What Is Disorganized Schizophrenia (Hebephrenia)? What Causes Disorganized Schizophrenia?

Disorganized schizophrenia, or hebephrenia (hebephrenic schizophrenia ) is one of several subtypes of schizophrenia, a chronic (long-term) mental illness - it is thought to be an extreme expression of disorganization syndrome that has been hypothesized to be one feature of a 3-factor model of schizophrenia symptoms; the others factors being delusions/hallucinations (reality distortion) and psychomotor poverty (poor speech, lack of spontaneous movement, and blunting emotion).

Disorganized schizophrenia is characterized by incoherent and illogical thoughts and behaviors; in other words, disinhibited, agitated, and purposeless behavior.

Experts say disorganized schizophrenia is a more severe schizophrenia type because the patient cannot perform daily activities, such as preparing meals and taking care of personal hygiene (washing). According to the Mayo Clinic, USA, people may not be able to understand what the person with disorganized schizophrenia is saying. The patient may become frustrated and agitated, causing him/her to lash out.

According to Medilexicon's medical dictionary:

Disorganized schizophrenia is A severe form of schizophrenia characterized by the predominance of incoherence, blunted, inappropriate, or silly affect, and the absence of systematized delusions.

What are the signs and symptoms of disorganized schizophrenia?

• Disorganized thinking - the patient is unable to form coherent or logical thoughts. This inability affects speech - during a conversation the individual cannot stick to the subject, and leaps from one disparate subject to another. The speech problem may become so severe that it is perceived as unintelligible garble (a muddle of sounds) to those around him/her. Writing is also severely affected by disorganized thinking.
• Grossly disorganized behavior - these symptoms may be so severe that the patient is unable to perform regular daily activities, such as bathing, dressing properly and preparing meals. For example, during a warm day the individual may put on several layers of clothing. There may be unprovoked agitation, or sexual behavior in public. Grossly disorganized behavior may feel normal to the person with schizophrenia, but appears bizarre to those around them. Behaviors may vary from being child-like and silly, to aggressive and violent.
• Inappropriate or lacking emotional expression (flat affect) - flat affect, also known as blunted affect, is sometimes a symptom of people with severe depression or schizophrenia - the individual may show the signs of normal emotion, may even talk with a monotonous voice. However, the face appears blank, facial expressions are significantly diminished. The patient appears extremely apathetic. There may be no eye contact with other people or any display of body language. On some occasions the individual may display behavior with is not appropriate for given situations - this may include bursting out laughing during a serious event.

Apart from the above, which are examples of disorganized schizophrenia symptoms, the patients may also have the following signs and symptoms of schizophrenia:

• Delusions - The patient has false beliefs of persecution, guilt of grandeur. He/she may feel things are being controlled from outside. It is not uncommon for people with schizophrenia to describe plots against them. They may think they have extraordinary powers and gifts. Some patients with schizophrenia may hide in order to protect themselves from an imagined persecution. According to Medilexicon's medical dictionary: a delusion is A false belief or wrong judgment, sometimes associated with hallucinations, held with conviction despite evidence to the contrary.
• Hallucinations - hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, but seem very genuine to the patient.
• Social withdrawal - when a patient with schizophrenia withdraws socially it is often because he/she believes somebody is going to harm them. Other reasons could be a fear of interacting with other humans because of poor social skills.
• Unaware of illness - as the hallucinations and delusions seem so real for the patients, many of them may not believe they are ill. They may refuse to take medications which could help them enormously for fear of side-effects, for example.
• Cognitive difficulties - the patient's ability to concentrate, remember things, plan ahead, and to organize himself/herself are affected. Communication becomes more difficult.
• There may also be grimacing, bizarre postures, problems functioning at school/work, and clumsy/uncoordinated movements.

Patients with disorganized schizophrenia symptoms are not usually able to get medical help on their own. When their symptoms appear to have subsided, it is common for them to believe they are fine and do not need treatment. Seeking medical help is frequently initiated by a family member or good friend.

What are the risk factors for disorganized schizophrenia?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

The risk factors for disorganized schizophrenia are essentially the same as those for most schizophrenia sub-types, including:

• Genetics (family history) - individuals with a family history of schizophrenia have a higher risk of developing it themselves. If there is no history of schizophrenia in your family your chances of developing it (any type) are less than 1%. However, that risk increases to 10% if one of your parents was/is a sufferer.
  
  A gene that is probably the most studied schizophrenia gene plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.
  
  A Swedish study found that schizophrenia and bipolar disorder have the same genetic causes.
• Viral infection - if the unborn baby in the womb (fetus) is exposed to a viral infection, there is a greater risk of developing schizophrenia.
• Fetal malnutrition - if the fetus suffers from malnutrition during the mother's pregnancy there is a higher risk of subsequently developing schizophrenia.
• Stress during early life - experts say that severe stress early on in life may be a contributing factor towards the development of schizophrenia. Stressful occurrences often precede the emergence of schizophrenia. Before any acute symptoms are evident, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely hard to know whether schizophrenia made certain stresses happen, or whether they occurred as a result of them.
• Childhood abuse or trauma
• Age of parents when baby is born - older parents have a higher risk of having offspring who develop schizophrenia, compared to younger parents.
• Drugs - the use of drugs that affect the mind or mental processes during adolescence may sometimes raise the risk of developing schizophrenia.

What are the causes of disorganized schizophrenia?

Experts are not sure what the causes of disorganized schizophrenia and all other types of schizophrenia are. Studies suggest there is some kind of brain dysfunction, probably caused by a combination of environmental triggers and genetic factors.

What are environmental triggers? Imagine your body has a load of buttons, and some of these buttons result in schizophrenia if enough of them are pressed, and pressed in the right sequence. The buttons would be your genetic susceptibility, while whatever pressed them would be the environmental triggers.

Doctors say that most likely an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They say this imbalance is probably caused by your genes making you susceptible to the illness. Some say the levels of other neurotransmitters, such as serotonin, may also be involved.

Changes in key brain functions, such as awareness, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.

Schizophrenia could be caused by faulty signaling in the brain, according to research published in the journal Molecular Psychiatry.

How is disorganized schizophrenia diagnosed?

A doctor who believes a patient may have disorganized schizophrenia will recommend a series of medical and psychological tests and exams in order to help with the diagnosis. Diagnostic tests and exams may include:

• Physical exam - the patient's height, weight, heart rate (pulse rate), blood pressure, temperature are checked. The doctor will listen to the heart and lungs, and also check the abdomen.
• CBC (complete blood count) - to check for alcohol and drugs, as well as thyroid function.
• MRI (magnetic resonance imaging) or CT (computed tomography) scan - the aim here is to look for brain lesions or any abnormalities in the brain structure.
• EEG (electroencephalogram) - to check for brain function.
• Psychological evaluation - the psychiatrist will ask patients about their thoughts, feelings and behavior patterns. They will discuss symptoms, when they began, how severe they are, and how they may affect the patient's life. The doctor will also try to find out how often and when schizophrenia symptoms had occurred.
  
  The doctor will most probably try to find out whether the patient had any thoughts about self-harm or harming other people.

Diagnostic criteria for disorganized schizophrenia - the patient must meet specific symptom criteria to be diagnosed with disorganized schizophrenia. These criteria are spelled out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association.

For a diagnosis of disorganized schizophrenia, there must be clear evidence of:

• Disorganized speech
• Disorganized behavior
• Lack of or blunted emotion
• Emotions which are not appropriate for given situations

Diagnosis may take time - some time may pass before the right diagnosis is confirmed. Other conditions or illnesses which may have overlapping symptoms need to be ruled out.

What are the treatment options for disorganized schizophrenia?

Disorganized schizophrenia is a condition that lasts throughout life - it is a chronic condition. Patients with disorganized schizophrenia need treatment on a permanent basis; even when symptoms seem to have gone away - a time when patients may be inclined to feel that they are fine and require no more help. Treatment is basically the same for all forms of schizophrenia; there are variations depending on the severity and types of symptoms, the health of the patient, his/her age, as well as some other factors.

A team of health care professionals will be involved in treating a person with disorganized schizophrenia. Schizophrenia can affect many areas of the patient's life - thus the team will include a wide range of dedicated professionals, including:

• A case worker
• A GP (general practitioner, primary care physician, family doctor)
• A pediatrician
• A pharmacist
• A psychiatric nurse
• A psychiatrist
• A psychotherapist
• A social worker
• Members of the patient's family

Treatment options include drugs (medications), psychotherapy, hospitalization (or partial hospitalization), ECT (electroconvulsive therapy), and vocational skills training.

Medications:

Atypical antipsychotics (2^nd generation antipsychotics) - a group of antipsychotic drugs used for the treatment of psychiatric conditions. Atypicals differ from typical antipsychotics in that they are less likely to cause extrapyramidal symptoms (EPS). EPS include parkinsonian-type movements, rigidity and tremor.

Side effects may include:

• Weight gain
• Diabetes
• High cholesterol

Typical antipsychotics (1^st generation antipsychotics) - although they are as effective in treating the same symptoms atypical antipsychotics are, patients are more likely to have extrapyramidal symptoms (EPS), including involuntary movements of the face, tremor and parkinsonian-type movements. The generic versions of these drugs are much cheaper than atypical antipsychotics.

Other drugs (medications) - people with schizophrenia tend to have other mental health issues, such as depression. The doctor may prescribe an antidepressant, an anti-anxiety drug, or a mood-stabilizing medication.

Hospitalization - when symptoms are severe the patient may need to be hospitalized. A hospital setting may be safer, where proper nutrition may be provided, and the patient may get better sleep and receive help with hygiene. Sometimes partial hospitalization is also possible.

Psychotherapy - for patients with disorganized schizophrenia, medications are the key part of treatment; however, psychotherapy is also important.

Psychotherapy consists of a series of techniques for treating mental health, emotional and some psychiatric disorders. Psychotherapy helps the individual understand what helps them feel positive or anxious, as well as accepting their strong and weak points. If patients can identify their feelings and ways of thinking there is a better chance of coping with challenging situations.

Social and vocational skills training - this may help the patient live independently; a vital part of recovery for the patient. The therapist can help the patient learn good hygiene, prepare nutritional meals, and have better communication. There may be help in finding work, housing and joining self-help groups.

Compliance (adherence) - compliance or adherence in medicine means following the therapy regime (the treatment plan). Unfortunately, lack of compliance is a major problem for patients with schizophrenia. Patients can go off their medication for long periods during their lives, at enormous personal costs to themselves and often to those around them as well.

As a significant percentage of individuals go off their medication within the first 12 months of treatment, a life-long regimen of both drug and psychological/support therapies are important for treatment to be effective and long-lasting.

ECT (electroconvulsive therapy) - in this procedure an electric current is sent through the brain to produce controlled seizures (convulsion). It may be used on patients with severe symptoms or depression who either have not responded to other treatments or cannot take antidepressants. It is also sometimes used for patients at high risk of suicide. Experts believe that ECT triggers a massive neurochemical release in the brain, caused by the controlled seizure. Side effects may include short-term memory loss (usually resolves rapidly). It is important that the doctor explain clearly the pros and cons of ECT to the patient and/or guardian or family member.

What are the possible complications of disorganized schizophrenia?

Untreated disorganized schizophrenia may develop into serious and severe problems of a health, financial, behavioral and legal nature - these problems may affect every part of the patient's life. Complications may include:

• Depression, Suicidal thoughts, Suicidal behavior - a considerable number of individuals with schizophrenia have bouts of depression. It is important not to ignore depression symptoms, as there is a risk that it may worsen and lead to suicidal thoughts and behaviors if left untreated. The National Health Service (NHS), UK says that "Research has found that 30% of people with schizophrenia will attempt suicide at least once, and 1 in 10 people with schizophrenia will commit suicide." (this refers to schizophrenia in general, and not specifically to disorganized schizophrenia).
• Malnutrition
• Hygiene problems
• Substance abuse - which may include alcohol, prescription medications and illegal drugs.
• Inability to find or maintain employment - which may result in poverty and homelessness. The patient may feel unwilling to go back to work because of fears of being unable to cope with responsibilities. Psychiatrists say that patients who do manage to carry on working tend to have a better quality of life compared to those who don't.
• Prison
• Serious family conflicts
• Inability to study or attend school and other educational institutions
• Being a victim of crime
• Being a perpetrator of crime
• Smoking-related diseases - smoking, and especially heavy regular smoking is common among people with schizophrenia. Some say it helps them concentrate. However, apart from causing serious health problems, smoking may also interfere with certain medications.