What's to know about disorganized schizophrenia?
Schizophrenia can involve delusions, hallucinations and disorganized thinking and speech.
Disorganized schizophrenia, or hebephrenia, refers to incoherent and illogical thoughts and behaviors related to schizophrenia.
However, hebephrenia is no longer considered a distinct form of schizophrenia. The change in status happened because keeping the different types separate did not appear to help with diagnosis.
Since 2013, the American Psychiatric Association (APA)'s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has defined schizophrenia as a single condition, which may or may not include disorganization.
Schizophrenia affects around 1.1 percent of the world's population.
Here are some key points about disorganized schizophrenia. More detail is in the main article.
- Schizophrenia is a serious, lifelong mental disorder that can involve disorganized and illogical thinking and behavior.
- Disorganized schizophrenia, or hebephrenia, used to be a subtype, but since 2013, it has been included under the heading "schizophrenia."
- Treatment is available, and if a person adheres to it, it can enable them to cope with everyday life.
- The complications of schizophrenia can be severe, but support from family and friends may help a person avoid some of these.
The signs of schizophrenia fall into the following key symptom categories of all psychotic disorders:
Delusions: The patient has false beliefs of persecution, guilt, or grandeur. It is not uncommon for people with schizophrenia to describe plots against them, or to believe they have extraordinary powers and gifts. Some patients may hide to protect themselves from an imagined persecutor.
Hallucinations: These involve seeing, feeling, tasting, or smelling things which are not there. Hearing voices is the most common hallucination.
Disorganized speech and thoughts: The patient is unable to form coherent or logical thoughts, and this is signified by disorganized speech. During a conversation, the individual will be unable to stick to the subject. They will leap from one topic to another. In severe cases, speech may be perceived by others as unintelligible garble.
Disorganized or catatonic behavior: Behaviors may vary from being child-like and silly, to aggressive and violent. There may be unprovoked agitation, or sexual behavior in public. Excessive movement, bizarre actions, freezing in place, or a lack of response to instructions or conversation are other ways this symptom can manifest.
Negative symptoms: This refers to the inability to function normally and can include symptoms such as a lack of personal hygiene, social withdrawal, and an inability to show emotion such as avoiding eye contact or speaking in a monotone voice.
Causes and risk factors
Experts are not sure what causes schizophrenia, but research suggests there is some kind of brain dysfunction, probably influenced by a combination of biological and environmental factors.
Chemicals in the brain - such as the neurotransmitters dopamine and serotonin - may be involved in the onset of schizophrenia.
The condition could be caused by faulty cell-to-cell signaling in the brain, according to 2009 research published in the journal Molecular Psychiatry. Scientists in the study identified 49 genes that work differently in the brains of schizophrenia patients compared to controls.
The risk factors for schizophrenia include:
Genetics: Individuals with a family history of schizophrenia have a higher risk of developing the condition. If there is no history of schizophrenia, the chances of developing it are less than 1 percent. However, that risk increases to 10 percent if one parent has the condition. Research has suggested that schizophrenia and bipolar disorder have the same genetic basis.
Viral infection: If a fetus is exposed to a viral infection, there is a greater risk of developing schizophrenia. There is no definitive list of viruses which pose a risk, but possible candidates include influenza, herpes, toxoplasmosis, and rubella.
Fetal malnutrition: If the fetus suffers from malnutrition during pregnancy there is a higher risk of developing schizophrenia.
Severe stress during early life: Children who experience extreme forms of stress early on in life may be at risk of schizophrenia. This could be due to childhood abuse or trauma.
Age of parents when infant is born: Children born to older parents have a higher risk of schizophrenia than children born to younger parents.
Drugs: Using substances that affect the mind or mental processes during adolescence may increase the risk of developing schizophrenia. Illegal drug use is common among those with schizophrenia, although it is not certain whether such drug use is a cause, or an effect, of the condition.
If schizophrenia is suspected, a series of medical and psychological tests will be carried out to rule out other conditions.
Such tests include:
Physical exam: The patient's height, weight, pulse, blood pressure, and temperature are checked. The doctor will also listen to the heart and lungs and check the abdomen to rule out alternative physiological causes.
Complete blood count: To check for alcohol and drug use, as well as thyroid function.
MRI or CT scan: These imaging techniques are used to look for brain lesions or other abnormalities in brain structure. An EEG may also be used to check for brain function.
Psychological evaluation: A doctor or psychiatrist will check mental health status by asking patients about their thoughts, feelings and behavior patterns. They will look for anything unusual in the appearance or behavior of the patient, and they will take a detailed family and personal medical history.
To receive a diagnosis of schizophrenia, a number of criteria must be met. The DSM-5 outlines the symptom criteria.
The symptoms are:
- disorganized speech
- disorganized behavior
- negative symptoms
The person must experience two of the five key symptoms of psychotic disorders, and at least one symptom must be among the first three listed.
People with schizophrenia will need treatment on an ongoing basis, even when symptoms seem to have gone away. At these times, patients may believe they are fine and require no more help, but if they stop using their medication, symptoms will usually return.
Treatment varies depending on the severity and types of symptoms, the health of the patient, their age, and other factors.
Atypical or second-generation antipsychotic drugs are used to treat psychiatric conditions. They differ from typical, or first generation, antipsychotics, as they are less likely to cause extrapyramidal symptoms (EPS). EPS include Parkinsonian-type movements, rigidity and tremor.
Other drugs may be used to address additional mental health issues in those with schizophrenia, such as antidepressants or anti-anxiety medications.
When symptoms are severe, the patient may need to be hospitalized. A hospital setting may be safer, and it increases the chances of the patient getting proper nutrition, better sleep, and help with hygiene.
Counseling or psychotherapy may be suggested, usually in conjunction with medication. These techniques treat issues with mental health and emotional regulation.
Psychotherapy helps people to identify their feelings and ways of thinking, increasing their ability to cope with challenging situations.
Social and vocational skills training
This training can help the person live independently. This is a vital part of recovery. The therapist can help the patient learn proper hygiene, meal preparation, and communication skills. There may be help in finding work, housing, and joining self-help groups.
Electroconvulsive therapy (ECT)
ECT involves sending an electric current through the brain to produce controlled seizures, or convulsions. It may help patients at high risk of suicide, depression, or those with other severe symptoms who have not responded to other treatments or who cannot take antidepressants.
The controlled seizure that is triggered by the ECT is thought to provoke a major neurochemical release in the brain. Side effects may include short-term memory loss, which usually resolves rapidly.
The doctor must clearly explain the pros and cons of ECT to the patient and their guardian or family member before carrying out the treatment.
The importance of compliance in treatment
A key issue in treating schizophrenia is that of compliance. Also known as adherence, compliance in medicine means following the treatment plan.
This can be challenging for patients with schizophrenia, and a significant number stop taking their medication within the first 12 months - making things worse for themselves and those around them.
Complications of schizophrenia may include:
- depression, suicidal thoughts, and suicidal behavior
- hygiene problems
- substance abuse
- inability to find or maintain employment which may result in poverty and homelessness
- family conflicts
- inability to study or attend school
- becoming a victim of crime
- smoking-related issues
Some people with schizophrenia say smoking helps them concentrate, but it may interfere with medications and lead to serious health issues.
Schizophrenia is a serious, lifelong condition. Being aware of what it involves can help family and friends support a loved one who has this condition.