Hebephrenic schizophrenia
| Classification according to ICD-10 | |
|---|---|
| F20.1 | Hebephrenic schizophrenia |
| ICD-10 online (WHO version 2019) | |
The disorganized schizophrenia (from ancient Greek ἥβη = "Youth" and φρήν = " soul ", " mind ", " diaphragm ") refers to a subtype of schizophrenia . In this subtype, changes in the emotional and emotional life are in the foreground. Delusions and hallucinations are only fleeting and fragmentary. Thinking and behavior can be disorganized and language can be mixed up.
Other names for the clinical picture are hebephrenia and disorganized schizophrenia , disorganization syndrome or disintegrative schizophrenia . In the past it was also referred to as adolescent madness or silly idiocy , which is inappropriate today.
The disease is named after Hebe , the goddess of youth. In ancient Greece , the diaphragm was believed to be the seat of the soul, which is why the word “phren” (φρήν) stands for both terms.
history
Hebephrenia ( Dementia hebephrenica) was first defined and described by Ewald Hecker in 1871 .
In 1893 Emil Kraepelin coined the name Dementia praecox under the impression of a similar illness . It therefore initially had about the same meaning as Dementia hebephrenica . In the following years, however, the term Dementia praecox expanded and in 1899 finally included Dementia catatonica and Dementia paranoides in addition to Dementia hebephrenica . So it was no longer just referring to a single sub-form, but to an entire group of diseases.
In 1908, Eugen Bleuler rejected the term dementia praecox and invented a new name for this type of disease: schizophrenia.
In 1957 Karl Leonhard distinguished four subtypes of hebephrenia in his classification of endogenous psychoses .
In 2013, hebephrenia was removed from the American diagnostic system DSM-5.
Clinical picture
Emotional life
The Hebephrenic schizophrenia leads to an impoverishment of the emotions ( affects ) and a reduced ability to "participate emotionally". Those affected only react to a limited extent to normally moving events and appear to be little affected by the pleasant and the unpleasant. The normal ability to oscillate between different affective states (joy, curiosity, sadness, anger, pride ...) is lost. A flat, partially resonance-free mood prevails without emotional warmth (see schizophrenic negative symptoms and behavioral deficits).
Paradoxically, however, there are sometimes noticeably silly cheerful or even silly behavior, such as B. through an incomprehensibly strong laugh and a mismatch between the external situation and reaction ( inadequate affect , see also affect lability ). The patient often has accompanying mannerisms and grimacing : Purposeful movements are then carried out in a strange, unnatural, artificial and eccentric way.
Language and motor skills
The language of the sick is often characterized by loosening of associations, by speaking at the same time (answers are only indirectly or not connected to the question at all) or even disorganized to the point of incomprehensibility (word salad, schizophasia ). Those affected seem to be talking confused stuff or in a language and grammar they have invented themselves or with errors, or write in sentences that are sometimes incomprehensible . Kraepelin was one of the first to study the various forms of language disorders mentioned above (see e.g. the eighth edition of his textbook Psychiatry, but also his comparative study on the development of language disorders: About language disorders in dreams .).
The psychomotor behavior and mentality are turned away from reality , appear autistic and spooky and are often reminiscent of a distorting caricature of the behavior of adolescents . It is precisely this pseudo-pubertal behavior that, because of its insolence, often appears as if the patient is intentionally trying to provoke or mock his counterpart . The actual cause , on the other hand, is that the person concerned is not even aware of the distortion of his behavior and therefore shows no inhibition or shame about it .
Personality and behavior
The awareness and the orientation are mostly preserved. Often, however, a gradual loss of personality structure sets in and the personality loses its real essence, which existed before the illness. This is shown, among other things, by increasing weakness of will and decision-making ( Abulia ): This is often based on an inability to make the more correct decision, which is perceived as agonizing. Often thinking about one's own future is lost, the sick can no longer go to work ( early retirement ) or see no need to do so. The ability for self-reflection and self-criticism has mostly been lost, as has social competence . Insight into the disease is usually not available. On the other hand, there are also patients who are very well aware of the cause of their different behavior or have been successfully made aware of them. In these cases, the sick can then often suffer additional depression . Out of desperation, some are prone to use alcohol and other drugs or to commit suicide .
In advance, the personality is usually shy and solitary , but also often intelligent and conscientious. The intelligence is preserved in certain areas and in special cases even extraordinary skills develop . However, cognitive losses are possible with increasing age and the progression of the disease.
diagnosis
In the currently valid ICD-10 , hebephrenic schizophrenia is listed under F20.1 in the chapter "Schizophrenia, schizotypal and delusional disorders". The general criteria for schizophrenia must be met to be diagnosed .
The specific diagnosis of hebephrenic schizophrenia also requires that there be a clear and persistent flattening or inadequacy of affect . In addition, aimless and incoherent behavior or clear thought disorders can occur. Hallucinations or delusions can occur in mild form, but do not determine the clinical picture . As a rule, the diagnosis of hebephrenia should only be made in adolescents or young adults and only after several months of observation.
In the DSM-IV the disease occurred as a so-called disorganized type (295.10). In the DSM-5 , this diagnosis is possible not because there all subtypes of schizophrenia have been removed.
causes
Like all diseases of the schizophrenic type, hebephrenia is a serious mental illness . The causes essentially coincide with those of other forms of schizophrenia.
A neuronal developmental disorder of individual areas of the brain in the womb is suspected to be the main cause of the disease ( prenatal origin). In addition, British-Swedish scientists working with Finn Rasmussen at the Karolinska Institute have found a statistical connection between the increasing age of the father at conception and the risk of a schizophrenic disease. The connection is explained by the hypothesis that with increasing age, mutations in the sperm that favor this disease occur more frequently.
Another explanation for the onset of the disease during puberty (or a little later) is offered by the vulnerability-stress model , which assumes an innate susceptibility to schizophrenia ("vulnerability" ), but ascribes the actual onset of the disease to external factors such as stress .
course
The onset of the disease lies between puberty and the middle of the third decade of life, between the ages of 15 and 25. In females , the onset of the disease usually occurs a little later, which is most likely due to the protective influence of estrogen , which causes a certain delay.
The disorder is often not recognized at first but as hallucinations, delusions and catatonic motor symptoms (movement abnormalities) standing in the background, the patient display behavior or Eigenbrötlertum is attributed and they are regarded as eccentrics.
therapy
The focus is on drug therapy, often supplemented by supportive psychotherapeutic measures as well as occupational and physiotherapy . Inpatient therapy is often necessary.
Antipsychotics work particularly well in the case of schizophrenic positive symptoms ("excess symptoms", such as hallucinations, delusional ideas), as usually occurs in the paranoid type. There, brain metabolic disorders and changes in the neurotransmitter balance are assumed to be the cause. If the symptoms are predominantly negative (“deficiency symptoms”, e.g. lack of willpower , joylessness , “dynamic emptying”), they are significantly less effective. It is assumed that the cause of the disease lies more in structural changes in the brain and is also related to cell losses , especially in the prefrontal and temporal cortex and in the hippocampus .
forecast
Among the subtypes of diseases of the schizophrenic group in the ICD-10, the hebephrenic type has a rather poor prognosis . The hebephrenic subtype is chronic in most cases and generally only responds poorly to therapeutic measures .
Illness relapses can also occur later , especially in stressful situations and under stress. After each attack, however, there is a risk of an irreversible increase in negative symptoms and a loss of personality. When used in a targeted manner and under supervision, atypical neuroleptics in particular can alleviate these relapses.
literature
- Amarilis de Lokee: Development of the concept of hebephrenia and its current status in modern psychiatry . Technical University of Aachen , 1973 ( dissertation )
- Siegfried Rahm: Current psychopathology in patients with the diagnosis of hebephrenia in the further course . University of Munich , 2004 (dissertation)
- Markus Schlemmer: The course of the disease and coping with the disease in hebephrenics. Case report of a catamnestic examination of 50 patients diagnosed with hebephrenia . University of Munich, 1998 (dissertation)
- Uta Thilo: Psychopathological considerations on Hebephrenia. A retrospective study of 372 patients . University of Munich, 1995 (dissertation)
Individual evidence
- ↑ Horst Dilling (Ed.): ICD – 10 Chapter V (F): Diagnostic criteria for research and practice . Hogrefe, Bern 2016, ISBN 978-3-456-85700-8 : “Brief description: A form of schizophrenia in which affective changes are in the foreground, delusions and hallucinations appear fleeting and fragmentary, behavior is irresponsible and unpredictable and mannerisms are frequent are. The mood is flat and inappropriate. Thinking is disorganized, language disorganized. The patient tends to isolate himself socially. Because of the rapid development of negative symptoms, especially flattening of affect and loss of drive, the prognosis is mostly poor. As a rule, hebephrenia should only be diagnosed in adolescents or young adults. "
- ^ SL Bressler: Cortical coordination dynamics and the disorganization syndrome in schizophrenia. In: Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology. Vol. 28 Suppl 1, July 2003, pp. S35-S39, ISSN 0893-133X . doi: 10.1038 / sj.npp.1300145 . PMID 12827142 . (Review).
- ^ Kraepelin: Dementia praecox. Translation of German-language psychiatry texts, 1896. In: John Cutting, Michael Shepherd: The clinical roots of the schizophrenia concept - Translations of Seminal European Contributions on Schizophrenia. ISBN 978-0-521-26635-2 .
- ↑ See also: A. Müller, RW Schlecht, Alexander Früh, H. Still The way to health: a faithful and indispensable guide for the healthy and the sick. 2 volumes, (1901; 3rd edition 1906, 9th edition 1921) 31st to 44th edition. CA Weller, Berlin 1929 to 1931, Volume 2 (1929), p. 123 f .: Das Jugendirresein (Dementia praecox, Hebephrenia) .
- ^ Eugen Bleuler: Dementia praecox or group of schizophrenias , Deuticke, Leipzig / Vienna 1911.
- ↑ Grit Althaus u. a .: The autistic hebephrenia. Concepts and Findings . In: Advances in Neurology and Psychiatry . tape 69 , no. 10 , 2001, p. 482-487 , doi : 10.1055 / s-2001-17561 .
- ↑ About language disorders in dreams - Internet Archive
- ^ A b Helmut Remschmidt : Schizophrenia . Springer, 2011, ISBN 978-3-540-36273-9 , pp. 23 ( limited preview in Google Book search).
