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Disorganized schizophrenia

http://www.mayoclinic.org/diseases-conditions/cyclothymia/basics/definition/con-20028763
http://www.mayoclinic.org/diseases-conditions/dysthymia/basics/definition/con-20033879
http://www.mayoclinic.org/diseases-conditions/disorganized-
schizophrenia/basics/prevention/con-20029138

Definition
By Mayo Clinic Staff
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 Staff
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 affected 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 affected 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 affect) has a blank face and doesn't make eye
contact or use common body language. Although an affected 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 offer
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 Staff
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 differences in the brain structure of people with schizophrenia,
but the significance of these changes is unclear.

Risk factors
By Mayo Clinic Staff
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 Staff
Left untreated, disorganized schizophrenia can result in severe emotional,
behavioral, health, and even legal and financial problems that affect 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

Preparing for your appointment
By Mayo Clinic Staff
If your loved one has signs and symptoms of disorganized schizophrenia,
schedule an appointment with your family doctor or mental health provider.
After an initial evaluation, your loved one may be referred to a psychiatrist for
further evaluation. Join your loved one for these appointments. Your input will
help the doctor or mental health provider make an accurate diagnosis.
What you can do
To make the most of your loved one's first appointment, prepare a list of
questions in advance. Questions that may be helpful to ask include:
Do you think my loved one has disorganized schizophrenia?
How do you treat disorganized schizophrenia?
How could treatment change things for my loved one?
How could counseling help?
How long will my loved one need treatment?
With treatment, what goals are realistic for my loved one? Will he or she
be able to work or to live independently?
What can I and my family do to help my loved one's treatment succeed?
Are there any brochures or other printed material that I can take home with
me? Or can you recommend reliable websites?
In addition to your prepared questions, don't hesitate to ask questions at any
time during your appointment if you don't understand something.
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask
you a number of questions about your loved one's thoughts, behavior and
mood. You may be asked such questions as:
What signs and symptoms have you noticed?
When did these signs and symptoms develop?
How have these signs and symptoms changed over time?
Does anything in particular seem to trigger these signs and symptoms or
make them worse?
What impact do these symptoms have on your loved one and on your
family's daily life?
Have any of your loved one's relatives had a mental illness?
Does your loved one ever talk about suicide or about harming others?
Does your loved one smoke? How much?
Does your loved one use alcohol or recreational drugs? How much?
What medications or over-the-counter herbs and supplements does your
loved one take?

Tests and diagnosis
By Mayo Clinic Staff
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 affect 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 different
conditions can have similar symptoms.

Treatments and drugs
By Mayo Clinic Staff
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 effective 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 affect 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
affecting brain chemicals called neurotransmitters. These medications have traditionally been very
effective in managing delusions and hallucinations. These medications, however, have frequent and
potentially severe neurological side effects, 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 effective
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 effects, 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 effectively 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 effects, the treatment team may recommend
combining medications, switching to a different 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 effects 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 effects 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 off, 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 affected 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 affected 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 affected 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 affected 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 Staff
To improve the likelihood that your loved one's treatment plan will be effective, 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 Staff
Coping with an illness as serious as disorganized schizophrenia can be challenging. Medications can
have unwanted side effects, 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 Staff
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

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