Disorganized schizophrenia

Definition
By Mayo Clinic Staf

Disorganized schizophrenia is one of several types of schizophrenia, a chronic mental

illness in which a person loses touch with reality (psychosis). Disorganized
schizophrenia is marked by thoughts, speech and behavior that are inappropriate and
don't make sense.
Disorganized schizophrenia is considered a more severe type of schizophrenia because
people with this condition may be unable to carry out routine daily activities, such as
bathing and meal preparation. It may be hard to understand what people with
disorganized schizophrenia are saying. Also, frustration and agitation may cause them
to lash out.
Disorganized schizophrenia is sometimes known as hebephrenic schizophrenia.

Symptoms
By Mayo Clinic Staf

Signs and symptoms of disorganized schizophrenia fall into several categories of

disorganized thinking and behaviors, including:

Disorganized thinking. Disorganized thinking causes illogical, nonsensical thought

patterns. This disorganization is also noticeable in the way an afected person talks. A
person with disorganized thinking may not be able to stay on track in a conversation, instead
jumping from one unrelated idea to another, so that it's impossible to understand what the
person is trying to say. Making up words is common. Written communications also are very
disorganized.

Grossly disorganized behavior. The disorganized behavior common to this type of

schizophrenia causes severe problems in an afected person's ability to function in daily life.
Bathing, dressing appropriately or preparing meals may be impossible. Other common
issues include confronting others without logical reason, wearing many layers of clothing on
a warm day, having a very messy appearance or engaging in sexual behavior in public.

Absent or inappropriate emotional expression. A person who lacks emotional

expression (flat afect) has a blank face and doesn't make eye contact or use common body

language. Although an afected person may show emotion at times, the person's range of
expression is very limited compared with others. Emotions inappropriate to the situation also
are common, such as acting silly or laughing loudly during a serious event.

Other signs and symptoms of disorganized schizophrenia

Although the main symptoms of disorganized schizophrenia are disorganized thinking and
behavior, people with this condition may also have some of the other common signs and
symptoms of schizophrenia, such as:

Having beliefs not based on reality (delusions)

Seeing or hearing things that don't exist (hallucinations), especially voices

Grimacing

Odd postures

Trouble functioning at school or work

Social isolation

Clumsy, uncoordinated movements

Helping someone who may have disorganized schizophrenia

If you have a loved one you think may have symptoms of disorganized schizophrenia,
have an open and honest discussion about your concerns. You may not be able to force
someone to seek professional help, but you can ofer encouragement and support and
help your loved one find a qualified doctor or mental health provider.
If your loved one poses a danger to himself or herself or to someone else, you may
need to call the police or other emergency responders for help. In some cases,
emergency hospitalization may be needed. Laws on involuntary commitment for mental
health treatment vary.

Suicidal thoughts
Suicidal thoughts and behavior are common to disorganized schizophrenia. If someone
you love is threatening suicide right now, call 911 or your local emergency services
number.

Causes
By Mayo Clinic Staf

Disorganized schizophrenia and other forms of schizophrenia are brain disorders.

Genetics and environment likely both play a role.
Problems with certain naturally occurring brain chemicals called neurotransmitters may
contribute to disorganized schizophrenia. Imaging studies show diferences in the brain
structure of people with schizophrenia, but the significance of these changes is unclear.

Risk factors
By Mayo Clinic Staf

Although the precise cause of disorganized schizophrenia isn't known, certain factors
seem to increase the risk of developing or triggering the condition, including:

Having a family history of schizophrenia

Exposure to viruses while in the womb

Poor nutrition while in the womb

Stressful life circumstances

Older paternal age

Taking psychoactive drugs during adolescence

Signs and symptoms of schizophrenia typically develop between the teenage years and
the mid-30s, although disorganized schizophrenia may start earlier.

Complications
By Mayo Clinic Staf

Left untreated, disorganized schizophrenia can result in severe emotional, behavioral,

health, and even legal and financial problems that afect every area of life.
Complications that disorganized schizophrenia may cause or be associated with
include:

Suicidal thoughts and behavior

Self-destructive behavior

Inability to perform daily activities, such as bathing, dressing or preparing meals

Frequent hospitalizations

Depression

Abuse of alcohol, drugs or prescription medications

Poverty

Homelessness

Incarceration

Family conflicts

Inability to work or attend school

Violent crime may be a victim or perpetrator

Heart and lung disease related to smoking

Tests and diagnosis

By Mayo Clinic Staf

To diagnose disorganized schizophrenia, a doctor or mental health provider typically

runs a series of medical and psychological tests and exams. These can help pinpoint a
diagnosis, rule out other problems that could be causing symptoms and check for any
related complications.
These exams and tests generally include:

Physical exam. This may include measuring height and weight, checking vital signs,
such as heart rate, blood pressure and temperature, listening to the heart and lungs, and
examining the abdomen.

Laboratory tests. These may include a complete blood count (CBC), screening for
alcohol and drugs, and checking thyroid function.

Psychological evaluation. A doctor or mental health provider will interview the person
with possible schizophrenia about thoughts, feelings and behavior patterns. The provider will

ask about symptoms, including when they started, how severe they are, how they afect daily
life and whether similar episodes have occurred in the past. The provider will also ask about
thoughts of suicide, self-harm or harming others. Talking with family or friends may help the
doctor or mental health provider make an accurate diagnosis.

Diagnostic criteria for disorganized schizophrenia

To be diagnosed with disorganized schizophrenia, a person must meet certain symptom
criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
This manual is published by the American Psychiatric Association and is used by mental
health providers to diagnose mental conditions and by insurance companies to
reimburse for treatment.
Diagnostic criteria for disorganized schizophrenia include:

Disorganized speech

Disorganized behavior

Lack of emotion

Emotion inappropriate for the situation

It can sometimes be difficult to diagnose disorganized schizophrenia, especially

because diferent conditions can have similar symptoms.

Treatments and drugs

By Mayo Clinic Staf

Disorganized schizophrenia is a chronic condition that requires lifelong treatment, even

during periods when symptoms have lifted. People with this condition may feel as if
treatment isn't necessary, and may be tempted to ignore treatment recommendations.
But efective treatment can help people with disorganized schizophrenia take control of
the condition and enjoy a happier and healthier life.
Treatment options are similar for all types of schizophrenia. But the specific treatment
approach that's best for you depends on your particular situation and the severity of
your symptoms.

Treatment teams
Disorganized schizophrenia treatment is usually guided by a psychiatrist skilled in
treating the condition. But there may be others on the treatment team, as well, because
the condition can afect so many areas of life.
Treatment team members may include:

Family or primary care doctor

Psychiatrist

Psychotherapist

Pharmacist

Family members

Case worker

Psychiatric nurse

Social worker

Main treatment options

The main treatments for disorganized schizophrenia are:

Medications

Psychotherapy

Hospitalization

Electroconvulsive therapy (ECT)

Vocational skills training

Medications for disorganized schizophrenia

Medications are a key disorganized schizophrenia treatment. Among the medications
most commonly prescribed for disorganized schizophrenia are:

First-generation (typical) antipsychotics. These medications are thought to control

symptoms by afecting brain chemicals called neurotransmitters. These medications have

traditionally been very efective in managing delusions and hallucinations. These

medications, however, have frequent and potentially severe neurological side efects,
including the possibility of tardive dyskinesia, or involuntary jerking movements. Typical
antipsychotics, especially generic versions, are often cheaper than are their newer
counterparts, which can be an important consideration when long-term treatment is needed.

Second-generation (atypical) antipsychotics. These newer antipsychotic medications

are efective at managing hallucinations, delusions and other symptoms, such as loss of
motivation and lack of emotion. Atypical antipsychotic medications pose a risk of metabolic
side efects, including weight gain, diabetes and high cholesterol.

Other medications. It's common to have other mental health issues along with
disorganized schizophrenia. Antidepressants can help symptoms of depression. Anti-anxiety
medications improve anxiety or agitation. And mood-stabilizing medications may help with
aggression or hostility.

Choosing a medication
In general, the goal of treatment with antipsychotic medications is to efectively control
signs and symptoms at the lowest possible dose. Which medication is best depends on
each person's individual situation. It can take several weeks after starting a medication
to notice an improvement in symptoms.
If one medication doesn't work well or has intolerable side efects, the treatment team
may recommend combining medications, switching to a diferent medication or adjusting
the dosage.
If your loved one smokes, he or she may need a higher dose of antipsychotic
medication because nicotine interferes with these medications. Make sure your loved
one's doctors know about his or her smoking habits.

Medication side effects and risks

All antipsychotic medications have side efects and possible health risks. Certain
antipsychotic medications may increase the risk of diabetes, weight gain, high
cholesterol and high blood pressure, for instance. Others can cause dangerous changes
in a person's white blood cell count or cause health problems in older adults.
If your loved one is being treated for disorganized schizophrenia, talk with the doctor
about possible medication side efects and dangerous interactions with other

substances. Also be sure to follow the doctor's recommended scheduled for health
checkups.
It's not safe to make any changes to mental health medications without talking to a
doctor. Psychotic symptoms may relapse if medications are stopped. In addition,
antipsychotic medication needs to be tapered of, rather than stopped abruptly, to avoid
withdrawal symptoms.

Psychotherapy for disorganized schizophrenia

Although medications are a key disorganized schizophrenia treatment, counseling
(psychotherapy) also is essential. Psychotherapy may include:

Individual therapy. Psychotherapy with a skilled mental health provider can help teach
new ways to cope with the distress and daily life challenges brought on by disorganized
schizophrenia. One approach, called cognitive behavioral therapy, has proved to be
especially helpful in the treatment of schizophrenia. In cognitive behavioral therapy, a mental
health provider helps people with mental health problems recognize and change
harmful ideas and behaviors. As part of this process, the therapist will help the afected
person look back on his or her personal history, looking for insights into when, and why,
harmful ideas and behaviors formed. Building from this new understanding, the therapist can
help start to change those patterns. Psychotherapy can help reduce the severity of
symptoms and improve the afected person's communication skills, relationships, ability to
work and motivation to stick to a treatment plan.

Family therapy. Family therapy that provides support and education to families may help
improve family members' understanding of disorganized schizophrenia, improve family
awareness of stressful situations that might trigger a relapse, and increase the afected
person's ability to stick with a treatment plan. Family therapy can also help improve
communication, reduce conflict and help family members cope.

Hospitalization for disorganized schizophrenia

During crisis periods or times of severe symptoms, hospitalization may be necessary.
This can help ensure the safety of the afected person and others, ensure proper
nutrition, sleep and hygiene. Partial hospitalization and residential care also may be
options.

Electroconvulsive therapy (ECT) for disorganized

schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed
through the brain to trigger a brief seizure. This seems to cause changes in brain
chemistry that can reduce symptoms of certain mental illnesses such as disorganized
schizophrenia. Because ECT can provide significant improvements in symptoms more
quickly than can medications or psychotherapy, electroconvulsive therapy may be the
best treatment option in some cases.

Social and vocational skills training for disorganized

schizophrenia
Training in social and vocational skills to live independently is an important part of
recovery from disorganized schizophrenia. A therapist can teach skills as good hygiene,
cooking and better communication. Many communities have programs that can help
with jobs, housing, self-help groups and crisis situations.
If your loved one doesn't have a case manager to help with these services, ask your
loved one's doctors about getting one.

Lifestyle and home remedies

By Mayo Clinic Staf

To improve the likelihood that your loved one's treatment plan will be efective, help him
or her:

Take medications as directed. If your loved misses or stops taking prescribed

medications, schizophrenia symptoms are likely to come back.

Pay attention to warning signs. You and your loved one's care team may have
identified things that are likely to trigger disorganized schizophrenia symptoms,
cause a relapse or prevent your loved one from carrying out daily activities. Make a
plan so that you know what to do if symptoms return. Contact your loved one's
doctor or therapist if you notice any changes in symptoms or how your loved one
feels. Involve other family members or friends in watching for warning signs.
Addressing schizophrenia symptoms early on can prevent the situation from
worsening.

Avoid drugs and alcohol. Alcohol and illegal drugs can worsen schizophrenia
symptoms. Make sure your loved one gets appropriate treatment for a substance
abuse problem.

Check first before other medications are started. Contact the doctor who's
treating your loved one for disorganized schizophrenia before he or she starts
medications prescribed by another doctor or starts any over-the-counter medications,
vitamins, minerals or supplements. These can interact with schizophrenia
medications.

Coping and support

By Mayo Clinic Staf

Coping with an illness as serious as disorganized schizophrenia can be challenging.

Medications can have unwanted side efects, and you may feel angry or resentful about
having a condition that requires lifelong treatment. During periods when you feel better,
you may be tempted to stop treatment, which can trigger a relapse. Here are some ways
to cope with disorganized schizophrenia:

Learn about disorganized schizophrenia. Education about your condition can

empower you and motivate you to stick to your treatment plan.

Join a support group. Support groups for people with schizophrenia can help
you reach out to others facing similar challenges.

Stay focused on your goals. Recovery from disorganized schizophrenia is an

ongoing process. Stay motivated by keeping your recovery goals in mind. Remind
yourself that you're responsible for managing your illness and working toward your
goals.

Find healthy outlets. Explore healthy ways to channel your energy, such as
hobbies, exercise and recreational activities.

Learn relaxation and stress management. Try such stress-reduction

techniques as meditation, yoga or tai chi.

Structure your time. Plan your day and activities. Try to stay organized. You
may find it helpful to make a list of daily tasks.

Prevention

By Mayo Clinic Staf

There's no sure way to prevent disorganized schizophrenia. Some signs of

schizophrenia may be present from early childhood or even infancy. Early
identification and treatment for people at risk of schizophrenia, perhaps starting
in childhood, may help get symptoms under control before serious complications
develop and may help improve the long-term outlook. Also, sticking with a
treatment plan can help prevent relapses or worsening of disorganized
schizophrenia symptoms.