Schizophrenia is an extremely serious mental illness with a lack of connection to reality, the presence of hallucinations, delusions and abnormal thinking, and marked impairment of social functioning.
Schizophrenia is a worldwide public health problem with a prevalence of approximately close to 1%, although studies from different parts of the world are not entirely consistent. In the United States, hospitalizations for schizophrenia account for approximately 1/4 of hospital beds, and about 20% of people with disabilities are due to schizophrenia. The prevalence of schizophrenia is significantly higher than that of Alzheimer’s disease, diabetes mellitus and multiple sclerosis. Yang Mingzhe, psychiatry department, Guangzhou Brain Hospital
Many diseases have characteristics of schizophrenia. If it resembles schizophrenia but the symptoms last for less than 6 months, it is called schizophrenia-like disorder. If the psychotic symptoms last more than 1 day but less than 1 month, it is called transient psychotic disorder. If there is a predominantly psychotic disorder, such as mania and depression with typical symptoms of schizophrenia, it is called schizoaffective disorder. Patients with personality disorders can also have some of the symptoms of schizophrenia, but these symptoms are often less severe and do not meet the diagnostic criteria for psychosis and can be referred to as schizoid personality disorder.
I. Etiology
There is an obvious biological basis for the disorder, but the specific etiology is still unclear. Many scholars believe that the disease is susceptible, i.e., it occurs in people who are biologically susceptible. The causes of susceptibility are unknown and may include genetic factors, prenatal, intrapartum and postnatal injuries, and intracranial viral infections. A person with analytical and comprehension problems, difficulty concentrating, incomprehensible behavior, or poor coping with frustration may indicate susceptibility to the disease. Scholars who recognize the susceptibility of the disease believe that environmental stressors such as life events or substance abuse can trigger schizophrenia in susceptible individuals or contribute to recurrent episodes.
II. Symptoms
The peak age of onset of schizophrenia is 18–25 years in men and 26–45 years in women. However, it is not uncommon for patients to develop the disease in children or adolescents, as well as in later life. The disease can have an acute onset over days or weeks, or a slow or gradual onset over years.
The severity and presentation of symptoms varies from patient to patient. In general, the symptoms can be grouped into three groups: hallucinations and delusions, thought disorders and behavioral abnormalities, and negative symptoms. A patient can have one or all of these symptoms, which are often severe and significantly affect the patient’s work, interpersonal interactions, and even personal life care.
A delusion is a pathological belief, often a pathological interpretation of a personal perception or experience. For example, patients with this disease may experience delusions of victimization, believing that they are being tortured, stalked, teased, or spied on. Patients may also experience relational delusions, believing that the contents of books, newspapers, or songs are directed at or about them. Patients may also experience thought interruptions or thought insertion, believing that other people can know what is on their mind, or that their thoughts are being transmitted to others, or that certain thoughts and impulses are being imposed on them by outside forces. Patients with this disease may experience hallucinations of hearing, vision, smell, taste or touch, with hallucinations of hearing being the most common. The content of hallucinations can be talking to each other, commenting on their behavior, or critical or insulting remarks to the patient.
Thought disorder refers to disorganized thinking and is more pronounced in patients with this disease when they exhibit disorganized speech and switch from one topic to another without a central goal. The patient’s speech can be mildly disorganized or completely incoherent and incomprehensible. Behavioral disturbances can manifest as silly behavior, agitation, and uncomfortable appearance, hygiene, or behavior. Catatonic movements are an extreme form of conduct disorder in which the patient maintains a fixed posture and resists being moved, or exhibits purposeless and voluntary activity.
The negative symptoms of schizophrenia include emotional retardation, verbal poverty, pleasure deficit, and withdrawn nonconformity. Emotional dullness refers to flat affect, fixed facial activity, dull gaze, and lack of emotional expression in patients who do not experience and respond to normal human pleasure or pain; verbal paucity refers to a decrease in thinking activity reflected by a decrease in the amount of speech, simple, trivial answers to questions, and a paucity of inner activity; and pleasure deficit refers to a diminished ability to experience pleasure, little or no interest in prior activities, and spending much time Engaging in purposeless activities. Isolation and lack of meaningful connections with those around them. Behind these negative symptoms there is often a general lack of motivation and a lack of a sense of purpose or goal.
III. Types of schizophrenia
Some researchers consider schizophrenia to be a single disorder, while others consider schizophrenia to be a syndrome (collection of symptoms) that encompasses multiple disorders. In order to provide a uniform classification of the disorder, it has been divided into a number of subtypes. However, in the same patient, different subtypes can manifest over time.
1. Paranoid schizophrenia.
The main features are the presence of delusions and hallucinations, while disorganized speech and emotional discomfort are not the main symptoms.
2.Adolescent schizophrenia.
The main features are disorganized speech, abnormal behavior, and flat or uncomfortable emotions.
3, catatonic schizophrenia.
The main characteristics are manifestation of wood stiffness, increased activity or strange posture.
4. Unclassifiable schizophrenia.
The main feature is the presence of various subtypes, such as delusions, hallucinations, thought disorders and bizarre behavior, as well as multiple negative symptoms.
In recent years, schizophrenia has been classified as negative or positive based on the presence or absence of negative symptoms and their severity. Negative schizophrenia is dominated by negative symptoms, such as flat affect, lack of motivation and reduced sense of purpose, while positive schizophrenia is dominated by hallucinations and delusions, and negative symptoms are relatively uncommon. Overall, patients with positive schizophrenia have a slightly better prognosis, less disability, and better treatment outcomes.