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Disorganized schizophrenia is one of the five subtypes of schizophrenia. It is characterized by disorganized behavior and speech and includes disturbance in emotional expression. Hallucinations and delusions are less pronounced with disorganized schizophrenia, though there is evidence of these symptoms occurring.

Symptoms of disorganized schizophrenia:

Disorganized Speech
Schizophrenia can cause people to have difficulty concentrating and maintaining a train of thought, which manifests in the way they speak. People with disorganized speech might speak incoherently, respond to questions with unrelated answers, say illogical things, or shift topics frequently. Signs of disorganized speech involve the following:

  • Loose associations: Rapidly shifting between topics with no connections between topics
  • Perseveration: Repeating the same things over and over again
  • Made up words that only have meaning to the speaker
  • Use of rhyming words without meaning
  • When cognitive disorganization is severe, it can be nearly impossible to understand what the person is saying.

Disorganized Behavior
Schizophrenia negatively impacts goal-directed behavior. A person with disorganized schizophrenia is likely to have difficulty beginning a specific task (ex: cooking a meal) or difficulty finishing a task. Independent functioning is exceptionally difficult due to this gross disorganization.

Disorganized behavior can manifest as the following:

  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Lack of impulse control
  • Behaviors that appear bizarre or lack purpose
  • Routine behaviors such as bathing, dressing, or brushing teeth can be severely impaired or lost.

Inappropriate Affect
Affect refers to a person’s emotional responses, including the way emotions are expressed (ex: smiling when feeling happy.) People with disorganized schizophrenia exhibit flat affect, which means that they show little or no emotions in their facial expressions, voice tone, or mannerisms. At times they exhibit affect that is inappropriate to the situation, such as laughing at something sad.
In addition to lack of emotional expression, people with disorganized schizophrenia are likely to experience other negative symptoms, including failing to make eye contact and blunt facial expression.

Development and Course:

Disorganized schizophrenia is associated with early onset, between the ages of 15-25. Earlier age of onset is traditionally associated with a worse prognosis due to lower educational achievement, more prominent negative symptoms, and cognitive impairments. Early detection, diagnosis, and treatment of the disorder contributes to better outcomes.

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Beginning treatment as soon as possible is crucial to making a recovery. Treatment for disorganized schizophrenia involves a multimodal approach, including the following:

  • Medication management: Medication for schizophrenia can help reduce hallucinations and delusions, paranoia, and disordered thinking. Finding the right medication depends on the prominent symptoms of the disease.
  • Psychotherapy: Cognitive Behavioral Therapy (CBT) is recommended to reduce certain symptoms and enhance overall functioning. Through CBT, individuals identify target problems and work to develop coping strategies specific to those issues.
  • Life skills training: Assistance with life skills can help individuals with disorganized schizophrenia improve social interactions and increase daily living skills, with a goal of increasing independence.
  • Supported employment services: Individuals with disorganized schizophrenia benefit from training in the area of finding and maintaining employment.
  • Family education and support: Individuals with disorganized schizophrenia benefit from ongoing contact with family. Support to educate family about treatment and how to support a family member with schizophrenia is crucial. Family support increases family member’s understanding of the disorder and helps family members develop coping strategies.

Though the signs of disorganized schizophrenia tend to appear at a younger age, they can be difficult to spot. The symptoms of this subtype are often very gradual and unlikely to subside. With appropriate and ongoing treatment, however, the prognosis for disorganized schizophrenia improves. Assistance with daily living skills, educational attainment, employment services, and family support play a key role in improving the course of the disease for individuals diagnosed with disorganized schizophrenia.

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Last Updated: Feb 13, 2018