Hebephrenic Schizophrenia: Symptoms Of Disorganized Schizophrenia
Schizophrenia is a complex mental illness that can cause a spectrum of diverse symptoms. This condition can impact all areas of functioning, and various labels might be used to describe it, including hebephrenic. Exploring the term hebephrenic schizophrenia may be helpful when learning more about this disorder and its symptoms.
What is schizophrenia?
Considered a complex mental illness, schizophrenia "affects the way a person thinks, feels, and behaves." The National Institute of Mental Health (NIMH) describes it as a "mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions." The condition is also referred to as a spectrum of mental disorders that affects how reality is perceived.
Hebephrenic schizophrenia as a subtype of schizophrenia
Previously, schizophrenia was divided into different subtypes, including hebephrenic schizophrenia, which is also known as disorganized schizophrenia. Primary features of hebephrenic schizophrenia refer to unusual or disorganized behavior, disorganized speech, and inappropriate affect.
While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer recognizes hebephrenic as a subtype of schizophrenia, clinicians and other healthcare providers may still use the term. Those with schizophrenia may benefit from ongoing treatment throughout their lives, as well as medication, peer support, and therapy to help manage symptoms.
The DSM-5 and the ICD-11
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition by the American Psychiatric Association, combines all the subtypes of schizophrenia into one. In the fourth edition of the Diagnostic and Statistical Manual (DSM-IV), schizophrenia was divided into disorganized schizophrenia (hebephrenic schizophrenia), paranoid schizophrenia, residual schizophrenia, undifferentiated schizophrenia, and catatonic schizophrenia. Catatonia is now separated into its own category, with schizophrenia as a specifier.
ICD for hebephrenic schizophrenia
In the ICD-10, however, hebephrenic schizophrenia was described as "meeting the generic criteria for schizophrenia" and presenting "signs in the domains of affect, behavior, and thought." Some researchers also contend that clinicians may want to "consider it as a differential diagnosis, particularly in suspected personality disorder."
Features of hebephrenic schizophrenia or disorganized schizophrenia
According to the American Psychological Association (APA), prominent symptoms of what was called hebephrenic (or "disorganized") included:
- Disorganized thinking, speech, and behavior
- Fragmented speech
- Flattened affect (showing little or no emotions)
- Inappropriate affect that doesn't fit the situation
- Extreme social withdrawal
- Unusual mannerisms, such as laughter and grimaces
However, hebephrenic schizophrenia is not usually associated with hallucinations and delusions. Instead, disorganized speech and unusual behavior tend to be the more telling signs of hebephrenia.
To prevent misdiagnosis and mistreatment, some researchers contend that hebephrenia might be better considered a "differential diagnosis in individuals who present with erratic and challenging behavior, in the relative absence of symptoms such as hallucinations or delusions."
The history of schizophrenia
Dementia praecox (premature dementia) was a diagnostic concept devised by the German physician Emil Kraepelin (1856 to 1926) for what is now referred to as schizophrenia. Some researchers note that Kraepelin described "the symptoms and course that characterize the disease." Kraepelin combined hebephrenia, catatonia, paranoia, and dementia simplex under the term dementia praecox, as he considered that specific symptoms that manifested in adolescence would progress to dementia in these four mental health disorders.
The term schizophrenia was coined by Swiss psychiatrist Eugene Bleuler, who objected to Kraepelin's prognosis model of dementia praecox, prompting a search for "alternative characterizing features that would allow scientific description and classification." Schizophrenia means “split mind” in literal terms, relating to the "breaking up or splitting of psychic functioning" that Bleuler described as characteristic of its central features. Bleuler considered hallucinations and delusions secondary schizophrenia symptoms.
Bleuler is credited for considering social and psychological factors along with the neurological disease process in charting the development of schizophrenia. Some researchers have suggested that he "acknowledged both brain and mind, as well as social factors, as equally important elements in mental health and illness."
Schizophrenia features and symptoms
Each person with schizophrenia may experience different symptoms, but there are several standard features.
According to the National Institute of Mental Health (NIH), most people are diagnosed with schizophrenia between the ages of 16 and 30 following an episode of psychosis. However, gradual changes in thinking, behavior, and social functioning may be apparent much sooner. Schizophrenia may be primarily characterized by psychotic symptoms, negative symptoms, and cognitive features.
Psychotic features include:
- Hallucinations, such as hearing voices
- Delusions, such as believing that a newscaster on TV is sending them secret messages or that they are in imminent danger
- Exhibiting a loss or reduced ability "to initiate plans, speak, express emotion or find pleasure"
- Exhibiting a thought disorder that reflects in speech, behavior, or movements
- Exhibiting a movement disorder, such as repeating body motions that may be considered unusual or abnormal
Other features include positive symptoms, cognitive symptoms, and negative symptoms.
Positive symptoms
The term positive symptoms may also be used, as these relate to the degree to which they distort reality and functioning, as in the case of hallucinations, delusions, and thought disorders.
Cognitive symptoms
Cognitive symptoms relate to challenges with attention, concentration, and memory.
Negative symptoms
Negative symptoms refer to loss of motivation, interest, and enjoyment in activities, social withdrawal, reduced ability to show emotions, and impaired ability to function. For example, negative symptoms may make it difficult for someone to show pleasure in receiving affection or a compliment.
A flattened affect may mean a person speaks in a monotone or dull voice. Challenges with social interactions may make someone withdraw from contact or act awkwardly in situations where they engage with others. Low energy or motivation may translate into little or no interest in activities. In some cases, one may stop talking or moving for a time.
Those with schizophrenia may require ongoing treatment throughout one's life, as well as medication, peer support, and therapy to manage symptoms. Therapy approaches include cognitive-behavioral therapy (CBT) and assertive community treatment (ACT).
Therapy for fostering mental wellness
Reaching out for help can be challenging when you're experiencing difficulties connecting with others. Speaking to a therapist may be helpful, as they can help you manage symptoms and find the support to live your life healthily.
However, if attending in-person sessions is inconvenient, you may want to consider online therapy. Platforms like BetterHelp allow clients to have sessions with a licensed therapist via phone, video, or live chat without physically going to appointments. You can also exchange messages in-app, which may be helpful when you've had a particularly stressful day and would like your therapist to get back to you quickly.
A clinical trial tested the effectiveness of telehealth psychoeducational intervention for people with schizophrenia and their family members. The study's 30 participants with schizophrenia reported having less stress and more social support after undergoing the three-month program.
Takeaway
Those with schizophrenia may benefit from ongoing treatment throughout their life, as well as medication, peer support, and therapy to manage symptoms. If you are experiencing symptoms affecting your well-being, speaking to a therapist may be supportive. If attending in-person sessions presents a challenge, you may consider online therapy, which has been shown to alleviate some symptoms of schizophrenia and stress.
What are people with disorganized schizophrenia likely to experience?
People with a schizophrenia diagnosis may experience disorganized symptoms. Disorganization is a cluster of symptoms with the following symptoms:
- Unusual reactions, such as seeming emotionally flat or a lack of facial expressions
- Incoherent speech
- Unpredictable behaviors, such as wandering purposelessly
- Memory impairment
- Social withdrawal
- Lack of self-care
The Diagnostic and Statistical Manual used to recognize disorganized syndrome (or “hebephrenia”) as a subtype of schizophrenia, though it’s no longer recognized as a distinct diagnostic category. Non-disorganized symptoms of schizophrenia, like false beliefs or hallucinations, are also commonly evaluated by mental health professionals when diagnosing schizophrenia.
Which type of schizophrenia has the worst prognosis?
In the newest edition of the Diagnostic and Statistical Manual (DSM-5), there are no longer subtypes of schizophrenia recognized in an official diagnosis. Former subtypes included:
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
Risk factors for developing schizophrenia that is more severe include early age of onset, lack of access to treatment options, sedentary lifestyle factors, and the co-occurrence of other mental health disorders (like substance use disorders). With an effective treatment plan, many people with schizophrenia can lead a happy and fulfilling life.
Is hebephrenia curable?
“Hebephrenia,” also called disorganized schizophrenia subtype, is not a recognized disorder in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5).
Here is an overview and treatment options for schizophrenia:
Schizophrenia is a chronic mental disorder that impacts thoughts, feelings, and behaviors. Diagnostic criteria for the disorder include several prominent characteristics, such as gross disorganization, psychosis, social withdrawal, and other symptoms. While schizophrenia cannot be cured, antipsychotic medications, talk therapy, social skills training, and self-care can help people manage symptoms and live a more fulfilling life.
What is the strongest medication for schizophrenia?
There are a variety of medications that healthcare professionals may prescribe for the management of schizophrenia. These include:
- First-generation antipsychotics: First-generation antipsychotics are an older class of medications that have a higher risk of side effects than newer medications. For this reason, the prescription of first-generation antipsychotics has declined with the availability of second-generation medications. Examples of first-generation medications include chlorpromazine, fluphenazine, and haloperidol.
- Second-generation, or atypical, antipsychotics: Olanzapine, risperidone, and aripiprazole are often recommended as first-line treatments for schizophrenia. Research suggests that clozapine, another atypical antipsychotic, tends to be the most effective treatment of schizophrenia that is resistant to other treatments.
Overall, second-generation medications are generally preferred for the treatment of schizophrenia. However, the best medication for an individual may depend on things like the presence of other medical conditions, family history of poor antipsychotic medication response, environmental factors, and the presence of symptoms like self-harm or suicidal thoughts.
For people who are pregnant or planning to become pregnant, it’s a good idea to discuss this with your healthcare provider, as some antipsychotics may carry increased risks, especially during the first and second trimesters.
What are the effects of being hebephrenic?
Hebephrenia, also known as the disorganized schizophrenia subtype, is no longer recognized in the DSM-5. Instead, disorganized symptoms are considered some of the main symptoms of schizophrenia.
Disorganized symptoms of schizophrenia include:
- Grossly disorganized thoughts and/or sleep
- Aimless, erratic, or unpredictable behavior
- Unpredictable responses
- Emotional or facial “flatness”
- Emotional responses that do not match the situation
Disorganized symptoms can put people at an increased risk of impacting quality of life and social connectedness. These symptoms may or may not appear alongside symptoms like hallucinations, delusions, paranoia, or social isolation.
What qualifies as hebephrenic schizophrenia?
Hebephrenic schizophrenia refers to a schizophrenia subtype called “disorganized schizophrenia.” This subtype is no longer recognized.
What are the symptoms of hebephrenia?
Hebephrenia, or disorganized schizophrenia, is a subtype of schizophrenia that used to be recognized in the Diagnostic and Statistical Manual. It’s characterized by symptoms like:
- Disorganized thought and/or speech patterns
- Flat affect
- Emotions or facial expressions that don’t match the situation
- Erratic or unpredictable behavior, such as aimless wandering
- Fragmented sentences
Symptoms of schizophrenia are categorized into positive, negative, or cognitive symptoms. To make a diagnosis of schizophrenia, a mental health professional will typically conduct a detailed assessment of symptoms, family history, and behavior. A medical practitioner may also perform physical exams or order tests.
What is the difference between hebephrenia and schizophrenia?
Hebephrenia, or disorganized schizophrenia, used to be classified as a subtype of schizophrenia. However, subtypes are not included in the most recent edition of the Diagnostic and Statistical Manual (DSM-5). When it was used, the hebephrenic subtype described schizophrenia with primarily disorganized symptoms.
What is hebephrenia also known as?
Hebephrenia is also known as disorganized schizophrenia, though it’s not recognized in the most recent edition of the Diagnostic and Statistical Manual.
How to treat hebephrenic schizophrenia?
Schizophrenia with predominately disorganized symptoms is typically managed with a combination of:
- Medications, such as antipsychotics, mood stabilizers, and/or antidepressants
- Therapy, such as cognitive behavioral therapy, family therapy, and/or social skills training
- Support groups
- Family psychoeducation
In addition to these approaches, it’s recommended that people with schizophrenia practice self-care and healthy lifestyle habits, like prioritizing a consistent bedtime routine, spending time with loved ones, eating a nutritious diet, and getting regular exercise.
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