Hebephrenia (disorganized schizophrenia): symptoms and causes

This type of psychotic medical condition has for years been considered a type of schizophrenia.

Although the DSM-5 diagnostic manual of disorders eliminated the differentiation between the different types of schizophrenia, a large number of professionals still consider this subdivision to be very informative in that it highlights the main symptoms of each case.

One of the most common types is disorganized schizophrenia, classically referred to as "hebephrenia".. This early-onset disorder is differentiated from other forms of schizophrenia by the predominance of disorganization symptoms and psychological deficits over hallucinations and delusions.

Hebephrenia or disorganized schizophrenia

Hebephrenia, also known as "disorganized schizophrenia", is one of the types of schizophrenia described in the DSM-IV and ICD-10 manuals. It is a It is an extreme manifestation of the so-called "disorganization syndrome", present to a greater or lesser extent inIt is an extreme manifestation of the so-called "disorganization syndrome", present to a greater or lesser extent in many cases of schizophrenia.

The German psychiatrist Ewald Hecker made in 1871 the first detailed description of the syndrome that would first be called hebephrenia and later disorganized schizophrenia. Emil Kraepelin included hebephrenia among the subtypes of "dementia praecox", the concept he used to refer to schizophrenia.

According to DSM-IV, hebephrenia is characterized by a predominance of negative symptoms over positive symptoms. While the positive symptoms of schizophrenia are mainly hallucinations and delusions, among the negative symptoms we find cognitive, behavioral and emotional deficits of various types..

For ICD-10, the basic features of the disorganized subtype of schizophrenia include early onset of symptoms, behavioral unpredictability, presence of inappropriate emotional expressions, disinterest in social relationships, and motivational deficits.

Characteristic symptoms and signs

As we have said, hebephrenia is characterized mainly by the presence of negative symptoms and disorganization of language and behavior. On the other hand, there are also differences with respect to other types of schizophrenia in the age of onset of the disorder.

Early presentation

Disorganized schizophrenia is frequently detected between 15 and 25 years of age through the progressive development of negative symptoms. This characteristic was considered the key aspect in hebephrenia for a long time; in fact, the word "hebeos" means "young boy" in Greek.

2. Disorganized behavior

When we talk about schizophrenia, the concept "disorganized behavior" may refer to alterations in motivation to initiate or complete tasks or to eccentric and socially inappropriate behaviors, such as wearing strange clothes or masturbating in public.

3. Disorganized language

In schizophrenia, language disorganization appears as a manifestation of deeper disorders that manifestation of deeper disorders affecting thinking and cognitive processes. and cognitive processes. Among the typical linguistic signs of hebephrenia we can find sudden blocks when speaking or spontaneous changes of topic, which are known as "flight of ideas".

4. Emotional disturbances

People with hebephrenia show the affective flattening typical in schizophrenia in general, which is also associated with difficulties in feeling pleasure (anhedonia), among other negative emotional symptoms.

It is also remarkable the manifestation of emotional and facial expressions inappropriate to the context.. For example, a hebephrenic patient may laugh and make grimaces similar to smiles during a conversation about the death of a loved one.

5. Predominance of negative symptoms

In contrast to paranoid schizophrenia, in the case of hebephrenia the negative symptoms are clearly more marked than the positive ones; this means that, if hallucinations and delusions are present, they are less significant than the symptoms of disorganization, lack of interest in social interaction or emotional flattening..

It is important to keep in mind that negative symptoms respond to medication to a lesser extent than positive symptoms; in fact many antipsychotics, especially first generation antipsychotics, cause an increase in behavioral and emotional deficits. In addition, people with a predominance of negative symptoms generally have a poorer quality of life.

Other types of schizophrenia

The DSM-IV describes four subtypes of schizophrenia in addition to disorganized schizophrenia: paranoid, catatonic, undifferentiated and residual. However, the DSM-5 eliminated the distinction between different types of schizophrenia, which was was eliminated in the DSM-5 because it was considered not to be very useful. ICD-10 adds postpsychotic depression and simple schizophrenia.

1. Paranoid

Paranoid schizophrenia is diagnosed when the main symptoms are delusions and/or hallucinations, which are usually auditory.which are usually auditory. This is the type of schizophrenia with the best prognosis.

2. Catatonic

In catatonic schizophrenia, behavioral symptoms predominate; in particular, people with this subtype of schizophrenia show great physical agitation or tend to remain immobile. physical agitation or they tend to remain immobile; in the latter case it isIn the latter case, a state of stupor is common and the phenomenon known as "waxy flexibility" can be detected.

3. Undifferentiated

The undifferentiated subtype is diagnosed in case symptoms of schizophrenia are detected but the characteristics of the paranoid, disorganized or catatonic subtypes are not fulfilled.

4. Residual

Residual schizophrenia is defined as the presence of hallucinations and/or delusions of limited clinical significance after a period when symptoms have been more intense.

5. Simple

In people with simple schizophrenia, relevant negative symptoms develop progressively without the appearance of psychotic episodes (or outbreaks). psychotic episodes (or outbreaks) appear.. This subtype is associated with schizoid and schizotypal personality disorders.

6. Postpsychotic depression

Many people with schizophrenia suffer depression in the period following a psychotic episode. This diagnosis is usually used when the emotional disturbances are clinically significant and can be attributed to the negative symptomatology of schizophrenia. negative symptomatology characteristic of schizophrenia..