Hebephrenia (Disorganized Schizophrenia)


Verified by World Mental Healthcare Association

Hebephrenia or disorganized schizophrenia is one of the five subtypes of schizophrenia. This disorder is characterized by disorganized behavior and speech and includes disturbance in emotional expression. Hallucinations and delusions are less prominent in disorganized schizophrenia, yet there is evidence that they exist.

What Is Hebephrenia?

Hebephrenia 1 , a type of schizophrenia, is a mental disorder characterized by confused behavior, bizarre speech, disorganized thoughts that interferes with emotional expression. Schizophrenia is a mental disorder in which the person loses their connection with reality. Hallucinations and delusions are a rare occurrence in this type. However, there is evidence of these symptoms occurring in some cases. A person who has delusions may believe things to be untrue such as thinking someone is persecuting them or think they have extraordinary gifts. The individual may even try to hide to protect themselves. They experience an inability to form coherent or logical thoughts and this leads to disorganized speech. While having a conversation, they may even jump to a different topic altogether. When the symptoms are severe, the speech becomes so disorganized that it doesn’t make sense to the other person.

The symptoms often occur gradually and are unlikely to subside. With appropriate and ongoing treatment, it is possible to manage the symptoms. The patient may require assistance with daily living skills, educational attainment, employment services, and family support.

Disorganized behavior can vary from child-like and silly behavior to aggressive and violent behavior. The symptoms can also involve excessive movements, unusual actions, freezing in one place, or not responding to instructions or communication. Other behaviors may include unprovoked agitation or sexual behavior in public.

People with this condition often find it difficult to stick to their treatment plan. Studies 2 suggest that a significant number of people stop taking medication within the first 12 months of treatment. For this, it can be difficult for them to manage the symptoms. In such cases, family, friends, and healthcare professionals are an essential support system in managing this disorder. Studies 3suggest that the prevalence of hebephrenia is 13% in developing countries and 4% in developed countries.

Read More About Schizophrenia Here

Signs And Symptoms

Signs And Symptoms of Hebephrenia
Hebephrenia (Disorganized Schizophrenia)

The primary symptoms of this disorder are disorganized speech and behavior. However, there may be other symptoms associated with it. They are as follows:

1. Disorganized speech

Hebephrenia can cause a lack of concentration and maintaining a train of thought that tends to manifest in the way they speak. They might speak incoherently, respond to questions with unrelated answers, say illogical things, or may shift to different topics frequently while having a conversation. The signs of disorganized speech are as follows:

  • Loose associations that refers to rapidly shifting between topics with no connection between topics
  • Perseveration or repetitions of the same things over and over again
  • Making up words that only has meaning to the speaker
  • Use of rhyming words without meaning
  • When the cognitive disorganization is severe, it can be impossible to understand what the person is saying

2. Disorganized Behavior

Hebephrenia can negatively affect any goal-directed behavior. A person with this disorder finds it difficult to begin a specific task such as cooking a meal or difficulty finishing a task. They cant independently function in their daily activities due to their extreme disorganization. The signs of disorganized behavior are as follows:

  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Lack of impulse control
  • Behaviors that appear bizarre or lack of purpose
  • Routine behaviors are severely impaired or lost such as bathing, dressing, or brushing teeth

3. Inappropriate Affect

Affect refers to a person’s emotional responses that include the way emotions are expressed. For instance, smiling when feeling happy. People with this condition display a flat affect that means that they display little or no emotions in their facial expressions, voice tone, or mannerisms. Sometimes they express their affect in an inappropriate manner that is not at par with the situation such as laughing at something sad. People with this disorder are likely to experience other negative symptoms such as failing to make eye contact along with a lack of emotional expression.

Causes And Risk Factors Of Hebephrenia

Causes And Risk Factors Of Hebephrenia
Hebephrenia (Disorganized Schizophrenia)

Experts are still not sure of the exact cause of hebephrenia. Research suggests that the contributing factors include functions of the brain, environmental and genetic factors. There may be certain risk factors that are responsible for developing this disorder. They are:

1. Genetic Factors

Experts believe that the leading cause of developing this disorder is genetics 4. This disorder affects 1% of the entire world population. However, an investigation is still in progress to determine the exact causes.

2. Chemistry and brain structure

The imbalance of brain chemicals and neurotransmitters such as dopamine, glutamate, and serotonin may affect how the brain functions and interfere with how a person reacts to sight, sound, and other stimuli. This explains why people with this condition tend to react to loud noises or bright lights.

3. Age

According to research, 5the firstborn child may be at a higher risk of developing this disorder if they have older parents than a child being born to parents aged 25 to 29.

Read More About Aging Here

4. Viral Infection in the Womb

If there is a viral infection in the womb while the woman is pregnant, it may pass to the fetus and increase the risk of developing this type of schizophrenia. However it is still unclear which viruses may affect the fetus but they may include influenza, herpes, toxoplasmosis, and rubella.

5. Maternal Malnutrition

Some studies 6 suggest that maternal malnutrition can be a contributing cause of this disorder. A range of factors related to pregnancy can increase the risk of this disorder.

6. Severe Stress

Some people tend to have a genetic susceptibility to develop this condition for experiencing extreme stress during early childhood due to abuse or trauma according to studies 7.

Read More About Stress Here

7. Recreational Drugs

The usage of recreational drugs during adolescence may also increase 8 the risk of developing this condition. It is still unclear whether the drugs are a cause or an effect of this condition.

What Are The Complications Associated With This Disorder?

There may be several complications associated with this disorder. They are as follows:

  • Issues with self-care leading to low nutrition and poor hygiene 9
  • Substance abuse
  • Work and study issues
  • Anxiety
  • Depression
  • Panic
  • Obsessive compulsive disorder (OCD)
  • Housing and financial issues
  • Relationship problems
  • Self-harm
  • Suicidal thoughts and behaviors

Read More About Obsessive-Compulsive Disorder (OCD) Here

Diagnosis Of Hebephrenia

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has laid out the following diagnostic criteria for this disorder.

  • The person with this disorder must experience at least two 10 of the five following symptoms. They are:
  • Delusions
  • Hallucinations 11
  • Disorganized speech
  • Disorganized behavior
  • Negative symptoms
  • The symptoms tend to disrupt the person’s work, interpersonal relationships, or self-care.
  • The symptoms must last for at least six months.

If the person has symptoms for one month, the doctor may diagnose them with a psychotic disorder. The doctor will ask several questions to the patient about:

  • The symptoms and when they started
  • Personal and family medical histories
  • Lifestyle factors and recent events

They may also run tests to rule out or understand the cause of the symptoms such as substance use or brain injury. These tests can include:

  • A physical examination
  • Blood tests
  • Brain scan

If the doctor concludes that the individual has hebephrenia he may refer them to a psychologist or a mental health professional in order to devise a treatment plan.

What Are The Treatment Methods Of Hebephrenia?

The individual with this condition may require urgent care when the first symptoms start to appear. They require ongoing treatment to prevent the symptoms from reoccurring. The best form of treatment depends on the type and severity of the symptoms along with the person’s overall health, age, and other factors.

The treatment plan involves a combination of medication, therapy, and other forms of personal support.

1. Medication

The doctor can prescribe antipsychotic drugs in order to maintain the balance of chemicals in the brain. These can help to prevent a reoccurrence of the symptoms. However, these drugs can have adverse effects. Hence it is important to let the person know of the negative side effects of the medications. The doctor can adjust the dosage if there are signs of side effects.

2. Psychotherapy

Psychotherapy is a talk therapy that helps the patient to address their feelings and concerns to a trained mental health professional. It can help people to identify and adjust their feelings and ways of thinking, manage their symptoms, and increase their ability to handle challenging situations. The doctor can also help the patient to develop coping strategies in order to ease the symptoms.

3. Social and Vocational Training

This training is essential for a person to live independently. It is a crucial part of the recovery plan. It might involve helping a person manage everyday tasks such as maintaining hygiene, preparing meals, communicating effectively. this can also involve help finding work, housing, or support groups.

4. Hospitalization

In case of emergency and if the symptoms are severe, the individual may require hospitalization. The primary aim of hospitalization is to reduce symptoms and provide a safe, restful environment, nutrition, and help with hygiene.

Recovery From Hebephrenia

This disorder is an extremely serious issue that interferes with one’s mind that causes disorganized thinking, speech, and behavior. It can have a significant impact on a person’s life. With support, medication, and therapy it is possible to manage the symptoms and prevent complications. Sticking to the treatment plan and having a health care team is essential to maintaining a good quality of life.

Hebephrenia At A Glance

  1. Hebephrenia or disorganized schizophrenia is one of the five subtypes of schizophrenia.
  2. This disorder is characterized by disorganized behavior and speech and includes disturbance in emotional expression. 
  3. The primary symptoms of this disorder are disorganized speech and behavior. 
  4. The individual with this condition may require urgent care when the first symptoms start to appear. 
  5. This disorder is an extremely serious issue that interferes with one’s mind that causes disorganized thinking, speech, and behavior.
  6. With support, medication, and therapy it is possible to manage the symptoms and prevent complications.
👇 References:
  1. Kraam, Abdullah & Phillips, Paula. (2012). Hebephrenia: A conceptual history. History of Psychiatry. 23. 387-403. 10.1177/0957154X11428416. []
  2. Higashi, K., Medic, G., Littlewood, K. J., Diez, T., Granström, O., & De Hert, M. (2013). Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic advances in psychopharmacology, 3(4), 200–218. https://doi.org/10.1177/2045125312474019 []
  3. Bhugra D. (2005). The global prevalence of schizophrenia. PLoS medicine, 2(5), e151–e175. https://doi.org/10.1371/journal.pmed.0020151 []
  4. Henriksen, M. G., Nordgaard, J., & Jansson, L. B. (2017). Genetics of Schizophrenia: Overview of Methods, Findings and Limitations. Frontiers in human neuroscience, 11, 322. https://doi.org/10.3389/fnhum.2017.00322 []
  5. Ni, G., Gratten, J., Wray, N.R. et al. Age at first birth in women is genetically associated with increased risk of schizophrenia. Sci Rep 8, 10168 (2018). https://doi.org/10.1038/s41598-018-28160-z []
  6. Xu, M. Q., Sun, W. S., Liu, B. X., Feng, G. Y., Yu, L., Yang, L., He, G., Sham, P., Susser, E., St Clair, D., & He, L. (2009). Prenatal malnutrition and adult schizophrenia: further evidence from the 1959-1961 Chinese famine. Schizophrenia bulletin, 35(3), 568–576. https://doi.org/10.1093/schbul/sbn168 []
  7. Popovic, D., Schmitt, A., Kaurani, L., Senner, F., Papiol, S., Malchow, B., Fischer, A., Schulze, T. G., Koutsouleris, N., & Falkai, P. (2019). Childhood Trauma in Schizophrenia: Current Findings and Research Perspectives. Frontiers in neuroscience, 13, 274. https://doi.org/10.3389/fnins.2019.00274 []
  8. Gage, S. H., Jones, H. J., Burgess, S., Bowden, J., Davey Smith, G., Zammit, S., & Munafò, M. R. (2017). Assessing causality in associations between cannabis use and schizophrenia risk: a two-sample Mendelian randomization study. Psychological medicine, 47(5), 971–980. https://doi.org/10.1017/S0033291716003172 []
  9. Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645. []
  10. Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645. []
  11. Mueser, K.T., Bellack, A.S. and Brady, E.U. (1990), Hallucinations in schizophrenia. Acta Psychiatrica Scandinavica, 82: 26-29. https://doi.org/10.1111/j.1600-0447.1990.tb01350.x []
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