Throughout history, schizophrenia has been one of the most feared and misunderstood mental illnesses. It has been confused with multiple personality disorder, autism, dementia, and other conditions. Attempts to treat it have included inducing severe fevers, injecting sulphur or oil, lobotomies, immersion in ice water, being forcibly confined to bed, and long-term institutionalization. In recent years, scientists and doctors have come to understand much more about schizophrenia and disorganized schizophrenia in particular.
Instead of fearing and stigmatizing it, we are working towards better treatment options and ways to help those with any mental health conditions to lead full lives. This article will help others to understand one subtype of schizophrenia, known as disorganized schizophrenia. Of the 3.2 million Americans who have schizophrenia, the majority of them do not have the disorganized type. However, it may be the most severe subtype.
What Is Disorganized Schizophrenia?
Also known as hebephrenia, disorganized schizophrenia used to be considered one of five subtypes of schizophrenia. However, in the more recent versions of the Diagnostic and Statistical Manual, the subtypes are not used. The American Psychiatric Association made this change in 2013 after deciding that having separate subtypes was not helpful in diagnosing patients.
Instead, schizophrenia is classified as a spectrum disorder that can include symptoms of any of the former five subtypes. Disorganized schizophrenia is still recognized in the International Statistical Classification of Diseases and Related Health Problems. It often manifests for the first time when a person is between the ages of 15 and 25. People who begin to have symptoms of disorganized schizophrenia at an early age tend to be effected by it more severely than people who develop it in adulthood. Disorganized schizophrenia is a lifelong disorder. With treatment and time, symptoms may improve, but the disorder will always be there.
What Are the Causes?
Scientists are not completely sure what causes schizophrenia, but there do seem to be some links.
Genes
While there probably isn't one schizophrenia gene that can be isolated, multiple gene mutations may raise a person's chance of having schizophrenia. It may run in families. People who have a family member with schizophrenia have an increased chance of having it themselves. If one identical twin has schizophrenia, the other identical twin is 50% more likely than the rest of the population to also have schizophrenia. It has been found that schizophrenia and bipolar probably have the same genetic roots. Another recent study has suggested that autism may also be genetically related to schizophrenia.
Environment
Some environmental factors have been linked to schizophrenia in people who do not have a family history of it. They include:
- Exposure to certain viral infections in utero, such as influenza, herpes, toxoplasmosis or rubella
- Lack of proper nutrition in utero
- Use of mind altering drugs, especially at a young age
- Traumatic life events, especially during childhood, such as abuse
- Parental age - those born to older parents are more at risk
Brain Structure
Scientists have found some differences in the brain structures of people with schizophrenia. These include:
- Larger ventricles
- Smaller medial temporal lobes
- Fewer connections between brain cells
- Differences in levels of neurotransmitters
- Less gray matter
Signs and Symptoms
Disorganized schizophrenia is associated with several symptoms:
Disorganized Speech
People with disorganized schizophrenia have trouble staying on one train of thought, and their speech patterns reflect that difficulty. Someone with disorganized schizophrenia may suddenly change subjects for no reason, repeat the same things over and over again, use nonsense words, use rhyming words that don't mean anything together, or respond to questions with unrelated answers.
If someone has severe cognitive disorientation, it may be nearly impossible to follow what they are saying. For example, "Green I run the dog car sweet house walked ghostly apple flying." It is loosely structured to sound like a sentence but makes no sense to the listener.
Disorganized Behavior
People with disorganized schizophrenia have trouble beginning and following through with even simple tasks and goals. For instance, when living on their own, they may not eat regularly because they cannot concentrate long enough to prepare and eat a meal. Their hygiene may suffer because they cannot complete the task of taking a shower or putting on clean clothes.
They also lack impulse control, and their behavior may seem bizarre. Examples may include acting silly or childlike, aggression, unprovoked anger, sexual behavior in inappropriate settings, excessive movement, or not responding to stimuli around them such as people asking them questions or giving directions.
Inappropriate Emotional Response
People with disorganized schizophrenia may have a flat affect, which means they show little emotion. They may have a blank expression on their face and use a monotone voice. They may also show emotional responses that don't match the circumstances. For instance, when something very sad happens, the person may laugh. They may lack the ability to feel emotions such as pleasure, sadness or anger.
Delusions and Hallucinations
"Delusions" refers to beliefs that, to other people, are clearly not true. For instance, a person with disorganized schizophrenia may believe they have special powers, or believe that others are plotting against them. They may hide or become isolated in order to protect themselves from imagined enemies.
"Hallucinations" refers to seeing, hearing, tasting, touching and smelling things that are not really there. Hearing things is the most common hallucination. Many people with disorganized schizophrenia hear voices. Delusions and hallucinations are not as common in people with disorganized schizophrenia as they are in people with other subtypes.
Additional Signs
- Strange or childlike behavior
- Random movements that are not part of any task
- Outbursts of laughter or other emotional responses at inappropriate times
- Lack of eye contact
- Chronically lethargic
Treatments
Disorganized schizophrenia can be difficult to treat. This type of schizophrenia is considered to be more treatment resistant than other types. However, there are treatments available. People have a better chance of success if they participate in several times of treatments concurrently.
Medication
Antipsychotic medications may be used to control symptoms such as hallucinations, delusions, paranoia, disordered speech, and disorganized thinking. When doctors first began prescribing medication to treat schizophrenia, the drugs had strong side effects such as tremors and rigid movements. Modern antipsychotic medications are less likely to cause such side effects, but may cause milder side effects such as weight gain or high cholesterol. Anti-anxiety medications or antidepressants may also be prescribed to people with schizophrenia.
Psychotherapy
Cognitive Behavioral Therapy was originally developed to treat people who were recovering from schizophrenia. It helps people learn to cope with distressing situations. The person starts out by rating their level of distress. They identify what the emotional and behavioral consequences of the stress are... for instance, if a person under stress became angry and punched someone, their anger would be an emotional consequence and their punching someone would be a behavioral consequence.
They then identify what is causing the stress. The therapist works with them on re-framing their thoughts and beliefs about the cause of the stress, so that they can lower their stress levels and reduce the emotional and behavioral consequences of stress.
Life Skills Training
People with disorganized schizophrenia need to learn or re-learn life skills in order to live as independently as possible. Life skills training could cover things such as taking care of their own hygiene, preparing meals, household tasks, social skills, communication, and participating in the community,
Vocational Training
As a person's symptoms of disorganized schizophrenia begin to be controlled, they may be able to get a job. Vocational training can help them get back into the work force.
Electroconvulsive Therapy
If a person isn't responding well to other forms of treatment, ECT may be considered. ECT involves inducing a seizure through a series of electric shocks to the brain. The seizure is thought to cause neurochemicals to be released in the brain, relieving the symptoms of schizophrenia. While this was a common treatment in the past, it is now considered controversial. However, the methods of ECT are much safer than they were in the past.
Conclusion
While schizophrenia was once a mystery, we now know more about it than ever before. We are getting closer to knowing what causes it, and have reasons to believe that genetics, brain structure, and environment play a part in whether someone will get it. We are aware that the main symptoms of disorganized schizophrenia are disorganized speech, disorganized behavior, inappropriate emotional responses, and possible hallucinations and delusions.
While treatments for any kind of schizophrenic, and other mental health conditions, used to include treatments such as ice baths, lobotomies, injections, and being tied down to beds, we now have many other, more scientific, treatment options. Treatment options of today may include medication, psychotherapy, life skills training, and vocational training.
While disorganized schizophrenia was once considered a subtype of schizophrenia, the DSM-5 now classifies disorganized symptoms as part of the larger schizophrenia spectrum. Most importantly, we are now working towards ending the stigma related to mental health conditions such as disorganized schizophrenia, and instead hoping to find new ways to help people lead their lives as independently as possible.
