Etiology

Hebephrenic schizophrenia, like other types of disorders, does not have clearly defined causes and mechanisms of development - this issue is currently at the stage of research and multiple disputes.

The only proven provocateur is genetic predisposition. If one parent has schizophrenia, the chance of the child having mental problems is 10%; if both parents suffer from the disorder, the risk of having a child with the disorder increases to 20%.

The main risk group is identical twins, in whom the disease is diagnosed in 50% of cases.

It is worth noting that in families where there is no genetic predisposition, the risk of hebephrenia is only 0.5%. The disease is inherited, but the possibility of infection during communication with a sick person is completely excluded.

There are several theories regarding the mechanism of development of the disease:

• disruption of the functioning of mediators - this applies to a greater extent to dopamine: when it interacts incorrectly with external receptors, pronounced personality changes are noted, hallucinations and delusions begin;
• viral or protozoal infection - such an influence is possible only in the presence of an organic disease, which can be expressed in a schizophrenia-like symptomatic picture;
• breaking the barrier with the collective unconscious or psychotherapeutic theory;
• duality of parents or dual upbringing;
• inadequate course of pregnancy;
• dislike of parents, which children feel even at the stage of intrauterine development.

The hebephrenic form of schizophrenia occurs in 3% of situations compared to other types of the disease. This syndrome has several distinctive features:

• the predominance of movement disorders with unmotivated and absurd behavior;
• infantilism of behavior - very people look younger than their age;
• comments from strangers lead to the patient’s actions becoming even more meaningless;
• the average age of manifestation is 10–12 years, boys are more often affected by the disease than girls;
• spontaneous and acute appearance of the first signs;
• continuous course of pathology;
• low effectiveness of drug and psychotherapeutic treatment;
• the most disappointing prognosis compared to other forms of schizophrenia.

In some people, hebephrenia is mild. This is in most situations observed in persons suffering from the following pathologies:

• epilepsy;
• encephalitis;
• some types of psychopathy;
• brain injuries.

In such cases, the disease is expressed only in antisocial behavior.

Hebephrenia is

What is hebephrenic schizophrenia?

Hebephrenic schizophrenia or hebephrenic schizophrenia - what is it? Hebephrenic schizophrenia is one of the types of schizophrenia in psychiatry, characterized by the presence of hebephrenic syndrome, manifested in the weakening of a person’s intellectual and volitional abilities and the predominance of negative psychotypical symptoms over productive ones.

In 1878, hebephrenia was identified by E. Hecker as a separate mental illness, then it was classified as schizophrenia as one of its subtypes, and the disease was listed in the American Manual of Mental Disorders (DSM) as schizophrenia of the disorganized type.

Along with the paranoid and catatonic types of schizophrenia, hebephrenia forms the triad of dementia praecox, a differentiated endogenous disorder described by the famous psychiatrists of the 19th century - E. Kraepelin, S. Freud, C. Jung.

Prevalence of the disease and predisposition to it

Schizophrenia, including the hebephrenic form, does not depend on racial characteristics; differentiation by gender is significant only in relation to age: as a rule, the peak of the disease in men occurs in earlier years than in women.

Schizophrenia is considered a “disease of civilization”: it occurs much more often in urban areas than in rural areas; a modern city dweller has a greater risk of disease than a person leading a traditional lifestyle in the lap of nature.

This is explained by the connection of the disease with stress factors that are rarely encountered in a measured and calm existence, predetermined by the way of life. The disease often occurs in an emigrant environment, where problems with learning a new language, settling in, rejection by local residents, and finding a means of living create an ongoing series of stressful situations.

Predisposition to the disease is determined by genetics, prenatal infections and diseases of the nervous system, and is also influenced by the environment and social situation.

Domestic violence, excessive parental care, communication problems in the family, traumatic sexual experiences, bullying by peers and other sources of negative experiences can both serve as a trigger for the onset of the disease and contribute to its rapid development.

Epilepsy attacks, drug use, and traumatic brain injuries can also lead to a rapid deterioration of the patient’s condition.

As a rule, hebephrenia manifests itself in adolescence, during the period of puberty and self-determination, from approximately 14 to 18 years, it is often detected in the third decade, up to 25 years; cases of detection of hebephrenic schizophrenia in childhood or old age are extremely rare.

Schizophrenia and dopamine

How does hebephrenia occur?

The hebephrenic form of schizophrenia is an endogenous, practically irreversible disease , the chance of complete or at least partial recovery is much lower than with other forms of schizophrenia, characterized by a predominance of positive symptoms over negative ones, therefore the course of the disease is usually associated with a gradual deterioration of the patient’s condition, weakening it inclinations and interests and deterioration of mental activity.

Symptoms, which often appear during the period of maturation, during the development of hebephrenia become more pronounced and less scattered, the disease progresses at a high speed.

Gradually, communication with the patient becomes more and more difficult: the vocabulary becomes poorer, many swear words are used in speech, which succinctly and vividly express the confused emotional state, the number and intensity of gestures and facial expressions increases.

Soon it becomes difficult for the patient to express his thoughts other than through grimaces and active gestures; finding the right words seems almost impossible to him. The problem is further aggravated by the symptom of openness of thoughts, in which the patient thinks that anyone can and should understand what is happening in his head just by looking at a grimace or catching his eye.

At the same time, thought also becomes scarce, the head becomes empty, as soon as thoughts arise, they are interrupted and disappear. A disorder of the will discourages the very desire to get into contact and make an effort to communicate with another person; interest in learning and acquiring important skills also disappears, which makes the patient incapacitated.

Symptoms

Hebephrenic schizophrenia has a large number of external specific signs, which allows an accurate diagnosis to be made.

First clinical manifestations:

• isolation;
• sleep disorder;
• increased appetite;
• detachment from loved ones;
• a noticeable decrease in intellectual abilities;
• increasing weakness.

Main symptoms:

• pretentious and silly behavior is the most distinctive manifestation when, regardless of age category, a person behaves like a child;
• grimacing and moodiness;
• frequent mood swings;
• disorganization of thinking and speech;
• lack of logic in spoken phrases;
• intermittent speech and poor vocabulary;
• frequent repetition of the same movements or expressions;
• a gross form of infantilism;
• absolute lack of motivation for actions;
• brutality of actions;
• inability to predict words or actions, evaluate them from the point of view of common sense;
• causeless laughter or tears;
• increased sexual activity;
• sloppiness at the table against the backdrop of a good appetite;
• indifference and indifference to everything that happens;
• lack of plans for the future or manifestations of empathy for others;
• unfounded health complaints;
• tendency not to show interest in one's appearance and personal hygiene;
• empty euphoria;
• public display of genitals and masturbation, which is often accompanied by swearing, ridiculous language and insults - typical for sick children;
• abuse of bad habits - observed even in childhood;
• clownism and feigned prank;
• dementia and inability to concentrate;
• the presence of diminutive words in the lexicon;
• hallucinations and delusions - in some patients may be present on a constant basis, while in others - only occasionally; hallucinations may be of a religious, sexual or hypochondriacal nature.

Almost always, hebephrenia is expressed in a continuous course. In rare situations, a paroxysmal form is observed, when rare and short periods of remission are observed. The paroxysmal type of the disease gradually turns into a malignant form of schizophrenia with each subsequent exacerbation. The patient becomes socially dangerous within 2 years.

Signs of hebephrenia in adults

Diagnosis of hebephrenic schizophrenia

The diagnosis is usually made in adolescence when general criteria for schizophrenic diseases are detected in their combination with hebephrenic syndrome, given in a relatively differentiated, incomplete form.

To make a diagnosis, the doctor must observe in the patient for several months emotional inadequacy or flattening of affects, as well as incoherence of speech and thought or inability to be serious, obsessive foolishness in behavior in combination with one of the remaining general symptoms of schizophrenia, be it an echo effect in thinking , the presence of delusional ideas or voices heard only by the patient, apathy, elements of catatonia, or another symptom.

The doctor must separate hebephrenia from diseases with similar symptoms, but a different time course or mutual distribution of symptoms, including heboidophrenia and other schizophrenia-like disorders.

Neurosis-like schizophrenia

It is important to distinguish hebophrenic schizophrenia from Pick’s and Huntington’s diseases, as well as from a brain tumor. For this purpose, echo and electroencephalography, computer and magnetic resonance imaging are used.

Diagnostics

It is generally accepted among clinicians that the diagnosis of hebephrenia is made on the basis of the following signs:

• grimaces;
• unreasonable euphoria;
• the phenomenon of inaction of thought.

The basis of diagnostic procedures are the following manipulations performed by a psychiatrist:

• studying the family history of the disease - to confirm or refute the influence of genetic predisposition;
• collection and analysis of life history;
• assessment of general and mental health using special tests;
• a detailed clinical conversation with relatives - to determine the first time of appearance and severity of the symptomatic picture, which will indicate the severity of the disease.

Laboratory studies and instrumental procedures are uninformative and do not provide diagnostic value.

Treatment

Hebephrenia is distinguished by the fact that it is practically untreatable. Therapy consists of eliminating signs and reducing the intensity of manifestations of productive disorders.

Drug treatment has a low degree of effectiveness. Despite this, patients are advised to take the following groups of medications:

• neuroleptics;
• tranquilizers;
• drugs containing insulin and lithium;
• vitamin and mineral complexes.

The best way to administer medications is by injection.

List of the most effective medications:

• "Chlorpromazine";
• "Trisedil";
• "Haloperidol";
• "Levomepromazine";
• "Trifluperidol";
• "Chlorprothixene";
• "Risperidone";
• "Flupenthixol";
• "Sulpiride";
• "Triftazine";
• "Olanzapine";
• "Pipothiazine";
• "Clozapine."

Patients require long-term psychotherapy.

Diagnosis and treatment

The diagnosis of hebephrenia is most accurately and adequately facilitated by criteria that allow differential diagnosis and the elimination of certain inaccuracies in the diagnosis. In addition, there are special, very accurate diagnostic test methods that make it possible to identify symptoms and even divide them into productive and negative. The PANS technique is very common in diagnosing schizophrenia, which allows you to diagnose very accurately and observe dynamic changes.

Hebephrenia is a fairly severe form of schizophrenia, and in the old days, one of the shock techniques would undoubtedly have been used. They were considered very effective and gave long-term remission for years, but are now considered inhumane. These techniques consist of insulin and atropine coma, as well as electroconvulsive therapy.

One should not be disappointed in modern psychiatry, although inhumane but effective methods are prohibited, there are still ways to help an individual even with severe psychotic disorders. Modern antipsychotic therapy is very effective and excellent at maintaining remission states, but it is very expensive, which can affect certain patients. In general, the management of patients with hebephrenia and schizophrenia of other subtypes is very difficult and presents a large number of difficulties due to the problems of selecting therapy and the need for frequent and long-term inpatient treatment.

Neuroleptic therapy makes it possible to partially adapt patients with hebephrenia and prolong their life, while improving its quality. Modern antipsychotics are designed to relieve productive symptoms, but more and more attention and effort are being directed to negative ones, because they are very dangerous in the future prognosis.

The first therapy is set to strong sedation, which can be treated with classic antipsychotics: Triftazin, Truxal, Tizercin, Halopril, Chlorprothixene. These drugs relieve aggressiveness and lead to lytic relief of an attack of schizophrenia; the patient can sleep for a day under the influence of such drugs, and wake up in a much better mental state. Drugs designed for long-term action (up to a month) are called depot drugs; they guarantee therapy for unreliable patients who do not want to take pills, and for those who do not have time for it. These include: Moniten Depot, Clopixol Depot, Haloperidlol Deconaate, Rispolept Konsta and Fluanxol Depot.

The use of atypical antipsychotics is the gold standard for the relief of schizophrenia and helps maintain a stable patient's condition without producing such strong extrapyramidal side effects as typical antipsychotics. Atypical are: Zyprexa, Azaleptol, Olanzapine, Risperidone, Quetiapine. There are a large number of antipsychotics available, and in addition to branded drugs, there are generics; they have a significantly lower cost, but sometimes provide much higher effectiveness.