Simple-type schizophrenia

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Simple-type schizophrenia
Synonym Simple schizophrenia
Classification and external resources
Specialty psychiatry
ICD-10 F20.6
ICD-9-CM 295.0

Simple-type schizophrenia is a sub-type of schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-II[1] and the International Statistical Classification of Diseases and Related Health Problems, ICD-10. The later versions of the DSM (DSM-III, DSM-IV, DSM-5) do not include it. “Simple schizophrenia” is classified F20.6 in ICD-10.[2] and 295.0 in the ICD-9 code.[3]


Has possibly the earliest onset compared to all other schizophrenias, considered to begin in some within childhood. Symptomatic of the simplex is an absence of will, impoverished thinking and flattening of affect. There is a gradual deterioration of functioning with increased amotivation and reduced socialization.[4][5] It is considered to be rarely diagnosed and is a schizophrenia without psychotic symptoms (Mueser & Jeste 2008).[6]

In a study of patients in a Massachusetts hospital; persons suffering with simple-schizophrenia were found to make attempts at reality fulfillment with respect to the more primitive needs; tending toward the achievement of fulfillment of these needs rather than engaging in fantasy as is typically found as a reaction to environmental stimuli by the psychotic person (Kant 1948).[7]


Classification according to the World Health Organisation 1993 criteria [8] within the ICD-10 classification is ;

The only primary symptom is the withdrawal of the person from social and work related situations (Přikryl & Kučerová 2004) [10]


Definition of this type is without unity or is controversial, or else is within a divided opinion.[11] The classification was discontinued in the U.S. DSM system, although recommended for reinclusion (Black & Boffeli 1989),[12] was subsequently confirmed as having imprecise diagnostic criteria based on collective descriptions lacking in agreement (Black & Boffeli 1990).[13]


In an experiment with a small sample size (five) persons having had a diagnosis of simple-type (DSM-IV simple deteriotive disorder) were found to have grey matter deficits, atrophy and reduced cerebral perfusion in the frontal areas (Suzuki 2005).[14] Whitwell et al 2005 found justification to retain the classification on the basis of fulfillment of "dimensional" considerations of classification, as opposed to criticisms resulting from disagreement in considerations of classification using orientation from other categories.[15]


A progressive state of simple dementia results often in cases of adolescent onset Juvenile general paresis. Paresis is being caused by placental-foetal transfer of infection and results in intellectual (mental) subnormality. Occurrence of this type of paresis is altogether uncommon (Lishman 1998).[16]

History of definition[edit]

The early idea that a person with schizophrenia might present solely with symptoms and indications of deterioration (i.e. in presentation having no accessory symptoms [17][18]) was identified as dementia simplex (Serra-Mestres et al 1997),[11]

ICD-10 specifies the continuation of symptoms for a period of two years in the diagnosis of simple schizophrenia. This is because of disagreement on the classification validity of the sub-type, that having been retained by the ICD classification, has been omitted from DSM classifications.[19]

Symptoms identified earlier to dementia simplex are now DSM-attributed by way of improvements in diagnostic technique to other classifications such as neurodegenerative disorders.[20]

Early observations that concur with symptoms of the dementia praecox of the form classified later as simplex began in 1838 [21] with Esquirol. Morel in 1860 introduced the term dementia précoce, Langdon Down in 1887 provided the most complete description to that date of the clinical manifestation that Charpentier described in 1890 as dementia précoce simple des enfant normaux (Pick 1924).[22] The description simple schizophrenia is a description that is inter-changeable with describing symptoms as a form of dementia praecox known as simple dementing, at least in the time of Diem and Bleuler.[23] Kraeplin in 1893 considered there were four types (Green 2009),[24] was amongst the first to identify three types (hebephrenic, paranoid, simplex) of schizophrenia (Weinberger & Harrison 2011).This type was added by E Bleuler to the earlier Kraeplin four identified in 1899, and subsequently given a basic outline (Diem et al 1903),[25] in 1903 by O. Diem publishing a monograph on dementia praecox in the simple dementing form.[26] This was based on survey of two males having had a relatively normal childhood to then fall into patterns of living tending toward vagrancy.[17]

A description of a cerebral disorder in relation to organic factors and in the context of general paralysis of the insane only; with no reference to schizophrenia,shows a disorder with features of generalized dementia (Lishman 1998).[16]

In 1951 a film was made showing the clinical characteristics of chronic simple type.[27]


  1. ^ American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition. Washington, D. C. p. 33. 
  2. ^ World Health OrganisationInternational Statistical Classification of Diseases and Related Health Problems – Classification of Mental and Behavioural Disorders Retrieved 2012-01-21
  3. ^ World Health OrganisationManual of the international statistical classification of diseases, injuries, and causes of death (ICD-9) – Classification of Mental and Behavioural Disorders (1977)
  4. ^ Brown University - Schizophrenia DSM-IV TR#295.1-295.30, 295.90) Retrieved 2012-01-22
  5. ^ Baiceng Lou, Thomas Dey - Soothing the troubled mind: acupuncture and moxibustion in the treatment of schizophrenia Paradigm Publications, 1999 Retrieved 2012-01-22
  6. ^ Kim Tornvall Mueser & Dilip V. Jeste 2008 - Clinical Handbook of Schizophrenia - 650 pages Guilford Press, 27 Mar 2008 Retrieved 2012-01-22 ISBN 1-59385-652-0
  7. ^ Otto Kant Jan 1, 1948 - Clinical investigation of simple schizophrenia Psychiatric Quarterly Volume 22, Numbers 1-4, 141-151,[1] doi:10.1007/BF01572410 © 1948, The Psychiatric Quarterly Retrieved 2012-01-22
  8. ^ World Health Organisation 1993 - classifications/icd Retrieved 2012-02-04
  9. ^ F20.0 = Paranoid schizophrenia , F20.1 = Hebephrenic schizophrenia, F20.2 = Catatonic schizophrenia , F20.3 = Undifferentiated schizophrenia (same reference)
  10. ^ R.Přikryl & H.Kučerová Masaryk University document retrieved 2012-02-12
  11. ^ a b Jordi Serra-Mestres,Carol A.Gregory, Subash Tandon, Alison J.Stansfield, Paul M.Kemp & Peter J.McKenna Simple schizophrenia revisited : A Clinical, Neuorphysiological and Neoroimaging analysis of Nine Cases (PDF). Wilfrid Laurier Univ. Press (1997). Retrieved 2012-01-22. 
  12. ^ Black DW, Boffeli TJ. - Simple schizophrenia: past, present, and future. Am J Psychiatry. 1989 Oct;146(10):1267-73. PMID 2675642 Retrieved 2012-01-21
  13. ^ Donald W. Black, Todd J. Boffeli - Simple schizophrenia: Revisited published in Comprehensive Psychiatry July–August 1990 Copyright © 1990, Elsevier Retrieved 2012-01-22
  14. ^ Suzuki M, Nohara S, Hagino H, Takahashi T, Kawasaki Y, Yamashita I, Watanabe N, Seto H, Kurachi M. - Prefrontal abnormalities in patients with simple schizophrenia: structural and functional brain-imaging studies in five cases. Psychiatry Res. 2005 Nov 30;140(2):157-71. Epub 2005 Oct 21. ncbi.nlm mendeley Retrieved 2012-01-22
  15. ^ Susannah Whitwell, Jessica Bramham and John Moriarty 2005 - Simple schizophrenia or disorganisation syndrome? A case report and review of the literature Advances in Psychiatric Treatment (2005) 11: 398-403 [2] doi:10.1192/apt.11.6.398 © 2012 The Royal College of Psychiatrists Retrieved 2012-01-22
  16. ^ a b Organic psychiatry: the psychological consequences of cerebral disorder. Wiley-Blackwell, 12 Jan 1998. Retrieved 2012-02-12. 
  17. ^ a b J.K. Wing and N. Agrawal Early schizophrenia concepts. Armenian Medical Network. Retrieved 2012-02-06. 
  18. ^ James E. Maddux, Barbara A. Winstead Psychopathology: foundations for a contemporary understanding Routledge, 2005 Retrieved 2012-02-06
  19. ^ Armenian Medical Network - subtypes-of-schizophrenia Retrieved 2012-01-31 [content is found under heading Course and sub-types of schizophrenia]
  20. ^ Daniel R. Weinberger (U.S. National Institute of Health), Paul Harrison (University Department of Psychiatry Oxford) - Schizophrenia - 736 pages John Wiley & Sons, 13 Jul 2011 Retrieved 2012-01-22 ISBN 1-4443-4774-8
  21. ^ Jean-Etienne-Dominique Esquirol - Des maladies mentales considerées sous les rapports médical, hygiènique et médico-légal Chez J.-B. Baillière, 1838 Retrieved 2012-02-01 (original from the Complutense University of Madrid)
  22. ^ Joseph Zelmanowits - A Historical Note on the Simple Dementing Form of Schizophrenia Proc R Soc Med. 1953 November; 46(11): 931–933. Proceedings of the Royal Society of Medicine Retrieved 2012-02-01
  23. ^ J.K. Wing and N. Agrawal (ed, S. R. Hirsch. - Professor of Psychiatry Emeritus, D. R. Weinberger - Chief, Clinical Brain Disorders Branch Intramural Research Program [3] Retrieved 2012-01-31
  24. ^ Ben Green 2009 - Problem-Based Psychiatry - 253 pages Radcliffe Publishing, 2009 Retrieved 2012-01-22 ISBN 1-84619-042-8
  25. ^ Richard Noll 2006 - The encyclopedia of schizophrenia and other psychotic disorders - 409 pages Infobase Publishing, 30 Oct 2006 Retrieved 2012-01-22 ISBN 0-8160-6405-9
  26. ^ C. A. Gregory, P. J. McKenna & J. R. Hodges - Dementia of frontal type and simple schizophrenia: Two sides of the same coin? - Neurocase: The Neural Basis of Cognition Volume 4, Issue 1, 1998 [4] doi:10.1080/13554799808410601 Retrieved 2012-01-31
  27. ^ Canadian Medical Association Journal - Schizophrenia: Simple-type Deteriorated—1951; Sound; B & W; 11 minutes - Can Med Assoc J. 1959 September 15; 81(6): 499. PMC1831211 Retrieved 2012-01-22