Disorganized schizophrenia

Alternative names 
Hebephrenic schizophrenia; Schizophrenia - disorganized type

Definition
Disorganized schizophrenia is a type of schizophrenia characterized by disinhibited, agitated, and purposeless behavior.

Causes, incidence, and risk factors

As with all types of schizophrenia, the cause is unknown. The onset of this subtype of schizophrenia usually occurs in late adolescence or early adulthood - before age 25. A family history of depression or psychosis increases the likelihood of having the disease.

People with this form of schizophrenia are more likely than others to misuse substances such as alcohol and street drugs. They are particularly likely to become chain-smokers.

Symptoms

Delusions (false, fixed beliefs) and hallucinations (sensory perceptions without a source) are common in disorganized schizophrenia. Emotional responses of people with this condition are often bizarre and inappropriate. Lack of emotion and motivation, as well as the inability to feel pleasure, may occur with this condition.

Some of these symptoms are also seen in other types of schizophrenia. The characteristic distinction is erratic behavior, with ungrammatical or random-ordered speech.

Patients with disorganized schizophrenia are usually active but in an aimless, nonconstructive manner. Inappropriate grinning and grimacing are common. Behavior is sometimes described as silly or fatuous.

Signs and tests

Diagnosis is made from psychiatric evaluation, physical examination, and laboratory tests. Other causes of these symptoms must be ruled out.

Treatment

Treatment consists of anti-psychotic medications. Newer medications such as olanzapine, risperidone, and clozapine may be effective with fewer side effects. Sometimes, a patient needs acute hospitalization for safety, and for faster relief of symptoms.

Expectations (prognosis)

This is a chronic illness, and recurrence of symptoms is common. However, good management and return of function is possible. Involving the patient’s family in the treatment process can be very helpful for the patient and the treatment team.

At times, patients with this condition stop taking their medications. This occurs either because the side effects are unpleasant, or because patients believe they are cured and no longer require the medication. However, the treatment team can address these concerns with the individual patient, rather than discontinuing the medications altogether.

Family members and community psychiatric services can help ensure that medications are taken appropriately and that side effects are tolerable. The newer medications are far less likely to cause disturbing side effects.

Complications

Suicide and self-harm are possible serious Complications, as is loss of ability to work and function socially. Drug abuse is a major risk, and is found at a higher rate in patients with schizophrenia.

Calling your health care provider

Call your doctor if you or a loved one is experiencing symptoms of psychosis.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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