Disorganization in early psychosis: historical and clinical considerations

In the last two decades, the resurgence of the “late neurodevelopment” hypothesis of psychosis has brought into focus Kahlbaum’s and Hecker’s clinical reports of adolescents who, as a result of a loss of psychic energy, showed a rapidly progressive cognitive impairment leading to functional and behavioral disorganization. In line with their psychopathological descriptions of hebephrenia and heboidophrenia, disorganization could represent a core clinical dimension of early psychosis, especially during its prodromal stages (such as in people with ARMS) and during adolescence. Although under-investigated, disorganized features seem to be associated with early neurobiological alterations, functioning decline, and poorer outcomes and prognosis. Greater clinical attention on disorganization in young help-seeking individuals from researchers and clinicians is thus needed. This paper first summarized past conceptualization of heboidophrenia and hebephrenia as developmental illnesses. Moreover, a literature search was conducted on PUBMED/MEDLINE and PsycInfo, looking for “disorganization” AND “early psychosis” OR “ultra-high risk”, OR “clinical high risk” for psychosis. We then discussed recent clinical and neurobiological findings on disorganization in individuals with early psychosis, highlighting its prognostic significance.