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Psychopathological roots of early schizophrenia: adolescent vulnerability, hebephrenia and heboidophrenia

Stanghellini, Giovanni

History and philosophy

Purpose of review This paper focuses on socio-emotional problems in early schizophrenia. According to recent empirical studies, difficulties in interpersonal relationships during childhood and adolescence are the strongest predictors of schizophrenia. This finding is traced back to its historical antecedents. By reconsidering the works of those psychopathologists, like Hecker, Kahlbaum and Kretschmer, who first worked out the idea that schizophrenia develops out of the vulnerable condition that is immanent in adolescence, the nature of social, emotional and interpersonal abnormalities is clarified.

Recent findings Building on recent empirical studies, a hypothetical identikit of at-risk adolescents is sketched, including five main psychopathological dimensions: difficulties in interpersonal relations, abnormal emotional contact, self-disorders, neurodevelopmental disorders, and neuropsychological disorders. Research supporting this identikit is reviewed.

Summary Matching recent empirical studies with early descriptions, the hypothesis that an adolescent having persistent difficulties in managing the emotional side of interpersonal relationships is a candidate for schizophrenia is discussed. The aim is to shed new light on the controversial concept of social and emotional dysfunction.

Department of Mental Health, University of Florence, Florence, Italy

Correspondence to Giovanni Stanghellini MD, Viale Don Minzoni 45, 50100 Florence, Italy Tel: +39 347 3790707; e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.