Schizophrenia has wide varieties. It is classified according to the rate of progression, characteristic symptoms, intensity of symptoms, and other characteristics. In all, this pathology affects 0.5-1% of the population. One of its rare subtypes is hebephrenic schizophrenia. It is detected in 5% of patients with similar disorders. We will tell you about the features of hebephrenia and how it occurs, develops, and is treated.
The term “hebephrenic paraphrenia” was first used in 1871 by Ewald Hecker. Describing the disorder, he mentioned that it was “a particular form of terminal dullness, the signs that can recognize in the early stages of the disease. The pathology is named after Geba, the ancient Greek goddess of youth.
Equivalent terms “hebephrenic schizophrenia,” “hebephrenic schizophrenia,” and “hebephrenia” are used today. It is also possible to meet such a term as “disorganized type schizophrenia. It is outdated, but the wording “disorganized schizophrenia” can still be found in the literature.
The main feature of this disease is that the patient behaves childishly, even if he is an adult. His behavior is generally characterized by inadequacy, goofiness, and affectation. Sometimes it is ridiculous and obscene. The patient constantly giggles, smugly smiles, grimaces and pranks.
The onset of the pathology usually occurs between the ages of 15 and 25. Often it affects residents of large cities. The frequency of development in women and men is about the same. The disease is not shared. In its pure form, without signs of other forms and types of schizophrenia, it is observed only in 5% of patients.
The schizophrenic defect in hebephrenia develops rapidly, progresses rapidly, and is challenging to treat. The patient will probably lose his purpose in life, and his existence becomes meaningless.
Hebephrenic Schizophrenia Causes
Doctors name several causes that hypothetically could lead to or provoke hebephrenia:
- Genetic abnormalities;
- Fetal hypoxia;
- Intrauterine infections;
- Childhood psychological trauma.
These are disposing of factors. It is difficult to call them direct culprits, as their presence only increases the risk of developing the hebephrenic form of schizophrenia. The impetus for the appearance of the first signs can be:
- Child abuse;
- An unhealthy family environment;
- Constant stress;
- Bullying at school;
- Brain disease of different etiologies;
- Alcohol and drug use.
Medical practice shows that patients with hebephrenia as infants are underweight, have a low IQ, and have strong involuntary reactions to stimuli.
Also, children who are later diagnosed with hebephrenic schizophrenia are different:
- Persistent antisocial traits;
- Overly exemplary behavior;
- Dependence on adults;
- Unwillingness to do intellectual work;
- General lethargy and passivity.
In addition, patients with hebephrenia have early sexual intercourse, trouble with the law, and other antisocial behaviors. They are prone to rebellion, disobedience, and drug and alcohol use. In other words, they behave defiantly.
Hebephrenic Schizophrenia Symptoms
The onset of the illness is difficult to distinguish from bad or rude behavior. The sick person fools around, make jokes, and says silly things. But outsiders should be alert to the complete lack of logic in his words and actions. He also often complains about various illnesses, which indicates hypochondria. Sometimes the person is aggressive. In general, his mood is excessively elevated but often changes into apathy.
The main symptoms of hebephrenic schizophrenia:
- Disorganized thinking. The patient cannot formulate and logically justify his thought. Because of this, he jumps from one topic to another, unable to stop at one thing. Sometimes, his speech is so confusing and unclear that others perceive it as a collection of sounds.
- Disorganized behavior. A patient with hebephrenia may move about constantly as if he has nowhere to put his hands. He puts his hands behind his head, adjusts his socks, scratches, taps his fingers on the table, etc. In severe cases, he cannot perform routine daily activities such as bathing, shaving, and dressing. Some patients have childish and silly behavior, but sometimes they behave aggressively.
- Sexual deviation. It involves displaying genitals and defecating in public places. Also, those with hebephrenia like to make obscene jokes at the level of an eighth-grader who giggles in biology class. The sexual topic is exciting for the patient, just like any child during puberty.
- Inadequacy of emotion. The patient may be both overexcited and highly apathetic. Sometimes his face shows no emotion as if he does not feel anything. But he may laugh out loud at any time, wherever he is, such as in class or at an important event.
- Delusions. In hebephrenic schizophrenia, the person may be at the mercy of false beliefs, which form like delusions. He thinks he is a great person, or someone is constantly chasing him.
- Self-isolation. Gradually, the amount of contact with people decreases. The patient interacts less and less with those around him, including loved ones. Not only does the lack of interest on the part of the patient, but also poor social skills get in the way.
- Unconsciousness. In this case, we are talking about the fact that the patient does not consider himself sick. At the same time, he can easily explain his condition or stay in the clinic: “my parents wanted me to,” “the doctor advised me,” “the pills make me a fool,” etc.
The patient’s relatives often go to the doctor because the latter considers himself “normal.”
Delirium and hallucinations, typical features of almost any schizophrenia, may be absent in hebephrenia.
Severe catatonic and manic syndromes, delirium, hallucinations, and severe hypochondria are observed in severe forms. Symptoms such as depersonalization and derealization may be recorded when the world around seems unreal. Foolishness changes to apathy, and speech becomes increasingly feeble and primitive over time. Some patients become heavily involved in religion, philosophy, or a narrower topic like the subway.
In hebephrenic schizophrenia, the patient feels no shame and has no sense of responsibility or caution. He may behave defiantly, ask tactless questions without expecting an answer, giggle and use foul language. Almost invariably, such patients laugh at their jokes. Their laughter seems unnatural, childish, and affected.
A typical example is the development of hebephrenia in a 14-year-old adolescent. Until this age, he was diligent and obedient and did well at school,
he was brought up in a family without any relatives with mental disorders. During puberty, his behavior deteriorated.
The patient stopped attending school, hung around town, undressed and molested passers-by, and began smoking and drinking alcohol. He categorically refused to take hygienic procedures, was often rude, showed his genitals to others, and attempted to defecate in the middle of the room. He was forcibly hospitalized.
Another example is a 19-year-old boy. I came to the clinic with the typical symptoms of hebephrenia described earlier. During the conversations with the doctor, he constantly made faces and periodically inserted obscene jokes into his speech. On the whole, he reasoned relatively typically. He remembered dates and talked passionately about the subway system. When trying to remember all the stations, he got confused. The doctor tried to move the conversation to another topic, but the patient showed aggression.
See Also: What is Psychopathic Schizophrenia?
The patient thought that the state was paying him a minimal disability allowance and that the pills were making him “a fool. During the conversation with the doctor, he was always moving his arms and fidgeting in place. Demonstrating the behavior of a 10-year-old child. When asked “why is he in the clinic?” he answered that he was “crazy.”
The third example was a 16-year-old teenager. He was raised by his mother, a very suspicious woman. One of his relatives was treated in a psychiatric hospital. He normally developed until he was 12. He was good at school, was remarkable for his curiosity, and had a good school record.
However, suddenly the teenager became rude and disobedient. At the age of 14, he began to develop physically very quickly. He began to show signs of sexual deviation. He began to consider himself a freak, spent a lot of time making out in front of the mirror, and was addicted to gambling.
As time passed, he became more and more undisciplined, and hypochondria developed, forbidding his mother to touch food as he feared infection. He was hospitalized at 16 from the street while walking around naked.
Hebephrenic Schizophrenia Diagnosis
To make an accurate diagnosis of hebephrenic schizophrenia, the patient would have to be observed in the hospital for several weeks or months, depending on the patient’s condition. Typically, the question of hebephrenia comes up when the goofiness does not go away within a month of the first day of observation. The following criteria are also used:
- There is no overt delirium and hallucinations;
- There is a speech disorder;
- There are signs of nonsensical behavior.
It is essential to make a differential diagnosis. First, frontal lobe brain tumors, infectious inflammations, dementia with Pick’s disease (atrophy of brain structures), and Huntington’s chorea (a nervous system disease) should be excluded. A CT scan, MRI, EEG, and ocular fundus examination are prescribed for this purpose.
When schizophrenia is suspected, relatives’ medical history is always checked since this pathology is often genetically conditioned.
Second, it is necessary to differentiate hebephrenic schizophrenia from hebephrenic syndrome, which can develop both within schizophrenia and as a separate disease in the background of epilepsy. The syndrome proceeds with hallucinations, delirium, and catatonia and is also characterized by the following signs:
- Contraction of facial muscles, grimacing;
- Lack of motive in actions;
- Unexplained euphoria, high spirits.
The syndrome can lead to the development of schizophrenia or arise from its background, but it is not obligatory. It all depends on how early treatment began.
Thirdly, it is necessary to distinguish hebephrenia from hybrid psychopathy, which has similar signs but proceeds in a milder form.
Hebephrenic Schizophrenia Treatment
Therapy includes three directions: controlling symptoms, stabilizing the condition, and prolonging remission. The patient has been prescribed neuroleptics and other drugs to eliminate symptoms. In extreme cases, insulin-comatose therapy is carried out based on artificially putting a person into a hypoglycemic coma.
Stabilizing treatment of hebephrenic schizophrenia is aimed at consolidating the result after stopping therapy. For this purpose, antipsychotic agents are prescribed in minimal dosage. If there is a catatonic syndrome, large doses of tranquilizers are administered intravenously.
The patient stays in the hospital during treatment. He may be discharged later but must take neuroleptics permanently. The patient’s status is maintained permanently. The main task is to prolong remission. Individual work continues with the person. He visits a psychotherapist and sometimes goes to group sessions. Nursing assistance is essential. Specially trained caregivers and nurses deal with such patients.
At the same time, there are conversations with relatives who need to be taught how to communicate appropriately with schizophrenic patients. The problem is that any factor can provoke a new attack, even a minor one, such as a small argument, the conflict between spouses, divorce, etc.
In general, after successful therapy, it is possible to achieve the following effects:
- Prolongation of remission;
- An increase in the capacity for work;
- A return of interests;
- A decrease in aggression;
- Improvement in the quality of life.
If necessary, the doctor will lower or increase the dose of the medication.
The forecast for hebephrenic schizophrenia is disappointing. The chances of a positive outcome are minimal. In addition, this pathology develops rapidly. Treatment, as a rule, begins at the moment when the patient is at the stage of substantial aggravation.
Show the patient to a specialist much earlier – at the appearance of the first changes in behavior, especially in cases where a severe contrast is observed. So, if the teenager has always been obedient and was good at school but suddenly became rude to everyone and dropped out, it is recommended to see at least a psychologist.
However, even with treatment at an early stage, the effect is often temporary. It becomes increasingly difficult for the patient to control his outbursts of anger. He gradually withdraws into himself and loses touch with the outside world. Two to three years after the onset of the disease, an irreversible defect in the emotional and volitional qualities sets in. You must isolate the person from society forever, as he is a danger to himself and others.
The only thing that can do is to maintain the remission phase for as long as possible. But in most cases, relapse is unavoidable since the pathology leads to severe destruction of the brain. At the same time, the second relapse will be more severe than the first.
The complication of hebephrenic schizophrenia can be of two types. The first is the disintegration of the personality and withdrawal into oneself. The person’s life loses any sense. This variant is described above.
The second group of complications is connected with the period of pathology development before hospitalization. Because of the patient’s hypersexuality, irresponsibility, and aggressiveness, and also because of the lack of a sense of shame, the following variants of developments are possible:
- Violation of the law (theft, sexual abuse, etc.);
- Alcohol abuse and drug use;
- Dismissal from work, dropping out of school;
- Disorderly sexual contacts;
- Suicide attempts.
Convincing the patient to see a therapist is difficult. Specialists advise involving people who are authority figures for the child. Perhaps he will listen to them. If there are none, call the doctor at home. Experienced doctors know how to persuade such patients to be examined. Otherwise, the person will be hospitalized forcibly after committing a crime or attempting suicide.