What Are 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 a person's ability to collect and organize their thoughts. It also greatly disrupts speech, making it very difficult to communicate. Disorganization can also manifest as inappropriate or unpredictable behavior. These symptoms can make it very challenging for people with schizophrenia to work with others and interact 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.

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 that are referred to as "positive"—meaning people without this condition do not experience them—include the following:

• 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. They include:

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

Cognitive Symptoms

These symptoms, as named, relate to cognitive problems, such as:

• 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 of Mental Disorders," or DSM, was created to help healthcare professionals properly diagnose people with mental health disorders like schizophrenia. This manual is updated periodically 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, the current version, has 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, specifically if you are 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.

One theory, the neurodevelopmental hypothesis, asserts that schizophrenia results from a disruption in brain development early in life. Since symptoms usually do not appear 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 may also be the cause, including glutamate and GABA (gamma-aminobutyric acid).

Diagnosis

According to the DSM-5, a person who exhibits two or more of the following symptoms meets the criteria for schizophrenia. Also, the symptoms must be present for at least one month and must include at least one of the first three items on the list:

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

People must also show impaired functioning at work, in interpersonal relationships, and with self-care.

A psychiatrist or other 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 (magnetic resonance imaging) 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 medications are available to treat 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 (along with brand names) used to treat schizophrenia include:

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

Second-generation antipsychotics (along with brand names) 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 antipsychotic used to treat refractory schizophrenia (resistant to treatment) that is approved by the Food and Drug Administration (FDA). It also has been the only one indicated to reduce suicidal risk. However, there are multiple medical risks associated with it. 

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 some people to not want to use the medications.

There are now medications that do not need to be taken daily, which may be a good option for people who do not want to take pills regularly or cannot do so. 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 a doctor to find the best way to manage schizophrenia symptoms.

Psychotherapy

People with schizophrenia may also be helped by psychotherapy, or talk therapy. Mental health professionals trained to work with people with this condition may provide unique tools and strategies that can help manage symptoms. Different therapeutic approaches, including the following, 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 experiences and supports them in coping with schizophrenia
• Cognitive enhancement therapy (CET): Uses computer-based brain training and group sessions to promote cognitive functioning and confidence in cognitive ability

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 keep up with their 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: It's important to not use 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 members or friends may need to remind their loved one to take their medication, go to scheduled medical appointments, and take care of their health.

Tips for caregivers of someone with schizophrenia include:

• Respond calmly: The hallucinations and delusions seem real to your loved one, so calmly explain that you see things differently. 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 a disruption to 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 (long-term) condition. Caretakers must remember to take care of their health as well as that of their loved one and reach out for support when needed.

Don't hesitate to contact organizations and facilities that can help, including the following:

• NAMI Family Support Group
• Caregiver Action Network
• Family Caregiver Alliance