Schizophrenia and Other Psychotic Disorders 527
grandiose theme. An example of a paranoid theme is that the person believes that
he or she is being hunted by the CIA; an example of a grandiose theme is that the
person believes that he or she is God. Pamela Spiro Wagner describes one of her
paranoid delusions, which involves being hunted by “the Five People”:
The computers at the drugstore across the street, programmed by the Five People, have
tapped into my TV set and monitor my activities with special radar. If I go out, special
agents keep every one of my movements under surveillance. A man lighting a cigarette
near the drugstore uses his lighter to signal to another just down the street, warning
him of my approach. Another alerts conspirators inside. Nothing I do, indoors or out,
goes unremarked.
(Wagner & Spiro, 2005, p. 205)People with paranoid schizophrenia can have relatively intact cognitive and
emotional functioning when the content of their thoughts and experiences does not
relate to their delusion.
Diagnosing people with paranoid schizophrenia can be diffi cult because theymay seem normal if they don’t talk about the topic of their delusions. Although
the paranoid subtype has the best recovery rate (Fenton & McGlashan, 1991), it
is also the subtype most associated with aggressive behavior. People withthis sub-
type of schizophrenia can act aggressively toward either themselves or others, and
they have the highest suicide rate, 13%, among all patients with schizophrenia
(Fenton & McGlashan, 1991).
Disorganized Schizophrenia
Disorganized speech and behavior and inappropriate emotional expression are
typical of the subtype called disorganized schizophrenia. People with disorganized
schizophrenia may giggle, dress strangely, speak obscenely or incoherently (like
Emilio in Case 12.1), or urinate or defecate in public. People with disorganized
schizophrenia generally have a poor prognosis and, because of their inability to care
for themselves, may require constant care.
Disorganized schizophrenia
The subtype of schizophrenia characterized
by disorganized speech and behavior and
inappropriate emotional expression.Catatonic schizophrenia
The subtype of schizophrenia characterized
by stiff or “frozen” postures or poses, bizarre
jerky movements, or frozen facial expression.CASE 12.1 • FROM THE OUTSIDE: Disorganized Schizophrenia
Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his
twelfth hospitalization, by his mother because she is afraid of him. He is dressed in a ragged
overcoat, bedroom slippers, and a baseball cap and wears several medals around his neck.
His affect ranges from anger at his mother (“She feeds me shit... what comes out of other
people’s rectums”) to a giggling, obsequious seductiveness toward the interviewer. His
speech and manner have a childlike quality, and he walks with a mincing step and exagger-
ated hip movements. His mother reports that he stopped taking his medication about a month
ago and has since begun to hear voices and to look and act more bizarrely. When asked what
he has been doing, he says, “eating wires and lighting fi res.” His spontaneous speech is often
incoherent and marked by frequent rhyming and clang associations (speech in which sounds,
rather than meaningful relationships, govern word choice).
Emilio’s fi rst hospitalization occurred after he dropped out of school at age 16, and since
that time he has never been able to attend school or hold a job. He has been treated with neu-
roleptics [antipsychotic medications] during his hospitalizations but doesn’t continue to take
medication when he leaves, so he quickly becomes disorganized again. He lives with his elderly
mother, but sometimes disappears for several months at a time and is eventually picked up by
the police as he wanders in the streets. There is no known history of drug or alcohol abuse.
(Spitzer et al., 2002, pp. 189–190)Catatonic Schizophrenia
Catatonic schizophrenia is characterized by catatonic (stiff or seemingly “frozen”)
postures or poses, bizarre jerky movements, or frozen facial expressions. A person
with catatonic schizophrenia also may not speak, may involuntarily and senselessly
repeat words or phrases said by others, or may mimic other people’s bodily move-
ments. Because they are unable to take care of themselves, such as by eating and
washing, people with catatonic schizophrenia require constant care.
Grunnitus Studio/Photo Researchers
This woman suffers from catatonic schizophrenia.
People diagnosed with this subtype of schizo-
phrenia assume odd postures or poses for hours
at a time, and may senselessly repeat words or
remain mute. People with catatonic schizophrenia
typically cannot care for themselves and require
constant attention.