Schizophrenia is a group of psychiatric disorders of unknown etiology, most often starting in young adults, often with a slow onset, with multiple disorders of thought, emotion, behavior, and uncoordinated mental activity. There is usually no impairment of consciousness, but some patients may develop cognitive impairment during the course of the disease. The natural course of the disease is more prolonged, showing repeated aggravation or deterioration, and some patients eventually lead to mental decline.
I. Clinical manifestations that you need to know
1) Psychiatric symptoms: The symptoms of the disease are complex and varied, but clinical practice shows that in terms of the clinical features of schizophrenia, they can be divided into characteristic symptoms and other common symptoms. By characteristic symptoms, we mean that the patient’s mental activities are detached from reality, incongruent with the surrounding environment, and incongruent with basic mental activities such as thinking, emotion, and volition. Other common symptoms are the main symptoms in a certain type of stage of the disease. To a certain extent, they also reflect the characteristics of “schizophrenia”, such as hallucinations, delusions, and catatonia syndrome.
2) Recognizing the “telltale signs” of early schizophrenia
(1) Neurological disorders: headache, insomnia, dreaminess, wakefulness, loss of concentration, seminal emission, menstrual disorders, tiredness, and lack of energy.
(2) Personality change: A person who has always been gentle and calm suddenly becomes unreasonable, losing his temper over trivial matters, or being suspicious, thinking that everyone around him is having trouble with him, suspecting that he is talking about himself when he sees someone talking, or even suspecting that other people are coughing against him.
(3) Emotional abnormalities: laughing for no reason, becoming indifferent and distant to relatives and friends, i.e., not caring about others and ignoring others’ concern for him, or being nervous, anxious and afraid for no reason.
(4) The will is diminished: contrary to the original positive, enthusiastic, good and progressive state, become sloppy work, irresponsible, and even absenteeism, academic performance declined, do not pay attention to lectures, unwilling to hand in homework, and even truant; or life becomes lazy, grooming is not repaired, no enterprising spirit, get by, often day high three pole and embraced by not.
(5) Abnormal behavior and movement: the person is silent, hesitant, expressionless, or standing, sitting, staring, solitary, or cursing into the air, mumbling, or doing some inexplicable actions. If you find any of the above abnormal signs without a reasonable explanation and have a recent psychiatric history, you should pay great attention to them and seek timely examination and early treatment by a psychiatrist.
Second, you need to know the principles of treatment for schizophrenia.
1) Strive for maximum improvement: There is no cure for schizophrenia, but treatment can reduce or slowly resolve the disease and reduce the prevalence of other diseases and mortality. The goal of treatment is to reduce the frequency, severity, and psychosocial outcomes of relapses and to enhance psychosocial functioning in the interictal period;
2) Early detection and early treatment are advocated: the contributing or perpetuating factors of schizophrenia should be identified, and appropriate medication, psychotherapy and psychosocial rehabilitation should be applied. The latter is aimed at reducing stressful events and enabling patients to actively cooperate with treatment.
3) Promote comprehensive treatment: identify medications and other treatments, and develop a comprehensive treatment plan for the entire course.
4) Promote “individualized” treatment: Throughout the drug treatment process, attention should be paid to implementing the principle of “individualized” treatment. Efforts should be made to obtain the cooperation of patients and their families to enhance compliance with the treatment plan;
5) Promote a team approach: In addition to treating patients directly, psychiatrists often work as partners or mentors, working in teams with others to maximize social functioning and quality of life according to the needs of the patient;
6) Provide health education: Health education is provided in a manner appropriate to the patient and his or her family and should be provided throughout the treatment process.
7) Treatment of schizophrenia in all phases.
(1) Prodromal phase: Once the prodromal symptoms of schizophrenia are clearly identified, they should be treated immediately. Drugs can be used for the prodromal phase, aura attacks, or the prevention and treatment of acute onset as well as to improve intermittent symptoms.
(2) Acute phase.
①Try to alleviate and relieve acute symptoms and rebuild and restore the patient’s social function;
(2) Antipsychotics should be used as early as possible. Classical antipsychotics, as well as risperidone and olanzapine, should be used as first-line drugs. In case of non-compliance, intramuscular or intravenous drip administration may be used;
(iii) Other drugs may be used when an antipsychotic is not effective, such as carbamazepine, valproate, benzodiazepines, and second-line drugs such as clozapine;
④Electroconvulsive therapy (ECT) can be used as a backup when catatonia, medication is ineffective, or when there are contraindications.
(3) Recovery period.
① Reduce the stress on the patient, improve the symptoms, reduce the possibility of relapse and enhance the patient’s ability to adapt to community life. If an antipsychotic has brought about remission, it should be continued for 6 months with the same dose and then considered for maintenance treatment;
②Psychotherapy plays a supportive role;
(3) Attention should be paid to over-pressuring the patient to complete high-level occupational work or to implement social functions, which can increase the risk of relapse.
(4) Rehabilitation period.
①Ensure that the patient maintains and improves the level of function and quality of life, so that prodromal symptoms or gradual onset of schizophrenic symptoms are effectively treated, and continue to monitor treatment side effects;
② Once early symptoms appear, timely intervention should be made;
(iii) Antipsychotics: Long-term medication treatment plans should be weighed against the risk of adverse drug reactions and relapse. After 1 year of maintenance treatment for first-episode patients, the medication can be discontinued on a trial basis.
For patients with multiple recurrent episodes, maintenance treatment should be given for at least 5 years or even for life.
(5) Intermittent period.
Even if the patient is completely cured, care and support should still be given during the interval of resuming work and study. Reduce psychological stress. Once signs of recurrence are detected, prompt consultation and treatment should be provided.