Disorganized schizophrenia was classified up to ICD-10[4] as a mental and behaviouraldisorder,[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.
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 (formal thought disorder), which may include loosened associations and schizophasia ("word salad"), flat or socially inappropriate affect, 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. Examples in disorganized schizophrenia may include repetitive behavior such as stimming, grimacing, joking, mirror gazing, health complaining, utterance of profanity, exposing one's body in public spaces, inappropriate body contact, and urination outside socially acceptable areas (bathrooms).[8]
Delusions and hallucinations, seen in paranoid schizophrenia, were not,[clarification needed] 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.[9]
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.
There may also be cognitive impairement and irritability and impulsivity.
↑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. PMID3690102. S2CID15270392.
↑"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, EmilDementia praecox and paraphrenia, Chapter IX "Frequency and Causes", Chicago Medical Book. Co., (Text), 1919
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