HEBEFRENIC

SCHIZOPHRENI
A
By:
Aisyah Rizki Nirmala Hanum
Palmalina Anggita Swasti
Husna Iman Novira

DEFINITION
known as disorganized schizophrenia
a form of schizophrenia characterized by severe disintegration of

personality including erratic speech and childish mannerisms and bizarre

behavior (Princeton University, 2012)

SYMPTOMS
There are three prominent symptoms :
Disorganized speech when responding to a question, the person may give

an answer which has little or no relevance to the question. It often experience

something known as thought blocking. They may stop suddenly while talking,
as if the thought abruptly left them

Disorganized behavior unable to or lacks the motivation to start or carry

out a given task, such as preparing a meal or getting dressed. Their behavior
may be bizarre, such as wearing layer upon layer of clothing in the middle of
summer

Blunted or inappropriate emotional expression and response A person

will often appear to have no emotions. His/her face may look completely blank,
and his/her speech may be monotone, at times may have an emotional response
such as laughing or giggling suddenly, when nothing funny has occurred

HOW TO
DIAGNOSE

SCHIZOPHRENIA
HEBEPHRENIC
Hebephrenic schizophrenia tends to have an earlier onset
than the other subtypes and tends to develop very insidiously.
Although delusions and hallucinations are present, they are
relatively minor, and the clinical picture is dominated by
- bizarre behavior
- loosened associations, and
- bizarre and inappropriate affect.
Overall the behavior of these patients seems at times a caricature of childish
silliness. Senselessly they may busy themselves first with this, then with that,
generally to no purpose, and often with silly, shallow laughter. At other times they
may be withdrawn and inaccessible. Delusions, when they occur, are unsystematized
and often hypochondriacal in nature. Some may display very marked loosening of
associations to the point of a fatuous, almost driveling incoherence

 A doctor must make a diagnosis of schizophrenia on the basis of a standardized list of

outwardly observable symptoms, not on the basis of internal psychological processes.

There are no specific laboratory tests that can be used to diagnose
schizophrenia. Researchers have, however, discovered that patients with schizophrenia
have certain abnormalities in the structure and functioning of the brain compared to
normal test subjects. These discoveries have been made with the help of imaging
techniques such as computed tomography scans (CT scans).

When a psychiatrist assesses a patient for schizophrenia, he or she will begin by

excluding physical conditions that can cause abnormal thinking and some other behaviors
associated with schizophrenia. These conditions include organic brain disorders
(including traumatic injuries of the brain), temporal lobe epilepsy, Wilson's
disease, prion diseases, Huntington's chorea, and encephalitis. The doctor will
also need to rule out heavy metal poisoning and substance abuse disorders, especially
amphetamine use.

After ruling out organic disorders, the clinician will consider other psychiatric conditions

that may include psychotic symptoms or symptoms resembling psychosis. These

disorders include mood disorders with psychotic features; delusional disorder;
dissociative disorder not otherwise specified (DDNOS) or multiple personality disorder;
schizotypal, schizoid, or paranoid personality disorders; and atypical reactive disorders. In
the past, many individuals were incorrectly diagnosed as schizophrenic. Some patients
who were diagnosed prior to the changes in categorization should have their diagnoses,
and treatment, reevaluated. In children, the doctor must distinguish between psychotic
symptoms and a vivid fantasy life, and also identify learning problems or disorders.

 After other conditions have been ruled out, the patient must meet a set of criteria

specified:

the patient must have two (or more) of the following symptoms during a one-month period:
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms
- decline in social, interpersonal, or occupational functioning, including self-care
the disturbed behavior must last for at least six months
- mood disorders
- substance abuse disorders
- medical conditions, and developmental disorders have been ruled out

TREATMENT

TREATMENTS
Because the causes of schizophrenia are still unknown, treatments focus on

eliminating the symptoms of the disease. Treatments include antipsychotic

medications and various psychosocial treatments.

Antipsychotic medications
Antipsychotic medications have been available since the mid-1950's. The older

types are called conventional or "typical" antipsychotics. Some of the more

commonly used typical medications include:

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Perphenazine (Etrafon, Trilafon)
Fluphenazine (Prolixin).

Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples
include:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)

Side effects of many antipsychotics include:

Drowsiness
Dizziness when changing positions
Blurred vision
Rapid heartbeat
Sensitivity to the sun
Skin rashes
Menstrual problems for women.

Psychosocial treatments
Psychosocial treatments can help people with schizophrenia who are already

stabilized on antipsychotic medication. Psychosocial treatments help these

patients deal with the everyday challenges of the illness, such as difficulty with
communication, self-care, work, and forming and keeping relationships.

Rehabilitation. Rehabilitation emphasizes social and vocational training to

help people with schizophrenia function better in their communities. Because

schizophrenia usually develops in people during the critical career-forming
years of life (ages 18 to 35), and because the disease makes normal thinking
and functioning difficult, most patients do not receive training in the skills
needed for a job.

REFERENCES
Lane, Cheryl. 2012. Schizophrenia.
Andreasen NC. Negative symptoms in schizophrenia : definition and

reliability. Archives of General Psychiatry 2002;39:784788.

Barta PE, Pearlson GD, Powers RE, et al. Auditory hallucinations and

smaller superior temporal gyral volume in schizophrenia. The American

Journal of Psychiatry 1990;147:14571462.

Black DW, Boffeli TJ. Simple schizophrenia : past, present and future. The

American Journal of Psychiatry 2009;146:12671273.

Byne W, Buchsbaum MS, Mattiace LA, et al. Postmortem assessment of

thalamic nuclear volume in subjects with schizophrenia. The American

Journal of Psychiatry 2002;159:5965.

 U.S. Department of Health and Human Services

National Institutes of Health

NIH Publication No. 12-3679
Revised 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

NIH Publication 09-3517
Revised 2009