Hebephrenia

HEBEPHRENIA, a term introduced into psychiatric literature in 1863 by Kahlbaum for a mental disorder developing during the period of puberty. Hecker in 1870 gave a detailed description of the clinical picture of hebephrenia, which in its main features retains its significance to this day. Kraepelin included hebephrenia within the framework of the concept he created of early dementia (dementia praecox) as one of its forms. Contemporary psychiatry follows Kraepelin's viewpoint, for which the hebephrenic form, together with catatonic, paranoid, and others, represents one of the main types of schizophrenia (see). The most characteristic feature of this form, according to Kraepelin, is a peculiar psychic fragmentation, running parallel with the progressive impoverishment of mental life and manifesting itself in behavior most often in the form of absurd silliness. In typical cases, the appearance of clear symptoms of the disease is preceded by indefinite complaints of general nervousness, irritability, insomnia, headaches, dizziness, a feeling of general fatigue, distractibility, and forgetfulness. Then most often a state of depression develops, accompanied by hallucinations and delusional ideas (hypochondriacal, self-accusation, persecution, and physical effects). The mood, however, is not colored, as in circular depressions, by an intense affect; rather, it is an undefined melancholy or a shallow, often more apparent than real, sadness, sometimes mixed with fear. The affect is not only not deep, but also not persistent: depression easily gives way to unmotivated cheerfulness, mostly of an unnatural, even forced character; directly after tears there may follow some absurd prank, etc. These transitions are sharp, rapid, unexpected: patients as if play and flirt with their feelings. In some cases, following a depressed state, and sometimes from the very beginning of the illness, a state of heightened well-being and motor agitation develops, accompanied by absurd pranks, shameless erotic manifestations, often delusions of grandeur, etc. The delusional thoughts of patients, like their mood, are usually very changeable and often seem deliberately composed for amusement and foolishness. Their motor manifestations are striking for their lack of simplicity and naturalness. Patients are awkward and mannered: their facial expressions, postures, and gestures, on the one hand, are affected and deliberately theatrical, and on the other, lack true expressiveness; their speech is now pompously passionate, now as if deliberately incorrect: some of them distort pronunciation in the form of childish babbling, others speak through the nose, lisp, stutter, etc. They readily use strange, little-used, or even invented by themselves words and expressions, up to the use of some special, bizarre jargon. In content, their speech is usually incoherent, inconsistent, at full of contradictions, contrasts, and unexpected transitions: sentimental and poetic outbursts are interspersed with cynical expressions; into a serious business conversation, without any connection to its content, are inserted comic pranks, etc. To an even greater degree, the same features are manifested in their writing: sentences are incorrectly and carelessly connected, patients get lost in long periods, do not observe punctuation marks, their handwriting becomes uneven, and on the one hand, acquires a peculiar appearance from the careful execution of some special, intricate manner of writing, the use of flourishes, curls, etc., and on the other hand, in places strikes one by extreme carelessness. The combination of special elegance with striking carelessness generally represents one of the most characteristic features of the 'life style' of hebephrenics, manifested in all their manifestations: in clothing, manners, attitude to things, etc. The course of hebephrenia is irregular: acute hallucinatory-delusional attacks with confusion and agitation can sometimes quite unexpectedly give way to relatively good states with clear consciousness and return of a correct attitude to reality; however, even in these states, patients often continue to show both the general traces of the 'dementia-producing' process devastating their personality, and the specific features of hebephrenic behavior described above. In general, with this form, deep remissions are rare, and the final phase of the disease ('terminal dementia') sets in comparatively quickly, often taking the character of a complete emptying of the personality. It is also necessary to note that in many cases, hebephrenic features are found along with traits of other forms of schizophrenia (e.g., catatonic), which in individual attacks of the disease may even prove to be predominant.