In my clinical work, I have some experiences about the diagnosis and treatment of diseases, and I would like to share them with you here in the hope that they will help you in seeking medical treatment. I recommend reading this article first:
This is how I diagnose psychiatric disorders and what to expect from patients’ families
In my clinical work, I have some experience in the diagnosis and treatment of psychiatric disorders, and I would like to share it with you in the hope that it will help you to seek medical treatment.
I: The principle of prevention
As the ancient saying goes, “The best doctor treats the disease before it happens”, which means that the best doctor is to prevent people from getting diseases when they are not sick. Prevention is the most important thing, and this principle is suitable for all diseases.
In the case of mental illness, prevention can begin in the following ways.
First of all, to improve the psychological quality of each of us, improve our ability to cope with frustration, stress, sound personality, cultivate hobbies, moderate catharsis, work and rest, the work and life should be reasonably separated. We hope that each of us should not be: too strong, too perfect, too pursuing, too persistent, too serious, too caring, too capable, too good, too perfect.
Too capable, too good, perfecting bad character is fundamental to improve the individual’s ability to resist stress and maintain physical and mental health.
For adults, it is important to be aware of their own shortcomings and improve them in order to better adapt to the environment and society. To “be happy when you hear about your faults” and “correct them if you have them, but not if you don’t”, so that you can develop the following quotients.
”Guts quotient: independence, sense of autonomy, self-confidence, boldness.
”Adversity quotient”: the ability to cope with pressure, difficulties, frustration and criticism.
”Emotional intelligence”: interpersonal interaction, emotional development.
”moral quotient”: the cultivation of moral qualities such as respect, tolerance, honesty and courtesy
”IQ”: the cultivation of logical thinking and interest in learning.
For parents, cultivating the above five quotients in their children allows them to grow up independently, freely and naturally. Let your child have a good personality is the main thing, do not neglect the training of children’s independence and autonomy, do not spoil your child, that is “harm”, let your child have a good personality, good mental quality, far more important than buying him high class toys, wear expensive clothes. In the process of raising children, the role of parents is to “guide and direct”, in the process of child development need to pay attention to.
1. focus on achievement (intelligence) rather than quality.
2, only focus on success and not failure (failure is the mother of success).
3, only focus on the physical and not the psychological.
4.Focusing on the child instead of the parents.
5, focusing on the local rather than the whole
6.Concerned only with the present but not with the future
7.Concerned only with nutrition but not with exercise (behavior)
8. Focusing on the image but not the heart.
The measure of success in education is not 100 points on the test or a prestigious school, but: raising children to be adults who realize their self-worth, who are needed by society, and who feel happy themselves. Raising a child is not about focusing on the shortcomings in him, but recognizing and shaping the strongest in him, the best things he has, and turning those best qualities into the motivation that promotes their happy lives!
The direction of education is not only focused on intellectual education, but also on the orientation of everyone toward learning, work, and life. Emotions. Emotional interest, marriage. Family and other directions of integrated development.
Secondly, we should equip ourselves with the knowledge of mental health, such as what is depression? What is schizophrenia? How to diagnose and treat? You can buy such popular science books to learn, and with the knowledge, you can achieve early detection and diagnosis as well as early treatment.
The innate foundation of mental health is: family education, and the acquired foundation is self-growth.
My teacher, Professor Wang Weidong, believes that the main causes of poor personality are
1, the lack of family education during the growth process causes abnormal development of personality deficiency
2. Excessive bad stimulation in the process of growing up, resulting in abnormal development of personality deviation.
3. Insufficient self-growth in the process of individual growth, resulting in abnormal personality development.
If we use a big tree as a metaphor for personality, it means that the branches that should grow out do not grow out, the branches grow crooked, and we fail to trim the branches, which is like a big tree of personality growing crooked, growing less, and having a bad personality.
Second: the principle of early detection, early diagnosis and early treatment.
In clinical work, often met with the disease for several years, in the general hospital repeatedly examined and not cured patients, and finally came to the psychiatric consultation, only to get the correct diagnosis and treatment, both a lot of financial resources wasted and delayed treatment, for patients caused a great loss. Most of the reasons for this are that they do not know that they are mentally ill and need to see a psychiatrist. Others have misconceptions about psychiatry and feel ashamed to see it.
Generally speaking, the earlier the diagnosis is made and the earlier the medication is administered, the better the recovery and the higher the cure rate, while on the contrary, the longer the onset and the later the visit, the worse the recovery and the lower the cure rate. Therefore, it is the best choice to acquire more knowledge about mental health and come to see a doctor in time.
We all need to treat patients with mental illnesses correctly, mental illnesses and fever, are essentially diseases, no one wants to get sick, sickness requires us all to care for patients, do not discriminate against patients, to create a good recovery environment for patients, to know that many patients recovered well after treatment, made a great contribution, such as the famous American Nobel Prize in Economics For example, John Nash, the famous American economist who won the Nobel Prize in economics, was a schizophrenic himself and fought with the disease for his whole life and made extraordinary achievements.
With early detection, diagnosis and treatment, patients can recover better.
Third: the principle of systematic treatment.
When a patient is diagnosed, medication is generally essential, and when the condition is under control, many patients and families stop the medication, with the predictable result that relapse soon follows. Why? This is because mental illness is very different from physical illness. Many mental illnesses are chronic and prone to relapse, such as schizophrenia, bipolar disorder, depression, etc., which require long-term, systematic medication to maintain a healthy state, just like hypertension and diabetes, which require long-term medication to maintain treatment. Discontinuation and reduction of medication requires the consent of the doctor.
I often encounter old schizophrenic patients who have been ill for decades, who come to the clinic to be prescribed medication on their own, who are in a good mental state, who can do housework, and who did a good job when they were young. Patients with poor compliance tend to have poor mental status and relapse from time to time.
Systematic drug therapy means: taking the medication for a sufficient period of time, taking the medication in sufficient doses, assessing the efficacy of the treatment by the doctor, and adjusting the treatment plan if necessary: increasing the dose, changing the medication, and combining medications. After the illness is cured, the patient must take medication for a longer period of time to prevent relapse, depending on the patient’s diagnosis and previous illness, as recommended by the treating physician. Generally speaking, schizophrenia and bipolar disorder require long-term medication. For depression, it takes 2-3 years to take medication for the first time, 3-5 years for two times, and three times for long-term medication.
It is not advisable to reduce the dosage and stop the medication at will, nor is it advisable to change the medication at will. It is not scientific to evaluate the efficacy of medication if it has not been taken long enough, because most psychiatric drugs such as antidepressants, antipsychotics, and anticompulsive drugs take several weeks to take effect, and 8 weeks or more if the effect is obvious. Note that the general principle of taking psychotropic drugs is: start taking small doses and slowly increase the dosage over several days, and reduce the medication as well, slowly reduce the dosage over several days, and if you change the medication, you should not suddenly reduce and add, it is best to slowly reduce the old medication and slowly add the new one, and take both drugs together to minimize the withdrawal reaction. Sometimes, the process of drug reduction will find that the combination of drugs is more effective, you can follow this program of medication at this time, perhaps using the metaphor of a willow will grow.
Fourth: the principle of individualized drug therapy
The principle of individualization of drug therapy means that different patients, even if they have the same diagnosis, the same age and sex, and the same physical condition, will have significant differences in the effect of drug therapy, the dosage of drug effect, and the side effects of drugs will also be very different. The reason for the difference may be related to genetic factors. I have a patient oral clozapine 600mg a day, the dose is very large, is the maximum dose of the instructions, the effect is very bad, adverse drug reactions are not obvious, a check of the blood concentration of less than 100ng/ml, relatively low; while another patient oral clozapine only 200mg a day, the blood concentration is 300ng/ml, the effect is good, the side effects also came out, this is the individualized differences. Why is there such a big difference in efficacy and blood concentration? The following factors are related to.
1. Individuals are different, drug metabolism is different, blood concentration is different, the concentration of drugs entering the brain is different, thus the efficacy and side effects are different.
2. Different individuals, different causes of pathogenesis, pathological changes in the brain, different changes in brain transmitters and receptors, different sensitivity of individuals to drugs, and thus different efficacy.
First of all, let’s talk about how drugs are metabolized: after oral drugs are absorbed through the gastrointestinal tract, they first come to the liver and are metabolized in the liver, which is responsible for metabolizing drugs called hepatic enzymes. The activity of liver drug enzymes affects the blood concentration of drugs, there are many kinds of liver drug enzymes, responsible for metabolizing different drugs, metabolizing psychiatric drugs are generally 2D6, 3A4, 1A2, etc. The activity of liver drug enzymes is different for different people, the concentration of drugs is low for individuals with strong liver drug enzyme activity, and high for individuals with low liver drug enzyme activity, which causes the difference between taking the same drug dose and The blood drug concentration varies greatly, and this enzyme activity depends mainly on genes. It is best to measure the blood concentration while taking psychiatric drugs to help the doctor adjust the drug dose and program according to the blood concentration, if there is no condition to measure the blood concentration, you can indirectly speculate whether the blood concentration is high through adverse drug reactions. Injections are not absorbed by the gastrointestinal tract and do not have the metabolism of liver drug enzymes, so generally speaking, the effect may be faster and the dose needed is smaller than that of oral tablets.
There are two types of drug effects on liver drug enzymes: an inhibitor, which causes a decrease in enzyme activity and an increase in drug concentration, and an inducer, which causes an increase in liver drug enzyme activity and a decrease in drug concentration. For example, aripiprazole and fluoxetine are both metabolized by hepatic enzyme 2D6, and fluoxetine is an inhibitor of 2D6, which will lead to a decrease in metabolism of aripiprazole when they are combined, thus increasing the blood concentration of aripiprazole. Sometimes there is a clinical phenomenon: the dose of the drug eaten is very small, the efficacy is good, just reduce half a tablet, the effect is very poor, may be with individual metabolism of drugs is slow, taking a small dose of drugs blood concentration is higher; and some patients eat a large dose of drugs, the effect is not good, may be too strong liver drug enzyme activity, drugs are metabolized, not much drugs into the brain, natural effect is not good.
Individuals have different causes, different pathological changes in the brain, different brain transmitters and receptors, and different sensitivity to drugs, resulting in different efficacy: as the saying goes, “nine sons of a dragon are born, and the sons are different”. It is generally believed that depression is mainly due to the deficiency of neurotransmitters in the brain: 5-HT, NE and DA, but some patients may have a deficiency of 5-HT and some patients may have a deficiency of NE, which can cause huge differences in the efficacy and side effects of the same drugs for different patients.
Family members and patients should learn a little bit about this, carefully observe the changes in their condition and the situation after taking the medication, maintain close communication with the doctor, and adjust the plan in time to maximize the efficacy and minimize the side effects.
As for which drug is suitable for each patient, we should consider the patient’s condition, previous medication experience and the effect after taking the drug, the patient’s tolerance of the drug, side effects, and also consider the patient’s economic situation, and then make a decision after comprehensive consideration, and then follow up with the patient, during the treatment period, the family should closely check the patient’s performance, and regularly make the corresponding laboratory tests and examinations, so that problems can be found and solved in time. Adjust the treatment plan at any time, so that the patient gradually towards recovery.
For each patient, no matter what kind of medicine you take, as long as you eat the effect is good, the side effects are small, this is good medicine. There is no inevitable connection between the efficacy of the drug and the price, expensive drugs are not particularly effective, cheap drugs are not necessarily bad, the efficacy of the drug itself is related to the characteristics of the drug, but also varies from person to person.
As for the difference between imported and domestic drugs: the same drug is both imported and domestic, generally speaking, imported drugs refer to the original drug, the quality is better, if the economy is not a problem, eat imported drugs is the first choice, if you consider the cost, domestic drugs are more affordable, economic conditions are not so good, or eat domestic drugs can be. Generally large domestic drug manufacturers, the quality is still good, rational treatment of imported and domestic drugs can be.
Five: the principle of relapse prevention
Mental illnesses such as schizophrenia, depression, and bipolar disorder are more prone to relapse, and generally speaking: drugs, seasons, adverse stimuli, and poor personality are common causes of relapse.
Reasons for medication: For example, unexplained discontinuation or reduction of medication, patients and family members not realizing the need to adhere to medication, or side effects being too great, or economic conditions not being affordable, etc., all affect patients’ adherence to medication. Patients and family members should realize the importance and necessity of adhering to medication, and communicate with doctors about side effects and other problems that occur during treatment, so that they can find a treatment plan that is suitable for the patient as much as possible and create a good recovery environment for the patient. It is important to pay high attention to the side effects of drugs, both doctors and family members, as much as to the therapeutic effects of drugs, because side effects can seriously interfere with patients’ compliance with medication. My view is that the side effects of medications are as important, if not more important, than the therapeutic effects of medications. When I teach students, I often remind them that it is more important to give high priority to the side effects of medications and their management than to remember the therapeutic effects of medications.
Seasonal factors: Generally speaking, spring is the season when schizophrenia and mania are prone to relapse; late autumn and early winter are the seasons when depression is prone to relapse, which is related to the short time of light. If the patient has a seasonal pattern of onset, we should increase the dose of medication in advance and pay close attention to the relapse aura: insomnia, mood instability, abnormal behavior, etc.
Adverse stimuli: Give the patient a good recovery environment, good support, more communication and more exchanges, improve the patient’s ability to cope with adverse events and avoid the stimulation of adverse events.
Bad personality: from clinical experience, patients with good personality, good prognosis, bad personality, bad prognosis, easy to relapse, so character perfection, self-growth, family members to help patients improve their character, may be the most important part of relapse prevention, to improve the psychological quality of each of us, improve our ability to cope with frustration, stress, sound personality, hobbies, moderate catharsis of stress, work and rest. To do more activities that are beneficial to physical and mental health; to be able to realize their own shortcomings, and to improve, so as to better adapt to the environment and society. We should be able to be aware of our own shortcomings and improve them so that we can better adapt to the environment and society. We should also improve our “courage quotient”: independence, sense of autonomy, self-confidence and boldness; “adversity quotient”: coping with stress, self-confidence and boldness. Adversity quotient”: the ability to cope with stress, difficulties, frustration and criticism; “emotional quotient”: interpersonal communication, emotional training; “moral quotient”: respect, tolerance, honesty, courtesy and other moral qualities of training
IQ”: the cultivation of logical thinking and interest in learning.
Sixth: the principle of never giving up
When a family has a mental illness, it can be very unfortunate, the family has to pay energy, money, time, get may be suffering, the patient does not cure. As a psychiatrist, I understand you very well, at the same time, I am also deeply aware: you family members are the main force in the treatment and rehabilitation of patients, to care for patients, observe the condition, monitor the medication, medical care, buy drugs, encourage patients, pay a lot, as a doctor respect you, I hope we never give up, to persist, after all, technology and then develop, new drugs and new treatments are constantly emerging, we work together to find the right patient. We work together to find the right program for patients, as long as we can make a little progress, is our success.