Disorganized Symptoms of Schizophrenia

Schizophrenia is a heterogeneous condition characterized by a range of different symptoms. One very challenging symptom to manage is disorganization.

Disorganization impairs one’s ability to collect and straighten out their thoughts and greatly disrupts speech so that it is very difficult to communicate. Disorganization can also manifest as inappropriate or unpredictable behavioral changes. These symptoms can make it very challenging for people to work and interact with others in social settings.

Disorganized schizophrenia, also known as hebephrenia, was once recognized as a subtype of the condition, but is now simply considered a set of behaviors or symptoms that many people with schizophrenia experience.

Brain

Sean Gladwell / Getty Images

Signs and Symptoms

Each person with schizophrenia experiences different types of symptoms, which are generally organized into three categories: positive, negative, and cognitive symptoms.

Positive Symptoms

Some thoughts or behaviors are referred to as positive because people without this condition do not experience them, including:

  • Hallucinations
  • Delusions
  • Disorganized speech or behavior
  • Abnormal motor behavior

Negative Symptoms

Negative symptoms greatly disrupt quality of life and can be very difficult to treat, which include:

  • Depressed verbal expressions
  • Difficulty expressing emotion
  • Lack in interest in activities

Cognitive Symptoms

These symptoms, as named, relate to cognitive problems:

  • Trouble with memory
  • Difficulty concentrating
  • Trouble organizing thoughts

People with disorganized symptoms of schizophrenia may be more affected by speech difficulties and behavior.

Change in Schizophrenia Subtypes

The Diagnostic and Statistical Manual, or DSM, was created to help healthcare professionals properly diagnose people with mental health disorders like schizophrenia. This guide is updated every few years to take into consideration new research and clinical recommendations from leading mental health professionals.

In the DSM-4, schizophrenia was divided into several subtypes, including paranoid and disorganized. However, the DSM-5 removed these subtypes entirely and shifted instead to using dimensions to capture variability in symptoms of schizophrenia.

Therefore, disorganization is now considered a symptom of the disorder, rather than a subtype. Nevertheless, it remains important to understand disorganized symptoms as a person living with schizophrenia or a loved one caring for someone with this condition.

Causes

The exact cause of schizophrenia is unknown, but a host of genetic and environmental factors and their interaction have been found to contribute to this condition. Several genes, including DISC1, have been linked to the risk of developing schizophrenia. Life experiences, such as trauma, can also contribute to this risk.

The neurodevelopmental hypothesis asserts that schizophrenia results from a disruption in brain development early in life. Since symptoms usually do not emerge until adolescence or later when the brain is mostly developed, many have suggested this may be the key to understanding the disorder. However, this is only one of many theories.

Within the brain itself, schizophrenia is associated with excess dopamine, a neurotransmitter (or a chemical messenger) that regulates both motor and cognitive activity. However, many other neurotransmitters have also been implicated, including glutamate and GABA.

Diagnosis

According to the DSM-5, a person who exhibits two or more of the following symptoms:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms

They meet the criteria for schizophrenia if these symptoms last at least one month. Furthermore, the symptoms experienced must include delusions, hallucinations, or disorganized speech. People must also show impaired functioning in work, interpersonal relationships, and self-care.

A psychiatrist or another mental health professional can diagnose schizophrenia. A physician may perform a physical exam, run diagnostic tests such as blood work, and order a brain scan such as an MRI to rule out possible medical or neurologic contributions to the symptoms.

Conditions that a mental health professional may consider include:

  • Major depressive disorder with psychotic or catatonic features
  • Schizoaffective disorder
  • Schizophreniform disorder
  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Post-traumatic stress disorder

They will also need to determine that the symptoms are not a result of substance abuse or another medical condition. Once all of the test results are reviewed and alternative causes are ruled out, a definitive diagnosis of schizophrenia can be made.

Treatment

Medications

Several types of pharmaceutical therapies are available for treating schizophrenia.

There are two main categories of treatments: first- and second-generation antipsychotics. "First generation" refers to older medications while "second generation" refers to newer medications. Older medications include those that target the dopamine system in the brain. Newer medications also affect other neurotransmitter systems.

First-generation antipsychotics used to treat schizophrenia include:

  • Chlorpromazine (Thorazine)
  • Fluphenazine (Proxlixin)
  • Haloperidol (Haldol)
  • Loxapine (Loxitane)
  • Perphenazine (Trilafon)
  • Thiothixene (Navane)
  • Trifluoperazine (Stelazine)

Second-generation antipsychotics used to treat schizophrenia include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)

One unique second generation antipsychotic medication called clozapine is the only FDA-approved antipsychotic medication used to treat refractory schizophrenia and has been the only one indicated to reduce suicide risk. However, it does have multiple medical risks in addition to these benefits. 

While pharmaceuticals can be very effective, even newer medications are often accompanied by unwanted side effects such as weight gain. These side effects may cause lower adherence to medications.

There are now medications that do not need to be taken daily, which may be a suitable option for people who do not want or cannot take pills regularly. These are called long-acting injectables, and can be administered by a healthcare professional. They last in your system for several weeks. It's important to discuss all possible treatment options with physicians to find the best way to manage schizophrenia symptoms.

Psychotherapy

People with schizophrenia may also undergo psychotherapy. Mental health professionals trained to work with people with this condition may provide unique tools and strategies that can help make symptoms more manageable. Different therapeutic approaches can be tailored to address specific behaviors and symptoms that are most difficult to treat:

  • Cognitive behavioral therapy (CBT): Helps people understand how distorted thoughts contribute to symptoms and behaviors
  • Supportive psychotherapy: Helps a person process their experience and to support them in coping while living with schizophrenia
  • Cognitive enhancement therapy: Promotes cognitive functioning and confidence in one’s cognitive ability through computer-based brain training and group sessions

When to Seek Help

Many people with schizophrenia can manage their symptoms with the help of their healthcare professionals. However, some people may still struggle to manage certain behaviors or symptoms. They also might stop taking their medication without telling anyone. This can create a stressful situation for them and their loved ones.

It’s important to know when to call for emergency help. If a person with schizophrenia poses an immediate harm to themselves or to others, their loved one should call 911. If they are having suicidal thoughts, call 1-800-273-8255 to be connected with the National Suicide Prevention Lifeline for support from a trained counselor.

Coping

Diagnosis of a mental health condition like schizophrenia can be very overwhelming. Many people with schizophrenia, depending on the severity of their symptoms and how they respond to medications, are able to work and engage in social interactions. However, the stigma associated with this condition may make it difficult for people to accept a diagnosis and stay on treatment.

Some ways to help manage your illness include:

  • Managing stress: Stress can trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important. Don’t take on more than you can handle. Also, practice mindfulness or meditation to stay calm and keep stress at bay
  • Getting plenty of sleep: When you’re on medication, you most likely need even more sleep than the standard eight hours. Many people with schizophrenia have trouble with sleep, but lifestyle changes such as getting regular exercise and avoiding caffeine can help.
  • Avoiding alcohol and drugs: Substance use affects the benefits of medication and worsens symptoms.
  • Maintaining connections: Having friends and family involved in your treatment plan can go a long way towards recovery. People living with schizophrenia often have a difficult time in social situations, so surround yourself with people who understand what you are going through.

There are many resources available to help support people with schizophrenia, including:

  • The National Alliance on Mental Illness (NAMI)
  • Schizophrenia and Related Disorders Alliance of America (SARDAA)
  • Local support groups

Supporting a Loved One

People with schizophrenia may need a lot of help from loved ones. Family or friends may need to remind their loved one to take their medication, go to scheduled doctor appointments, and take care of their health.

Tips for caregivers of someone with schizophrenia:

  • Respond calmly: The hallucinations and delusions seem real to your loved one, so calmly explain that you see things differently and be respectful without tolerating dangerous or inappropriate behavior.
  • Pay attention to triggers: You can help your family member or friend understand, and try to avoid, the situations that trigger their symptoms or cause a relapse or disrupt normal activities.
  • Help ensure medications are taken as prescribed: Many people question whether they still need the medication when they’re feeling better or if they don’t like the side effects. Encourage your loved one to take their medication regularly to prevent symptoms from coming back or getting worse.
  • Understanding lack of awareness: Your family member or friend may be unable to see that they have schizophrenia. Show support by helping them be safe, get therapy, and take the prescribed medications.
  • Help avoid drugs or alcohol: These substances are known to worsen schizophrenia symptoms and trigger psychosis. If your loved one develops a substance use disorder, getting help is essential.

There is no cure for schizophrenia, and it is a chronic condition. Caretakers must remember to take care of their health as well as their loved one's and reach out for support when needed.

Don't hesitate to reach out to organizations and facilities that can help:

  • NAMI Family Support Group
  • Caregiver Action Network
  • Family Caregiver Alliance
Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39(9):638-645.

  2. Mattila T, Koeter M, Wohlfarth T, Storosum J, van den Brink W, de Haan L, et al. Impact of DSM-5 changes on the diagnosis and acute treatment of schizophrenia. Schizophr Bull. 2015;41(3):637-643. doi:10.1093/schbul/sbu172

  3. Harrison PJ. Recent genetic findings in schizophrenia and their therapeutic relevance. J Psychopharmacol. 2015 Feb;29(2):85-96. doi: 10.1177/0269881114553647

  4. Debost JP, Larsen JT, Munk-Olsen T, Mortensen PB, Meyer U, Petersen L. Joint Effects of Exposure to Prenatal Infection and Peripubertal Psychological Trauma in Schizophrenia. Schizophr Bull. 2017 Jan;43(1):171-179. doi: 10.1093/schbul/sbw083

  5. Howes O, McCutcheon R, Stone J. Glutamate and dopamine in schizophrenia: an update for the 21st century. J Psychopharmacol. 2015 Feb;29(2):97-115. doi: 10.1177/0269881114563634

  6. National Alliance on Mental Illness. Schizophrenia Treatment.

  7. Spertus J, Horvitz-Lennon M, Abing H, Normand SL. Risk of weight gain for specific antipsychotic drugs: a meta-analysis. NPJ Schizophr. 2018;4(1):12. doi:10.1038/s41537-018-0053-9

  8. National Alliance on Mental Illness. Schizophrenia Support.