Signs of Disorganized Schizophrenia and How to Cope

Disorganized schizophrenia is characterized by speech, emotional expressions, thoughts, and actions that are “disorganized” or not in tune with what is expected or appropriate. Disorganized schizophrenia was once recognized as a major subtype of schizophrenia, but it is now considered a subset of symptoms.

Schizophrenia is a serious mental illness that makes it difficult for a person to maintain relationships and participate in everyday activities. It is notoriously difficult to treat, due to the complexity of symptoms and the low effectiveness of treatments.

This article takes a closer look at the causes and symptoms of disorganized schizophrenia, along with how it is diagnosed and treated. It also provides ways to cope if you or someone you love has schizophrenia.

Symptoms of Disorganized Schizophrenia

Each person with schizophrenia experiences different types of symptoms, which are generally organized into three categories:

• Positive symptoms (those abnormally present) include hallucinations, delusions, abnormal motor behavior, and disorganization.
• Negative symptoms (those abnormally absent) include lack of verbal or emotional expressions and lack of interest in activities.
• Cognitive symptoms include trouble with memory, concentration, and organizing thoughts.

A person with disorganized schizophrenia may have any of these symptoms, but most prominently experiences symptoms of disorganization. These symptoms include:

Disorganized Thinking

Most people with schizophrenia experience cognitive deficits that can make it difficult to form or understand complex ideas. Such deficits can interfere with a person’s ability to form a personal identity or understand the motivations of others.

Disorganized thinking can also manifest in:

• Difficulty identifying or understanding facial expressions or tone of speech
• Difficulty interpreting or understanding the content of speech
• Lack of awareness of one’s own mental or emotional states
• Fragmented sense of self
• Difficulty understanding and responding to challenges
• Difficulty following and completing tasks
• Forgetfulness
• Difficulty following a plan or routine
• Difficulty focusing
• Problems with memory

Disorganized Speech

Effective communication is a challenge for many people with disorganized schizophrenia. Due to disorganized thinking and speech, it can be difficult for them to engage socially, maintain friendships, and perform well in their jobs.

Symptoms of disorganized speech include:

• Difficulty forming or structuring complete words, sentences, or paragraphs
• Responding to questions with unrelated or irrelevant matter
• Indirect, rambling speech that appears to have no goal
• Difficulty following conversations
• Repeating words
• Jumping from one topic to another quickly or incoherently

Disorganized Behavior

People with disorganized schizophrenia may act out in ways that seem extremely bizarre or without purpose. While some psychotic episodes may be characterized by bursts of inappropriately silly behavior, other episodes may manifest with severe aggression.

Symptoms of disorganized behavior can also include:

• Irresponsible and unpredictable behavior
• Unusual mannerisms
• Inappropriate giggling and grimaces
• Pacing or wandering aimlessly
• Childlike behavior
• Poor hygiene
• Social withdrawal
• Poor job performance
• Emotionless expressions or mannerisms (flat affect)

Change in Schizophrenia Subtypes

The “Diagnostic and Statistical Manual of Mental Disorders” (DSM) was created to help healthcare professionals properly diagnose people with mental health disorders like schizophrenia. This manual is updated periodically to take into consideration new research and clinical recommendations from leading mental health professionals.

In the DSM-4, schizophrenia was divided into several subtypes, including paranoid and disorganized. However, the DSM-5, the current version, has removed these subtypes entirely and shifted instead to capturing variability in symptoms of schizophrenia.

Therefore, disorganization is now considered a symptom of the disorder, rather than a subtype. Nevertheless, it remains important to understand disorganized symptoms, specifically if you are a person living with schizophrenia or a loved one caring for someone with this condition.

Causes and Risk Factors

The majority of people with schizophrenia are diagnosed between the ages of 16 to 30, usually after their first episode of psychosis.

The exact cause of schizophrenia is unknown, but researchers have identified a host of risk factors that likely contribute to its development. They include:

Genetics: Schizophrenia sometimes runs in families, and several genes, including DISC1, have been linked to the risk of developing schizophrenia. With that being said, having a family history of schizophrenia does not mean that you or other family members will develop it.

Environment: Life experiences are thought to play a role in the development of schizophrenia. This may include childhood trauma, poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional deficiencies before birth.

Brain structure and function: Schizophrenia is associated with excess dopamine, a neurotransmitter (or chemical messenger) that regulates both motor and cognitive activity. Many other neurotransmitters may also be the cause, including glutamate and GABA (gamma-aminobutyric acid). Some brain differences associated with schizophrenia may develop before birth.

It’s thought that several factors likely contribute to the development of schizophrenia.

Diagnosis

People don’t get specifically diagnosed with disorganized schizophrenia. Instead, if you meet these signs of disorganization, you fit into the third and fourth categories of symptoms for schizophrenia listed in the DSM-5. According to the DSM-5, a person who exhibits two or more of the following symptoms for at least one month meets the criteria for schizophrenia:

• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms

People must also show impaired functioning at work, in interpersonal relationships, and with self-care.

A psychiatrist or other mental health professional can diagnose schizophrenia. A physician may perform a physical exam, run diagnostic tests such as blood work, and order a brain scan such as an MRI (magnetic resonance imaging) to rule out possible medical or neurologic contributions to the symptoms.

Differential Diagnosis

Some mental illnesses cause symptoms that resemble schizophrenia, including:

They will also need to determine that the symptoms are not a result of substance abuse or another medical condition. Once all of the test results are reviewed and alternative causes are ruled out, a definitive diagnosis of schizophrenia can be made.

Treatment

The first line of treatment for schizophrenia is psychotropic medication. Most people with schizophrenia also require adjunctive treatments to enhance the effectiveness of medications, and help manage co-occurring disorders.

Medications

Several types of medications are available to treat schizophrenia.

There are two main categories of treatments: first- and second-generation antipsychotics. “First generation” refers to older medications, while “second generation” refers to newer medications. Older medications include those that target the dopamine system in the brain. Newer medications also affect other neurotransmitter systems.

First-generation antipsychotics used to treat schizophrenia include:

• Adasuve (loxapine)
• Chlorpromazine
• Fluphenazine
• Haldol (haloperidol)
• Perphenazine
• Thiothixene
• Trifluoperazine

Second-generation antipsychotics used to treat schizophrenia include:

• Abilify (aripiprazole)
• Clozaril (clozapine)
• Fanapt (iloperidone)
• Geodon (ziprasidone)
• Invega (paliperidone)
• Latuda (lurasidone)
• Risperdal; Risvan; Rykindo (risperidone)
• Saphris (asenapine)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

One unique second-generation antipsychotic medication called clozapine is the only antipsychotic used to treat refractory schizophrenia (resistant to treatment) that is approved by the Food and Drug Administration (FDA). It also has been the only one indicated to reduce suicidal risk. However, there are multiple medical risks associated with it. 

Muscarinic antagonist may also be used:

• Cobenfy (xanomeline and trospium chloride)

While pharmaceuticals can be very effective, even newer medications are often accompanied by unwanted side effects such as weight gain. These side effects may cause some people to not want to use the medications.

There are now medications that do not need to be taken daily, which may be a good option for people who do not want to take pills regularly or cannot do so. These are called long-acting injectables and can be administered by a healthcare professional. They last in your system for several weeks. It’s important to discuss all possible treatment options with a doctor to find the best way to manage schizophrenia symptoms.

Psychotherapy

People with schizophrenia may also be helped by psychotherapy, or talk therapy.

Mental health professionals trained to work with people with this condition may provide unique tools and strategies that can help manage symptoms. Different therapeutic approaches, including the following, can be tailored to address specific behaviors and symptoms that are most difficult to treat:

• Cognitive behavioral therapy (CBT): Helps people understand how distorted thoughts contribute to symptoms and behaviors
• Supportive psychotherapy: Helps a person process their experiences and supports them in coping with schizophrenia
• Cognitive enhancement therapy (CET): Uses computer-based brain training and group sessions to promote cognitive functioning and confidence in cognitive ability

When to See a Healthcare Provider

Many people with schizophrenia can manage their symptoms with the help of their healthcare professionals. However, some people may still struggle to manage certain behaviors or symptoms. They also might stop taking their medication without telling anyone. This can create a stressful situation for them and their loved ones.

It’s important to know when to call for emergency help. If a person with schizophrenia poses immediate harm to themselves or others, their loved one should call 911. If they are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor.

Coping

Diagnosis of a mental health condition like schizophrenia can be very overwhelming. Many people with schizophrenia, depending on the severity of their symptoms and how they respond to medications, are able to work and engage in social interactions. However, the stigma associated with this condition may make it difficult for people to accept a diagnosis and keep up with their treatment.

Some ways to help manage your illness include:

• Managing stress: Stress can trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important. Don’t take on more than you can handle. Also, practice mindfulness or meditation to stay calm and keep stress at bay.
• Getting plenty of sleep: When you’re on medication, you most likely need even more sleep than the standard eight hours. Many people with schizophrenia have trouble with sleep, but lifestyle changes such as getting regular exercise and avoiding caffeine can help.
• Avoiding alcohol and drugs: It’s important to not use alcohol and drugs. Substance use affects the benefits of medication and worsens symptoms.
• Maintaining connections: Having friends and family involved in your treatment plan can go a long way towards recovery. People living with schizophrenia often have a difficult time in social situations, so surround yourself with people who understand what you are going through.

Supporting a Loved One

People with schizophrenia may need a lot of help from loved ones. Family members or friends may need to remind their loved one to take their medication, go to scheduled medical appointments, and take care of their health.

Tips for caregivers of someone with schizophrenia include the following:

• Respond calmly: The hallucinations and delusions seem real to your loved one, so calmly explain that you see things differently. Be respectful without tolerating dangerous or inappropriate behavior.
• Pay attention to triggers: You can help your family member or friend understand—and try to avoid—the situations that trigger their symptoms or cause a relapse or a disruption to normal activities.
• Help ensure medications are taken as prescribed: Many people question whether they still need the medication when they’re feeling better or if they don’t like the side effects. Encourage your loved one to take their medication regularly to prevent symptoms from coming back or getting worse.
• Understand a lack of awareness: Your family member or friend may be unable to see that they have schizophrenia. Show support by helping them be safe, get therapy, and take the prescribed medications.
• Help avoid drugs or alcohol: These substances are known to worsen schizophrenia symptoms and trigger psychosis. If your loved one develops a substance use disorder, getting help is essential.

There is no cure for schizophrenia, and it is a chronic (long-term) condition. Caretakers must remember to take care of their health, as well as that of their loved one, and reach out for support when needed.

Don’t hesitate to contact organizations and facilities that can help, including the following:

• NAMI Family Support Group
• Caregiver Action Network
• Family Caregiver Alliance

Summary

Disorganized schizophrenia is not a subtype of schizophrenia, but rather a subset of disorganized thought, speech, and behavioral patterns seen in many people with schizophrenia. The exact cause of schizophrenia is unclear, although a combination of genetic, environmental, and neurological risk factors is likely at play. Schizophrenia is treated with psychotropic drugs, particularly antipsychotics, as well as adjunctive treatments like talk therapy.

If you or someone you know poses an immediate risk of harming themselves or others, call 911 immediately for help. If you are experiencing suicidal thoughts, call 988 to speak with a trained Suicide & Crisis Lifeline counselor.