- Disorganized schizophrenia, also known as hebephrenic schizophrenia, frequently has a poor prognosis.
- Disturbances in personality may be observed from very early on, and onset often occurs between the ages of 15 and 25.
- The person makes loose associations, jumps from thought to thought, and utters words with no apparent coherence and meaning.
- As within, so without--mental disorganization manifests in the person's physical appearance, which is often disheveled. Bizarre dressing is also another manifestation of the general symptom of disorganized behavior.
Schizophrenia is a serious mental disorder involving a breakdown that drastically affects how a person thinks, feels, and behaves. The disorder has five subtypes, one of which is disorganized schizophrenia. Its very name implies the typical and predominant characteristics by which it is identified: disorganized speech and behavior as well as troublesome problems in emotional expression. Also known as hebephrenic schizophrenia, the disorder frequently has a poor prognosis.
The symptoms of disorganized schizophrenia often begin at an earlier age than those in the other subtypes of schizophrenia do. Disturbances in personality may be observed from very early on, and onset often occurs between the ages of 15 and 25. Also, unlike paranoid schizophrenia in which the person has a distinctive psychotic break at the onset of the illness, disorganized schizophrenia usually develops gradually. It is also the subtype whose symptoms are least likely to subside by significant degrees.
Disorganized schizophrenia is a chronic mental illness of a severe type, according to experts, the reason being that the patient loses her capability to perform normal, daily activities. These daily activities include preparing meals and taking care of personal hygiene, for example, bathing and dressing.
The symptoms of disorganized schizophrenia
1. Disorganization of speech - The disorganization of speech in this disorder is sufficient to interfere with the person's ability to effectively communicate. The person makes loose associations, jumps from thought to thought, and utters words with no apparent coherence and meaning. Schizophasia or "word salad," confused babbling that is often repetitive, is often observed. The person responds inappropriately to questions and may also make up words (neologisms). Sometimes, she may stop suddenly in the middle of speaking, having lost her train of thought (if it may be called a train of thought, given the lack of logical connection between thoughts that commonly characterizes disorganized speech).
2. Disorganized behavior - This is expressed in a number of ways and is a primary reason why the prognosis for disorganized schizophrenia is particularly poor. The person is unable to begin even simple tasks, or if able to begin them, she is incapable of finishing them. Even the most basic daily functions such as personal hygiene become impossible for the schizophrenia sufferer to accomplish on her own. As within, so without--mental disorganization manifests in the person's physical appearance, which is often disheveled. Bizarre dressing is also another manifestation of the general symptom of disorganized behavior. Coherent or logical thoughts cannot be formed by the patient, affecting her speech during conversation. The person is not able to stick to the subject and leaps from one subject to another. The severity of the speech problem may increase so much that the speech is unintelligible garble to the people listening. Disorganized thinking also affects the writing of the patient.
3. Inappropriate behavior - A person with disorganized schizophrenia may become suddenly agitated for no apparent reason, or display actions and reactions unsuitable to given situations. He may also exhibit inappropriate sexual behavior, for example, touching himself in public. If it is a warm sunny day, the person may wear clothes of several layers. People around him may find the behavior bizarre, but to him, it is normal. He may show silly, childlike, and aggressive or even violent behavior.
4. Flat or inappropriate affect - A blunted affect, on one hand, means that either that the person demonstrates blunted or no emotions, or shows emotions that are inappropriate to speech and context. This is seen in the person's tone of voice, mannerisms, and facial expressions. She may speak in a monotonous voice and appear apathetic, expressions greatly diminished or face completely blank. She might not make eye contact with others or display any body language. Inappropriate affect, on the other hand, means that the person shows emotions or exhibits behaviors that are inappropriate to speech and context, such as bursting out in laughter during a serious event.
Other observed symptoms/characteristics
Odd or bizarre behaviors are also often seen in people with disorganized schizophrenia. They may have unusual mannerisms, sit or stand in odd positions, or make strange facial expressions. They are also often withdrawn and unsociable.
Hallucinations and delusions are possible, although not prominent in this subtype of schizophrenia, the way they are in paranoid schizophrenia. (In the latter, hallucinations and/or delusions are the primary symptoms.) Aside from not being a predominant expression of disorganized schizophrenia, the delusions or hallucinations in this subtype do not have any recurring or persistent theme, for example, persecution or religion, unlike those that occur in paranoid schizophrenia.
People with disorganized schizophrenia may feel that they have extraordinary powers and gifts. They have delusions of grandeur. Alternatively, they may have false beliefs of persecution and may even hide to protect themselves. Hearing voices that are not there is very common. To the patient the voices are real.
Social withdrawal - The person with disorganized schizophrenia may feel that somebody is out to harm them, and hence withdraw socially. Another possible reason for social withdrawal is fear of interaction because of poor social skills.
Unaware of illness - Many patients may not believe they are ill, since according to them, the hallucinations and delusions are real. Hence, they may even refuse to take medication.
Cognitive difficulties - The ability of the patient to concentrate, plan ahead, remember things, and organize are all affected. The person finds it difficult to communicate.
Usually, people with disorganized schizophrenia do not get medical help on their own. It is common for them to believe that they are fine and do not treatment once their symptoms subside. However, medical help is always necessary for a person with disorganized schizophrenia, since it does not really go away on its own.
For a case to be diagnosed as disorganized schizophrenia, the patient's symptoms should not meet the criteria for catatonic schizophrenia, another one of the five subtypes of schizophrenia.
The risk factors of disorganized schizophrenia
The factors that increase the likelihood of disorganized schizophrenia do not differ from those of the other subtypes of schizophrenia. Most of them occur or are sustained in the tender phases of a person's life, namely, from conception to his or her early years.
1. Family History/Genetics - An individual whose family has no history of schizophrenia has a less than 1% chance of developing the disorder. Having a parent who had or has schizophrenia increases a child's chances of developing schizophrenia to 10%.
The most studied gene is the schizophrenia gene, which plays a role in the brain. According to some scientists, this gene controls the birth of new neurons and their integration into the brain circuitry. In a Swedish study, it was found that the genetic cause of bipolar disorder and schizophrenia is the same.
2. Fetal malnutrition - Malnutrition of a fetus or baby while it is in the womb increases its chances of subsequently developing schizophrenia.
3. Viral infection - The exposure of a fetus to a viral infection increases the likelihood of its developing schizophrenia later on.
4. Childhood trauma or abuse - This significantly influences a person's risk of developing the disorder.
5. Stress, especially early in life - Great environmental stress, especially that caused by the circumstances of an individual's family and its relationships, is a strong factor influencing the likelihood of the illness in an individual. Severe stress in early life could also be a contributing factor towards the development of this condition. Even before the symptoms are evident, a person with schizophrenia becomes anxious, unfocused, and bad tempered. These symptoms trigger relationship problems, which are then blamed for the onset of the condition, although actually, it may have been the other way around. It can be extremely difficult to know whether the stress caused the condition or the condition caused the stress.
6. Age of parents when the baby is conceived and born - The offspring of older parents have higher chances of developing the illness than those of younger parents.
7. Drugs - The use of psychoactive drugs, that is, drugs that affect the mind and its processes, may increase the chances of the illness developing in adolescents.
Causes and triggers of disorganized schizophrenia
The exact cause of disorganized schizophrenia, or schizophrenia for that matter, has not been clearly determined by experts, although it is widely viewed as the existence of a brain dysfunction stemming from genetic factors and triggered by environmental factors (see risk factors). Changes in key brain functions in a case of schizophrenia point to the brain as the biological situs of the disorder. Furthermore, a number of experts believe that a dopamine imbalance caused by a person's genes is involved in the onset of schizophrenia.
An apt analogy for its development is a switchboard with buttons (an individual's genetic predisposition to the illness) and the pressing of just the right buttons, in the right order (the environmental triggers).
Diagnosis of disorganized schizophrenia
If the doctor suspects disorganized schizophrenia, he will recommend a medical exam and psychological tests. These are done to help with the diagnosis.
Physical exam - The height, weight, heart rate, blood pressure, and temperature of the patient are checked. The doctor listens to the heart and lungs, and checks the abdomen of the patient. On top of these, the doctor will order blood tests to check for drugs and thyroid function.
The DSM (Diagnostic and Statistical Manual for Mental Disorders), published by the American Psychiatric Association, lays out the specific criteria for disorganized schizophrenia. In sum, there must be clear evidence of disorganized speech and behavior, lack of or blunted emotion, and emotions inappropriate to given situations. Also, other possible illnesses whose symptoms may overlap with those of disorganized schizophrenia have to be ruled out.
A psychiatrist will undertake a thorough psychological evaluation and order a brain scan, specifically an MRI or CT scan, to look for abnormalities in the brain's structure, and an EEG to check brain function.
Psychological evaluation- The patient is asked about his thoughts, feelings, and behavior patterns. The psychiatrist and the patient discuss the symptoms, when they started, how frequent and severe, and how they affect the life of the patient. The doctor will also find out whether the patient ever thought about harming herself or others.
It may take time to confirm the diagnosis, as some conditions whose symptoms overlap will have to be ruled out first.
Treatment of disorganized schizophrenia
Because of the drastic development of negative symptoms and decline of mental and social functioning in disorganized schizophrenia, the disorder is often seen as one that has a poor prognosis. It typically requires lifelong treatment, and the chances of drastic improvements in its symptoms are not especially good. Nevertheless, antipsychotic drugs can help control or mitigate some of the symptoms to allow the patient to become more functional. With good results, the patient can be led, through vocational training and other types of therapy, to living a more fulfilling life.
A team of dedicated professionals that includes a case worker, a GP, a pediatrician, a psychiatric nurse, a psychiatrist, a psychotherapist, a pharmacist, and a social worker is needed. Members of the family will also need counseling on how to cope with the patient and the situation.
Medications for disorganized schizophrenia
- Atypical antipsychotic - Psychiatric conditions are treated using second-generation, or atypical, antipsychotic drugs. Atypical antipsychotics are a different form antipsychotic. They are less likely to cause extra-pyramidal symptoms (EPS) such as parkinsonian-type movements such as rigidity and tremors. Side effects of these drugs include weight gain, high cholesterol, and diabetes.
- Typical antipsychotic - These are first-generation antipsychotics. They may cause EPS such as involuntary movements of the face and parkinsonian-type movements.
- Other drugs - Patients with schizophrenia may suffer from depression. Hence, an antidepressant, an anti-anxiety drug, or a mood stabilizer may be prescribed by the doctor.
- Hospitalization - In a hospital, the patient receives proper nutrition and gets better sleep, help, and hygiene. A hospital setting is safer. Partial hospitalization is possible in some cases.
- Psychotherapy - It a series of techniques that helps to treat mental, emotional, and psychiatric disorders. It helps the patient feel positive, accept strong and weak points, and may change their feelings and their ways of thinking.
- Social and vocational skills - This helps the patient become independent, which is very important for recovery. The patient may learn good hygiene, how to prepare nutritious meals, and how to communicate better.
- Compliance - Some patients go off their medication within the first 12 months of treatment. For the treatment to be effective and long-lasting, a life-long course of both drugs and support therapies is needed.
- ECT (electroconvulsive therapy) - in order to reproduce a controlled seizure, an electric current may be passed through the brain of the patient. This can be used for patients whose symptoms are severe, or who are not responding to medication, undergoing a depression, or at a high risk for suicide. In a controlled seizure, there is a massive release of neurochemicals. Side effects of ECT include loss of memory. It is important for the doctor to explain the pros and cons of this treatment.
Complications of disorganized schizophrenia
- If disorganized schizophrenia is left untreated, it may result in serious or severe health, behavioral, financial, and legal problems, all of which will affect the life of the patient and his loved ones.
- Depressions, suicidal thoughts, suicidal behavior – People with schizophrenia have bouts of depression. If untreated, it may worsen and lead to suicidal thoughts and behavior.
- Substance abuse - Included are alcohol, illegal drugs, and prescription medicines.
- Inability to maintain or find a job - This may result in homelessness or poverty. The patient may feel an inability to cope with responsibilities, and so may be unwilling to go back to work. Psychiatrists say that patients who continue working have a better quality of life than those who cease working.
- Being a victim of a crime
- Serious family conflicts
- Being a perpetrator of a crime
- Diseases related to smoking - One thing common in people with schizophrenia is smoking, especially regular heavy smoking. It is believed that this behavior helps their concentration skills. However, it may cause health problems and also interfere with certain medications.