Correctly Diagnosing Schizophrenia: Paranoid Type vs. Undifferentiated Type
Reader’s Question
My wife was recently diagnosed with Schizophrenia, Undifferentiated Type. She is 27 years old. She was put on Haldol, Cogentin (for extrapyramidal symptoms) and Ativan (as needed).
I am concerned that she may have been diagnosed incorrectly. She is clearly paranoid much of the time. For example, she refuses to touch the stove or microwave buttons because it will let the “demons” gain control of her mind, reading her thoughts and giving her bad ideas. Another example of this is how she obsessively watches programs and movies that are about demons because she is convinced that these shows are telling her how to stop them from taking over the world and destroying everyone and of course, her specifically. Everything she does lately centers around finding “the key” to defeat them. She was once a vibrant and energetic — although shy — person. Now it’s an epic battle to even get her to leave places she considers safe, like our bedroom, since she fears they are going to come in and take her to prison for knowing too much about their plans. Reasoning with her that none of it is real only works partially on a “good day”. On a bad one everyone is out to get her. I guess what I’m trying ask is, don’t her symptoms suggest that the correct diagnosis should have been Schizophrenia, Paranoid Type as opposed to the Undifferentiated Type?. Could it be something else entirely?
The doctor she is seeing has already lost her trust because he told her at the start of the first session: “I promise it’s not Schizophrenia,” yet had to give the diagnosis when the session concluded. I just don’t know what to think.
Our Clinical Psychologist’s Reply
It would be impossible to make any kind of definitive statement about your wife’s diagnosis without a lot more information. However, you raise some legitimate concerns that warrant some comment.
Schizophrenia is a pretty serious diagnosis, and there many valid reasons why any mental health professional would exercise great caution in making the diagnosis. Even clearly psychotic behavior (e.g., hallucinations and delusions), need not necessarily be the result of schizophrenia. Because some diagnoses carry with them some fairly significant implications with regard to prognosis as well as long-term treatment, and because sometimes even though some critical positive signs of an illness are present, others might be conspicuously absent, many professionals tend to take a more conservative approach to making a firm diagnosis and prefer to continually assess over a period of time before reaching a final conclusion. Also, although the additional symptoms you describe clearly suggest a paranoid flavor to some of your wife’s delusions, some professionals reserve judgment about categorizing them as paranoid if they are not of clear persecutory or grandiose character, and some resist categorization period if they have reason to suspect that it’s too early in the course of the illness or their ongoing assessment to make a definitive diagnostic call.
Of course the biggest concern you are likely to have is that if the diagnosis is not accurate, then the prescribed treatment might not be optimal as well. This is a legitimate concern, although the various subtypes of some mental illnesses do not necessarily require treatment with different medications. And given your wife’s relatively young age as well as the seriousness of this type of problem, you and/or your wife would be well within your rights to seek a second opinion — and your physician should have no problem with that. In the end, you will likely be most at ease when it is clear to you that both the diagnosis and treatment given your wife are based on an accurate and comprehensive evaluation of all the facts, history, and careful ongoing observation.
