A 46-year-old woman was admitted to the emergency unit because of sudden onset of abnormal behavior. Relatives said that she had started to behave strangely the day before “talking nonsense,” with ongoing laughter without apparent reason, confusion, and tiredness. She had complained about headaches a few days before, which was not unusual for her; otherwise, her medical history was unremarkable. She took an oral contraceptive.
On examination, she was somnolent without fever or stiffness of the neck. When aroused, she was disorientated and inattentive. Speech was incoherent without signs of aphasia. Affect was changed with flat reactions and inappropriate laughter when confronted with questions concerning her condition. Her behavior suggested the presence of visual hallucinations. She did not complain about headache. Psychiatric and neuropsychological symptoms were concordant with clinical criteria of International Classification of Diseases, 10th Revision (ICD-10) for the hebephrenic subcategory of schizophrenia (F20.1).1
Paus S, Urbach H, Klockgether T, Hartmann A. Acute Hebephrenia. Arch Neurol. 2005;62(8):1312-1313. doi:10.1001/archneur.62.8.1312