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Hebefrenic Schizophrenia

By:
Wulladah Nur Jihan
Tasya Felicia Macellin
Azilu Fala biba rusda
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 At other times they may be withdrawn and inaccessible.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;39:784–788.
• Barta PE, Pearlson GD, Powers RE, et al. Auditory hallucinations and
smaller superior temporal gyral volume in schizophrenia. The American
Journal of Psychiatry 1990;147:1457–1462.
• Black DW, Boffeli TJ. Simple schizophrenia : past, present and future. The
American Journal of Psychiatry 2009;146:1267–1273.
• Byne W, Buchsbaum MS, Mattiace LA, et al. Postmortem assessment of
thalamic nuclear volume in subjects with schizophrenia. The American
Journal of Psychiatry 2002;159:59–65.
• 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

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