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Diseases and Conditions
Special to CNN.com
Schizophrenia is a chronic mental illness that causes altered perceptions of the world. Subsequently, a person with schizophrenia often responds to events and people in ways that make little sense to others.
Disorganized schizophrenia, also known as hebephrenic schizophrenia, is a subtype of schizophrenia. People with disorganized schizophrenia display disorganized thinking, grossly disorganized behavior, and absent or inappropriate emotional expression. The disease significantly disrupts a person's ability to function in regular daily activities and interactions with other people.
Schizophrenia usually appears in men in their teens or 20s and in women in their 20s or early 30s. Disorganized schizophrenia tends to begin at the younger end of this age range.
Although there's no cure for disorganized schizophrenia, medications and well-coordinated mental health care services may help people manage the disease.
Signs and symptoms
Early signs and symptoms of schizophrenia — such as social withdrawal, unusual behaviors, anxiety and decline in daily functional abilities — may begin gradually before the primary symptoms of schizophrenia, known collectively as psychosis, are manifested. But disease onset may also be acute with the sudden appearance of psychosis.
The distinguishing psychotic features of disorganized schizophrenia include:
- Disorganized thinking. When people experience disorganized thinking, they can't form logical and coherent thoughts. This impairment is also evident in people's speech patterns. They may not be able to stay on track, their speech may "wander aimlessly" through a topic, or they may jump from one unrelated idea to another. These speech patterns are severe enough to render the speech virtually unintelligible. If the thinking is severely disorganized, a person may speak in ungrammatical phrases or use made-up words. These same patterns are evident in written communication.
- Grossly disorganized behavior. As the word "grossly" suggests, the disorganized behavior of schizophrenia is severe and causes significant impairment in a person's ability to function in regular daily activities. Examples of such behaviors include childlike silliness, sudden displays of agitation (swearing or shouting "out of the blue"), wearing many layers of clothes on a warm day, inappropriate sexual behavior in public, urinating in public and neglecting personal hygiene.
- Absent or inappropriate emotional expression. When people show a complete absence of emotional expression (flat affect), their faces seem blank. They don't make eye contact or display observable body language. Although a person with flat affect may occasionally show some emotion, the range of expressions is usually very limited. Sometimes people with disorganized schizophrenia express emotions that are inappropriate to the situation, such as laughing when something bad happens.
Additional signs and symptoms
While the prominent signs and symptoms of disorganized schizophrenia are related to thought processes, behaviors and emotions, people with this subtype of schizophrenia may exhibit other psychotic behaviors:
- Hearing voices or experiencing other sensory events that aren't real (hallucinations)
- Holding untrue beliefs about reality (delusions)
- Little verbal communication with other people
- Inability to initiate plans
If hallucinations and delusions do occur, they tend not to be organized into coherent themes, as they tend to be in other forms of schizophrenia. People with disorganized schizophrenia generally do not display symptoms known as catatonic behaviors — physical immobility or excessive mobility with no purpose.
The other subtypes of schizophrenia include catatonic, paranoid and undifferentiated schizophrenia.
Most researchers believe that schizophrenia results from problems with early brain development. Studies have focused on the way brain cells communicate with each other through nerve pathways. Too many or too few connections in the important pathways of emotional regulation may lead to psychotic symptoms. More specifically, certain areas of the brain that are rich in the chemical dopamine seem to be affected most often in schizophrenia.
The contributing factors associated with the development of these brain-pathway problems are controversial and are being carefully investigated. Some of the areas of current research include risk-associated genes, exposure to certain viruses or malnutrition in the womb, and stressful childhood environments in genetically susceptible children.
When to seek medical advice
A person with disorganized schizophrenia isn't likely to seek treatment. If you believe a family member or friend is exhibiting signs of disorganized schizophrenia, help that person seek medical care.
Screening and diagnosis
There are no blood or brain-imaging tests that can be used to make a diagnosis of schizophrenia. A doctor makes a diagnosis of disorganized schizophrenia when:
- Prominent manifestations of the disease are disorganized thinking, grossly disorganized behaviors, and absent or inappropriate emotional expression
- Catatonic behaviors are either nonexistent or mild
- Symptoms can't be attributed to another medical or psychiatric disorder
Diagnosis of any schizophrenia subtype may change. Although the disorganized symptoms may dominate the picture at the time of initial assessment, other symptoms may appear and become prominent during the course of the disease.
Disorganized schizophrenia is a chronic disease. While episodes of symptoms may vary in intensity and duration, people with the disorder don't return to their previous functional abilities without treatment. It can often be managed with coordinated treatments, including:
- Antipsychotic medications that may prevent the recurrence or lessen the intensity of psychotic episodes
- Individual psychotherapy that supplements drug treatment
- Family or group therapy
- Training in social and vocational skills
People with disorganized schizophrenia are more likely to abuse alcohol or drugs than are those with other schizophrenia subtypes. They are especially likely to be heavy smokers. In addition to its associated health risks, substance abuse can exacerbate the symptoms of schizophrenia, lead to risky behaviors in order to procure substances, and disrupt treatments or other interventions. Smoking, in particular, may counter the effect of antipsychotic medications.
To address these issues, people with disorganized schizophrenia may need access to social service programs, long term care in a supervised setting or hospitalization.
Organizations such as the National Schizophrenia Foundation and the National Alliance on Mental Illness facilitate support groups for people with schizophrenia and their family members. People in these groups can learn about schizophrenia, develop coping skills, find encouragement to stay on treatment plans and experience a sense of community.
People with disorganized schizophrenia may depend on the help of family members or friends to take medications as directed and keep doctor appointments. These care partners can also watch for unusual behaviors or possible relapses that require immediate assessment and care.
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