Symptoms and treatment of schizophrenia

  The clinical symptoms of schizophrenia are complex and diverse, and can involve perception, thinking, emotion, volitional behavior, and cognitive function, etc. Symptoms vary greatly among individuals, and even the same patient may exhibit different symptoms at different stages or stages of the disease.  The most prominent perceptual disorders are hallucinations, including hallucinations of hearing, vision, smell, taste and touch, and hallucinations of hearing are the most common.  2. Thought disorder Thought disorder is the core symptom of schizophrenia, mainly including thought form disorder and thought content disorder. Thought form disorders are mainly manifested by thought association process disorders, including thought association activity process (amount, speed and form), thought association coherence and logic disorders. Delusions are the most common and important disorders of thought content. The most frequent delusions include delusions of victimization, delusions of relationship, delusions of influence, delusions of envy, delusions of exaggeration, and delusions of nonancestry. It is estimated that up to 80% of schizophrenic patients have delusions of victimization. Delusions of victimization can manifest as varying degrees of insecurity, such as being watched, rejected, fear of being drugged or murdered, etc. Under the influence of delusions, patients will engage in defensive or aggressive behavior. In addition, passive experiences are also more prominent in some patients and have an impact on patients’ thinking, emotions and behavior.  In addition, emotional symptoms such as incoherent excitement, irritability, depression and anxiety are also common.  4.Will and behavior disorders Most patients have a reduced will or even a lack of will, as evidenced by reduced activity, isolation, passive behavior, lack of motivation and initiative, reduced interest in work and study, lack of concern for the future, and no clear plans for the future, some patients may have some plans and intentions, but rarely implement them.  5. Cognitive dysfunction The incidence of cognitive deficits is high in patients with schizophrenia, with about 85% of patients showing cognitive deficits, such as information processing and selective attention, working memory, short-term memory and learning, and executive function. There is some correlation between cognitive deficit symptoms and other psychotic symptoms, such as cognitive deficit symptoms are more pronounced in patients with significant thought form impairment, cognitive deficit symptoms are more pronounced in patients with significant negative symptoms, and cognitive deficits may be associated with the production of certain positive symptoms. Cognitive deficits may occur before psychotic symptoms become explicit (e.g., prodromal phase), or they may decline sharply with the onset of psychotic symptoms, or they may decline gradually with the prolonged course of the illness, and it is tentatively believed that cognitive deficits are more pronounced in patients with chronic schizophrenia than in patients with first-episode schizophrenia.  Schizophrenia has a high relapse rate and disability rate, a high disease burden, and the disease course often manifests itself chronically prolonged, with most patients requiring long-term or even lifelong treatment and care. Therefore, reasonable and effective treatment can serve to improve the condition, promote patients’ recovery of daily life functions, better integrate into society, and promote family and social harmony. Generally, we follow the following treatment principles: 1. Clear diagnosis is a prerequisite for treatment: correct treatment depends on correct diagnosis, and for schizophrenia, repeated evidence-based diagnostic assessments must be used throughout the treatment process. This generally includes: ① comprehensive judgment at the time of initial consultation; ② repeated verification of the correctness of the diagnosis or revision of the original diagnosis through observation and reassessment during the subsequent treatment process; ③ longitudinal follow-up, and regular assessment of the severity of the disease, drug efficacy and adverse effects throughout the treatment process, and adjustment of the treatment plan when necessary.  2. Emphasize early intervention: ① early identification of disease signs and improve recognition ability; ② shorten the untreated period, once the suspicious cases are found, promptly seek treatment and get treatment as soon as possible; ③ adopt correct early intervention means.  3. Timely formulation and implementation of treatment plans: Once the diagnosis is clear, corresponding treatment plans (including short-term and long-term plans) should be formulated and implemented.  4.Individualized treatment: Each patient is a unique individual, and the principle of individualization should be taken in the selection of drug types and doses. The treatment plan for each patient needs to be formulated with multiple considerations and adjusted at any time according to the patient’s response to treatment.  5. Long-term treatment: Schizophrenia has a high relapse rate, so after treatment to control symptoms, it is necessary to continue long-term, standardized consolidation and maintenance treatment to prevent relapse of the disease.  6.Comprehensive treatment: The occurrence and development of mental illness is in turn closely related to specific biological, psychological and social factors. In recent years, emphasis has been placed not only on the treatment of core symptoms of schizophrenia, but also on the recovery of cognitive and social functions. Therefore, optimal medication treatment, together with psycho-behavioral treatment and social function rehabilitation, is indispensable.  Discontinuation of medication or irregular medication is a common cause of schizophrenia relapse; therefore, maintenance treatment is the main means of relapse prevention for patients with multiple relapses.