Disorganized schizophrenia

Disorganized schizophrenia, or hebephrenia, is an obsolete term for a subtype of schizophrenia. It is no longer recognized as a separate condition, following the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, which dropped the concept of subtypes of schizophrenia, and global adoption of the eleventh revision of the International Classification of Diseases (ICD-11) in 2022.^[1] It was originally proposed by the German psychiatrist Ewald Hecker in the 1870s.^[2][3]

Disorganized schizophrenia
Other names	Hebephrenic schizophrenia, hebephrenia
Specialty	Psychiatry

Disorganized schizophrenia was classified up to ICD-10^[4] as a mental and behavioural disorder,^[4] because the classification was thought to be an extreme expression of the disorganization syndrome that has been hypothesized to be one aspect of a three-factor model of symptoms in schizophrenia,^[5] the other factors being reality distortion (involving delusions and hallucinations) and psychomotor poverty (lack of speech, lack of spontaneous movement and various aspects of blunting of emotion).

Presentation

The subtype was named by Hecker as "hebephrenia" ("insanity of youth") after the Greek term for "adolescence" – ἥβη (hḗbē) – and possibly the ancient-Greek goddess of youth, Hebe, daughter of Hera.^[6] The name referred to the ostensibly more prominent appearance of the disorder in persons between the ages of 15 and 25 years).^[7]

The prominent characteristics of the subtype were considered to be disorganized behavior and speech (see formal thought disorder), including loosened associations and schizophasia ("word salad"), and flat or inappropriate affect, and psychiatrists had to have ruled out any possible sign of catatonic schizophrenia. Delusions and hallucinations, as in paranoid schizophrenia, were not, although fleeting and fragmentary delusions and hallucinations are present. Behavioral disorganization, which may impair a sufferer's ability to carry out daily activities such as showering or eating, was also included.^[8] It was considered to have a poor prognosis.^[9]

The emotional responses of sufferers diagnosed with the subtype could seem strange or inappropriate, including inappropriate facial responses or laughter, or contrastingly a complete lack of emotion, including anhedonia (lack of pleasure), and avolition (lack of motivation). The subtype was considered to be one in which these features were more prominent than in other types of schizophrenia.

See also

• Catatonia
• Communication deviance
• Paranoid schizophrenia

References

1. "Event Information - Overview". rcpsych.ac.uk Royal College of Psychiatrists. Archived from the original on 24 June 2021. Retrieved 24 June 2021.
2. Hecker, E. (2009). Hebephrenia: A Contribution to Clinical Psychiatry. (Translated and introduced by A. Kraam.) History of Psychiatry 20: 87–106.
3. Yuhas, Daisy (1 March 2013). "Throughout History, Defining Schizophrenia Has Remained A Challenge (Timeline)". Scientific American. Retrieved 2 March 2013.
4. Sartorius, Norman; Henderson, A.S.; Strotzka, H.; et al. The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines (PDF). World Health Organization. pp. 76, 80–1. Retrieved 23 June 2021 – via who.int.
5. Liddle PF (August 1987). "The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy". Br J Psychiatry. 151 (2): 145–51. doi:10.1192/bjp.151.2.145. PMID 3690102. S2CID 15270392.
6. Athanasiadis, Loukas (December 1997). "Greek mythology and medical and psychiatric terminology" (PDF). The Psychiatrist. 21 (12): 781–782. doi:10.1192/pb.21.12.781.
7. "The very great majority of cases [of dementia præcox] begin in the second or third decade; 57 per cent, of the cases made use of in the clinical description began before the twenty-fifth year. This great predisposition of youth led Hecker to the name hebephrenia, "insanity of youth," for the group delimited by him; Clouston also, who spoke of an " adolescent insanity," had evidently before everything dementia praecox in view. ... Hecker was even inclined to regard the issue of his hebephrenia just as an arrest of the whole psychic life on the developmental stage of the years of puberty. In fact, we find in silly dementia at least many features which are well known to us from the years of healthy development. Among these there is the tendency to unsuitable reading, the naive occupation of the mind with the "highest problems," the crude "readiness" of judgment, the pleasure in catch words and sounding phrases, also sudden changes of mood, depression and unrestrained merriment, occasional irritability and impulsiveness of action. Further the desultoriness of the train of thought, the half-swaggering, boastful, half-embarrassed, shy behaviour, the foolish laughing, the unsuitable jokes, the affected speech, the sought-out coarseness and the violent witticisms are phenomena which in healthy individuals, as in the patients, indicate that slight inward excitement which usually accompanies the changes of sexual development." From Kraepelin, Emil Dementia praecox and paraphrenia, Chapter IX "Frequency and Causes", Chicago Medical Book. Co., (Text), 1919
8. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC. code 295.10 pp314
9. McGlashan TH, Fenton WS (1993). "Subtype progression and pathophysiologic deterioration in early schizophrenia". Schizophr Bull. 19 (1): 71–84. doi:10.1093/schbul/19.1.71. PMID 8451614.

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