Hebephrenic (hebephrenic) schizophrenia or hebephrenia F20.1 is one of the forms of schizophrenia with a continuous and unfavorable course, characterized by inappropriate emotions, silly behavior and torn thinking.
In 1863 , K. Kahlbaum first identified hebephrenia as an independent form that develops during puberty and is expressed mainly by the phenomena of mental weakness.
The first detailed descriptions of hebephrenia belong to E. Hecker (1871). In his opinion, in most cases, already from early childhood, a well-known mental weakness, lethargy and reluctance to mental work can be noted .
The boundaries of hebephrenia have always remained blurred. Even E. Bleuler (1911) considered hebephrenia as a combined group of mental illnesses. According to W. Mayer-Gross (1932), “heboidophrenia” or “heboid” is difficult to distinguish from psychopathies and neuroses. From his point of view, hebephrenia could stop at any stage and even manifest itself in the form of a single decrease in activity.
According to E. Kraepelin, the course of hebephrenia can be slow, subacute and acute. Many researchers believed that it is continuous and malignant, although structurally, from the point of view of psychopathology, it looks relatively simple.
R.A. Nadzharov (1972) attributed hebephrenia to a variant of nuclear schizophrenia, in his opinion, with this mental disorder, various, as it were, “compressed in time” and overlapping affective and catatonic symptoms alternate . The initial states of the hebephrenic form of schizophrenia are described in the literature somewhat contradictory. K. Leonhard (1936) described as one of them “silly, eccentric defect of hebephrenia”. According to V.N. Favorina (1964), in the initial state of hebephrenia, catatonic-apathetic states are noted.
O.V. Kerbikov (1949) singled out a diagnostic triad of symptoms in hebephrenia: “gymnastic contraction of facial muscles”, grimacing; the phenomenon of “inaction of thoughts” (Levi-Valensi A., 1926), accompanied by unmotivated actions; empty, unproductive euphoria. The hebephrenic form of schizophrenia is characterized by an early onset, beginning in adolescence, usually after 10 years.
According to E. Hecker, the main features of this disease are as follows: mood is characterized by rapid variability and inconstancy; although at the initial stage a depressed, but superficial mood (initial melancholie) prevails. The patient, after crying, fear and fear of persecution, suddenly becomes cheerful and bursts out with some stupid, senseless trick. These transitions are sharp, quick and unexpected: the patients seem to play and flirt with their feelings and mood.
Signs of hebephrenic schizophrenia
The main signs and features of the hebephrenic form of schizophrenia:
- early and acute onset;
- polymorphism of symptoms;
- pronounced disorganization of thinking, speech (meaningless rhymes, verbigeration, incoherence, neologisms) and behavior (foolishness, disorientation, demeanor, grimacing, importunity);
- inadequacy of emotional reactions (“empty euphoria”);
- increased appetite;
- malignant and continuous course;
- resistance to therapy.
The clinical picture is characterized by a state of excitement, disunity, foolishness, fragmentary, unsystematic, rudimentary delirium and unstable, episodic, simple hallucinations (Hecker E., 1871). According to many psychiatrists, pure hebephrenic form is rare.
Hallucinatory-delusional inclusions can be sexual, religious, hypochondriacal, and paranoid. Delusional statements are in the nature of something fictional, composed by the patient for fun and tomfoolery (“confabulation”, K. Kahlbaum). In the presence of delusional and, especially, affective disorders, the course of the disease can be paroxysmal and progressive in nature (Polishchuk Yu.I., 1965).
In the latest classifications, the hebephrenic form of schizophrenia is defined as a disorganized type of schizophrenia with incoherent speech and disorganized behavior.
The hebephrenic form often begins acutely, manifested by the syndrome of silly excitement and is often combined with euphoria and a kind of childishness.
Many psychiatrists emphasized that hebephrenia is characterized by a pronounced regression of mental development: primitive and disinhibited behavior; children’s and archaic speech (invectives) with meaningless rhymes and verbigeration.
Rapidly changing behavior is one of the significant symptoms of hebephrenia, probably reflecting in general the tendency of such patients to erratic activity, to impulsive, impulsive movements, to ridiculous behavior with the character of a feigned prank (Serbsky V.P., 1912).
With hebephrenia, the patient is often active, but this activity is unfocused, unconstructive. Persistent orders of the patient can be distracted from meaningless behavior, but this usually succeeds for a short time.
Usually a patient with hebephrenia exhibits increased sexual activity (casual relationships, sexual perversion). For women, it is quite typical to use diminutive – affectionate words, ridiculous coquetry, flirting, manifestations of exhibitionism.
Emotional reactions are inadequate, fluctuating in their intensity. The mood is usually heightened (“silly fun”), with a tendency to strange and incomprehensible humor, flat jokes. Unreasonable laughter without sufficient reason can be replaced by crying.
With hebephrenia, thinking and speech are impaired , which may include neologisms, be incoherent, the nature of the statements does not correspond to the experiences. Other formal speech disorders are also characteristic of hebephrenia : incorrect connection of sentences, violation of logical structures. Patients use the same phrases and phrases, resort to a set of pompous and meaningless words.
Hebephrenic schizophrenia treatment
The primary diagnosis of hebephrenic schizophrenia occurs during puberty. To make an accurate diagnosis, it is necessary to monitor the patient for 2-3 months, paying attention to the presence of characteristic symptoms, on the basis of which it is possible to draw a conclusion about the presence of the disease.
Treatment for hebephrenic schizophrenia differs significantly from treatment for other types of schizophrenia because this type is characterized by an unfavorable course, taking into account all its manifestations. Thus, only highly qualified specialists can carry out effective treatment.