

This will help them maintain their independence and function better in society.

The road to diagnosis, treatment and stability is a challenging one. Along the way, she recommends getting education and support from national organizations like the National Alliance on Mental Illness (NAMI), Recovery International and Emotions Anonymous.

To learn about local services, families can reach out to their county mental health board, local hospital or mental health center.