Disorganized schizophrenia

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Disorganized schizophrenia
Other namesHebephrenic schizophrenia, hebephrenia
Specialty Psychiatry

Disorganized schizophrenia, or hebephrenia, is an obsolete term for a subtype of schizophrenia. It is no longer recognized as a separate condition in DSM-5 and ICD-11, published in 2013 and 2022, respectively. [1] It was originally proposed by the German psychiatrist Ewald Hecker in the 1870s. [2] [3]

Contents

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). It is considered to have relatively poor prognosis. [6]

Presentation

The subtype was named by Ewald Hecker as hebephrenia, [7] meaning "insanity of youth" after the Greek term for "adolescence" – ἥβη (hḗbē) – and possibly Hebe, the goddess of youth from the Greek mythology. [8] The name referred to the ostensibly more prominent appearance of the disorder in teenagers and young adults. [9]

The prominent characteristics of the subtype were considered to be disorganized behaviour and speech (formal thought disorder), which may include loosened associations and schizophasia ("word salad"), flat or socially inappropriate affect, mannerism, and behaviour. Inappropriateness refers to the quality of an action that, when considering the circumstances under which it is performed, is perceived by social norms to be awkward, offensive or otherwise unacceptable. Delusions, hallucinations and behavioural disorganization may also be present; the lattermost describes one's impaired ability to carry out normal daily activities. [10]

The emotional responses of sufferers diagnosed with the subtype could seem strange or inappropriate, including inappropriate facial expression 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

References

  1. ↑ "Event Information - Overview". rcpsych.ac.uk Royal College of Psychiatrists . Retrieved 24 June 2021.{{cite web}}: CS1 maint: deprecated archival service (link)
  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. 1 2 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. ↑ 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.
  7. ↑ "The legacy of Ewald Hecker: a new translation of "Die Hebephrenie". Translated by Marie-Louise Schoelly" . American Journal of Psychiatry. 142: 1265–1271. November 1985. doi:10.1176/ajp.142.11.1265.
  8. ↑ 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.
  9. ↑ "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
  10. ↑ American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC. code 295.10 pp314
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