Hebephrenic syndrome is a psychopathological symptom complex characterized by the presence of childishness and foolishness in behavior. It is manifested by buffoonery, grimacing, emotional inadequacy, unreasonably high spirits, lack of purposefulness, and situational actions. Patients laugh loudly and for no reason, grimacing, rolling on the floor, absurdly joking, uncritical of their behavior. Diagnosis is carried out by clinical and psychodiagnostic methods. Medical treatment aimed at relieving symptoms may include antipsychotics, tranquilizers, insulin preparations, and other agents.

 

General information

The name of the syndrome comes from the ancient Greek language, which means “childish, youthful mind”. For the first time, the pathology was described in 1871 and isolated as a separate disease – hebephrenic paraphrenia. Doctors later began to view it as a variant of dementia and then as a form of malignant schizophrenia, rapidly leading to cognitive deficits. The epidemiological peak is observed in adolescence – at the age of 14-19, sharply decreases by the age of 25. At a later age, cases are rare. Among patients with schizophrenia, the prevalence of the syndrome is 4.5-6%. There is a gender predisposition – young men are more prone to hebephrenia.

hebephrenic syndrome

Causes of the Hebephrenic Syndrome

Hebephrenic syndrome often occurs in schizophrenia. This form of the disease is characterized by the onset of adolescence and the progressive development of cognitive and personality disorders. Less commonly, the syndrome is determined in patients with epilepsy, reactive, intoxication, and psychoses associated with organic brain damage. Predisposing factors for hebephrenia are:

 

  • Hereditary predisposition. The likelihood of the syndrome increases with a burdened history. Hebephrenic schizophrenia is often diagnosed in adolescents whose close relatives have a history of endogenous psychosis.
  • Organic lesions of the central nervous system. In rare cases, hebephrenia develops as a result of degenerative processes, injuries, and neoplasms in the brain. Inorganic epilepsy, temporal localization of the focus is characteristic.
  • Psychogenic adverse factors. Childhood trauma and stressful living conditions of a child or adolescent become triggers for the appearance of schizophrenic symptoms. The debut of the hebephrenic syndrome often coincides with the loss of a parent (divorce, death), a change of place of residence, and maladaptation in the school community.
  • Psychobiological features. A causal relationship of premorbid qualities with the onset of the syndrome is possible. It has been established that hebephrenia is preceded by antidisciplinary, asocial, and criminal behavior, early puberty, and homosexual experience in adolescents.

 

Pathogenesis of Hebephrenic Syndrome

The hebephrenic syndrome is based on deviations in the functioning of brain structures responsible for planning and controlling complex behavior, the manifestation of emotions, and the processing of multimodal information. Puberty becomes a critical period in relation to the stabilization of interneuronal connections. The manifestation of the syndrome occurs under the influence of endogenous and exogenous stress factors that cause a state of decompensation of the corresponding underdeveloped (dysontogenetic) or damaged functions.

 

Symptoms of the hebephrenic syndrome

One of the main characteristics of hebephrenia is its early onset. In most cases, the debut falls on adolescence. Reactive, organic, intoxication psychosis, epilepsy, and hebephrenic syndrome can develop at any age. Patients are distinguished by an increased background mood and foolishness of behavior. Unproductive euphoria is characterized by unreasonable fun, extraordinary brightness, and inadequacy of affective reactions, loss of nuance, impoverishment of emotions.

Patients are incapable of compassion, they are indifferent to problems and tragic events in the family, at school, and work. Patients’ actions are not related to impulsivity or delusions. Behavior has no motives or purposefulness and is determined by the situation and momentary inclinations. Patients perk up at the attention of others, and demonstrate mannerisms, grimacing, teasing, grimacing, laughing, and somersaulting. Hypersexuality is uncontrollable, and exhibitionism and demonstrative masturbation are noted.

Appetite increased, with frequent bouts of gluttony. The regression of behavior is accompanied by a return to children’s actions and skills. Patients refuse to sit at the table during dinner, scream, take food with their hands, or scatter it. When remarked and punished, they scream, squeal, growl, throw themselves on the floor, and become aggressive and vicious. Speech is loud, incoherent, and broken. Patients “slide” from one topic to another, cannot purposefully conduct a conversation, often answer inappropriately, and ask inappropriate and tactless questions. In the structure of the hebephrenic syndrome, depressive, delusional, hallucinatory, and catatonic disorders can be noted. Against the background of schizophrenia, the course is progressive, continuous, and malignant. Prolonged remission and seizures are unusual for this disorder.

 

Complications of Hebephrenic Syndrome

In hebephrenic schizophrenia, the pathology has a progressive course, leading to intellectual and emotional-volitional regression, and the development of the catatonic-hebephrenic and catatonic syndrome. Within 2-3 years from the moment of manifestation of symptoms, an oligophrenic-like defect with elements of dysontogenesis is formed. Patients are socially maladapted, unable to perform household tasks, and need constant care. As a rule, they confirm the second (rarely the first) group of disabilities.

 

Diagnostics of Hebephrenic Syndrome

When diagnosing hebephrenic syndrome, a psychiatrist draws attention to the presence or absence of three components: motor-volitional changes (grimacing, foolishness), emotional inadequacy, and paralogical thinking disorders. Delusions and hallucinations may be present but are inclusive. Methods of examination of the patient are:

  • Observation. The patient’s behavior and emotional reactions are monitored over several weeks of the hospital stay. Non-observance of regime requirements, disregard for discipline, and increased and unstable background mood are noted.
  • Conversation. The psychiatrist conducts a questioning of relatives: and clarifies the anamnestic data, the time of the onset of symptoms, their severity, and completeness. When talking with the patient, he reveals the fragmentation and duality of thinking, “slippage”, lack of purposefulness of speech, and loss of melodious pronunciation.
  • Psychodiagnostics. The psychologist examines the patient’s cognitive functions, and emotional and personal characteristics (in the absence or small depth of the defect). Severe amorphousness, inconsistency, ataxia of thinking, instability of attention, distractibility, and inability to concentrate on the task, and to learn the instruction are determined. In the personality complex, manic, hysterical, and schizoid traits are found.

It is important to distinguish between hebephrenic syndrome and similar behavioral changes in tumor neoplasms of the frontal parts of the brain, and dementia in the background of Huntington’s and Pick’s disease. For this purpose, differential diagnostics are carried out: examination by an ophthalmologist (identification of changes in the fundus), neurological examination, EEG, CT, and MRI of the brain.

 

Treatment of the hebephrenic syndrome

Effective treatments for hebephrenia continue to be explored. Existing therapy methods aim to eliminate behavioral, emotional disorders, and hallucinatory-delusional symptoms. The selection of medications, dosage, and duration of administration are determined by the psychiatrist individually. Insulin therapy, hyper vitamin therapy, tranquilizers, and antipsychotic drugs may be prescribed. To maintain a stable state, a combination of prolonged antipsychotics and lithium carbonate is used, this combination helps to prevent uncontrolled behavioral symptoms, in particular aggression.

 

Hebephrenic Syndrome Forecast and prevention

The prognosis of hebephrenic syndrome depends on the course of the underlying disease. In patients with schizophrenia, timely and regular treatment can slow down the regression and increase the duration of an active social life. In toxic, organic, and reactive psychosis, successful therapy contributes to the complete elimination of symptoms. For patients with epilepsy, the prognosis is determined by the effectiveness of seizure relief. Prevention of the syndrome is reduced to the prevention of diseases based on which it manifests itself. For children and adolescents predisposed to the development of schizophrenia, it is necessary to create conditions in which the likelihood of stress and psychological trauma is minimal. It is necessary to develop an upbringing tactic that promotes the formation of a stable system of generally accepted values, preventing the development of asocial and antisocial behavior.