Disease Awareness
Mental disorder is a serious “heart disease”
Nannon: mental illness is divided into serious and minor, the commonly referred to psychological problems also belong to the category of mental illness?
Peng Hongjun: This concept should be reversed, the scope of psychological problems is much larger, including general psychological problems and mental disorders (severe mental illness). In China, severe mental illnesses such as schizophrenia and depression account for 1-1.5 percent of the population, or about 16 million people; more are mild mental disorders, such as neurosis, and psychological problems of varying degrees.
Theoretically, more than 80% of people may have one or another psychological problem in their lifetime, most of them can overcome it through self-regulation, but some of them cannot relieve stress effectively and do not receive enough social support, and finally develop into mental disorders.
Nannon: What are the psychiatric disorders that are less typical and easy to be ignored? How should family members detect abnormalities?
Peng Hongjun: Some patients with anxiety and depression are initially unaware that they have psychological problems, manifesting as somatization symptoms such as headache, panic, dyspnea or local discomfort, and go to internal medicine for various tests repeatedly, but no disease is detected, and only then are they finally found to have psychological problems.
Another situation that can be easily overlooked is to ignore the high recurrence of mental illness. After a patient is discharged from the hospital, he or she does not follow the medical advice to consolidate treatment or regular outpatient review, and is not sent to the hospital for medical treatment until the patient develops obvious babbling and behavioral disorders (e.g., obvious abnormalities such as undressing and vandalism). Families need to be reminded that for patients recovering from mental illness, close attention should be paid to their sleep and emotional changes. If the patient sleeps poorly, is prone to temper tantrums, and is sensitive and suspicious, it is most likely a precursor to relapse, and it is recommended that they be brought to the outpatient clinic for review.
Nannon: For severe mental illnesses that may endanger the safety of society, the state has incorporated public health services for unified management. But there are still most patients with mild to moderate mental illness, especially at the grassroots level, and not many of these patients actively seek medical treatment.
Peng Hongjun: At the grassroots level, there are still some patients who refuse psychological treatment due to a sense of stigma and lack of relevant knowledge. The most important thing is to popularize the common mental illnesses and their manifestations, so that people can check if they have such conditions and family members can identify whether their loved ones have mental disorders at an early stage.
In addition, there may not always be a psychology department in the primary hospital. It is recommended that patients with somatic symptoms but unsatisfactory treatment and suspected psychological problems can first be seen in the appropriate internal medicine department. Currently, China has strengthened the training of primary care physicians, and many of them are able to identify psychiatric problems and can provide patients with proper medical guidance.
Treatment response
Early psychiatric consultation is recommended
Nannon: How are psychiatry departments generally divided? How to seek medical treatment more targeted?
Peng Hongjun: If we distinguish by age group, we generally divide into geriatric, adult and pediatric psychiatry. Geriatric psychiatric disorders are often accompanied by organic diseases, such as cerebrovascular disease, tumors, pituitary abnormalities, dementia, etc. Treatment not only requires both mental and physical, but also requires higher care, sometimes with cognitive and somatic function training.
Adult psychiatric disorders include schizophrenia, depression, mania, bipolar disorder, etc. Childhood psychiatric disorders are more often ADHD, autism, mood disorders, etc. For children, different treatments are usually required for different conditions, such as a combination of medication, psychological counseling and play therapy.
In addition, there are acute areas (such as our early intervention area) and chronic areas, depending on the severity of the illness. Patients with the first, acute onset of mental disorders are generally sent to the early intervention ward; those with multiple recurrent episodes requiring long-term hospitalization can stay in the chronic ward (such as our Jiangcun branch), and the chronic ward targets chronic patients, carrying out recreation and rehabilitation (such as handicrafts, sewing, vegetable gardening and other activities) to help patients fully recover.
Nannon: Is it better to take medication or to “chat” with a psychologist when psychological problems arise?
Peng Hongjun: Drugs, psychological counseling and physical therapy are called the “three magic weapons” of psychiatry, and the type of treatment used depends on the individual patient. Generally speaking, patients with acute episodes of severe mental illness, usually with severe insomnia, excitement, noise, babbling or impulsive injury, self-injurious behavior, should be treated mainly with medication; when the condition is controlled, excitement and agitation of psychiatric symptoms significantly improved, and can receive effective communication, in addition to maintaining medication, psychotherapy should also follow in a timely manner.
For psychological problems or mental illnesses that are obviously triggered by social and family factors, psychotherapy is the main treatment, combined with medication and other treatments. However, for some special types of psychiatric disorders, such as endogenous depression, when no obvious social stressors can be found, medication is recommended as the main treatment, supplemented by psychotherapy. In general, the focus of treatment varies for different patients, but in many cases, a combination of several treatments is more effective.
Nannon: It is said that “heart disease requires heart medicine,” but is it necessary to seek medical treatment when a suspected mental illness is detected? Can mild mental illness heal itself by getting care or satisfaction?
Peng Hongjun: In principle, early detection, early diagnosis, and early treatment of psychiatric disorders, as well as early intervention in the early stages of the disease, can prevent aggravation, reduce the risk of impulsive injury and self-injury, and reduce the rate of mental disability of patients. Two conditions require special attention: (1) occult depression, which may be a risk of suicide if not detected in time; (2) the longer schizophrenia is delayed, the less effective the treatment will be. 1/3 of patients in clinical practice end up with personality regression and reduced social functioning, becoming mentally disabled, which is a heavy burden for the family.
As the public’s demand for quality of life increases and they gradually realize the importance of mental health, it is advisable for patients with psychological problems to seek psychiatric consultation at an early stage, if possible. Psychotherapy combined with medication can usually achieve better results. Also, support and encouragement from family and friends can be an important factor in the improvement of the condition. There are indeed some clinical cases where the disease remits on its own without medication, or even for life, through rest, self-regulation, effective communication with family members, and more social support.
Family care
Respectful care + careful observation
Nannon: How do family members communicate with mentally ill people at home? What are the details that need special attention?
Peng Hongjun: Most of the psychiatric patients still have a sense of shame, the family should first of all unconditionally accept them and respect them. There is also care and support, some patients have recurring episodes and a long course of illness, family members should pay close attention to changes in their condition, supervise medication, medical consultation, and communicate with them more, which will help a lot in the recovery of the disease.
There are several aspects that family members need to pay attention to when accompanying patients with psycho-psychiatric problems.
(1) Children and adolescents with psycho-psychiatric problems are often closely related to internal family relationships and parenting styles. The symptoms they show are actually a protest against their parents, and the treatment process suggests that in addition to psychological counseling, family therapy should also be carried out, and parents should appropriately change their education style, improve family relationships, and learn to communicate with their children.
(2) For patients with depression, it is most crucial for family members to observe carefully and understand their true inner world to prevent suicide. Some depression suicidal thinking and behavior is very secretive, so that people can not be defended.
(3) Patients with schizophrenia may be impulsively injured under the domination of delusions, and family members should prevent patients from hurting themselves or others.
Nannon: What can family members do to cooperate with patients during their recovery?
Pang Hongjun: After psychiatric patients are discharged from the hospital and return home, some still need long-term consolidation treatment, maintaining 1/2-1/3 of the treatment period medication, family members should supervise them to take their medication on time and bring them for monthly follow-up. In addition, creating a good family atmosphere and encouraging them to engage in less stressful jobs will help them to return to society.
Family members should pay more attention to the patient. If insomnia, irritability, sensitivity and suspiciousness, and strange behavior appear, they may be the precursors of psychiatric relapse, and early recognition and timely and effective measures can often significantly improve the prognosis of the disease.
Nannon: Some family members worry that antipsychotic drugs will make the patient dull and physically deteriorate.
Pang Hongjun: Since the birth of the first psychotropic drug Thorazine in the 1950s, many new drugs have been developed one after another, and in general the efficacy is getting better and the side effects are less. What needs to be clarified is that antipsychotics themselves do not have a significant impact on intelligence, and there is no such thing as dulling the patient, and many drugs can now improve the patient’s cognitive function, making concentration and thinking more fluid. It is only that some antipsychotic drugs have side effects such as extrapyramidal system, patients may appear dull expression, drooling, dull gaze, hand trembling and other manifestations, but the current new drugs generally have fewer side effects, plus other drugs can be used to counteract such side effects, there are few patients appear the previous dull performance.
Nannon: Families of patients with mental illness not only have to bear the huge financial pressure caused by the medical treatment of the disease, but also may have to endure various sudden mental and even physical injuries during the patient’s attack. How should family members protect themselves from the “contagion” of mental illness on a daily basis?
Peng Hongjun: Family members are definitely affected by mental illness, and for family members, psychiatric patients are a chronic stressor, and many family members experience anxiety and depression. While accompanying the patient, family members should pay attention to self-regulation, for example, they can do some stress reduction, relaxation exercises, or participate in some social activities, or see a psychiatrist if necessary.
Common clinical psychiatric disorders
Depression]
Mainly manifested as a bad mood, lack of interest in anything, patients often say that they are not happy, sad face all day, slow thinking, slow reaction, talk less, energy fatigue, inactivity, insomnia, appetite loss, weight loss, serious self-blame and self-culpability, and even suicidal behavior.
OCD]
Thoughts, ideas or impulses that appear repeatedly in the patient’s mind in a stereotyped form, repeatedly thinking about meaningless things, such as repeatedly wondering if they said the wrong thing and repeatedly asking others what they said; repeatedly wondering if they did the wrong thing and repeatedly checking its correctness; repeatedly recalling something that happened before; repeatedly worrying that they will be infected by some kind of bacteria and poison and repeatedly washing their hands, bathing, and Washing clothes.
These thoughts come from within the patient, and the patient feels painful about them, but cannot control them.
Schizophrenia]
It usually starts in young adults and is characterized by psychosis, mania, hallucinations and delusions, excitement and agitation, hitting and destroying things, and depression and paranoia.
The paranoid type is characterized by hearing voices out of thin air, sensitivity and paranoia, and gradually develops into exaggerated, victimized and other delusions, and most patients indulge in hallucinations or delusions and do not get in touch with people around them. The adolescent type is characterized by increased speech, emotional moodiness, disorganized behavior, childishness and peculiarities. The nervous type mainly shows slow movements, little speech and little movement, maintaining a certain posture for a long time or just the opposite, impulsive behavior, incomprehensible, smashing things, hurting and destroying things, etc. The monotypic type is characterized by isolation, passivity, reduced activity, lazy life, gradual emotional indifference, and increasing detachment from real life.
Autism]
Autism, also known as autism, is a pervasive developmental disorder with a wide range of symptoms. The child often lacks eye contact with others, and does not use facial expressions, gestures and postures to communicate with others; the tone, stress, speed and rhythm of speech are abnormal, and often makes strange noises. The only way to communicate with peers is by pulling, pushing and hugging. They are indifferent, lack interest in group games, are lonely, self-indulgent, have limited interests, and often behave in a self-stimulating, self-harming, or stereotypical, eccentric manner.
Dementia]
There are two types of dementia: vascular dementia and senile dementia, both of which share the common manifestation of increasing difficulty in reversing the loss of intelligence and memory, and in severe cases, the person does not recognize his or her home or family, and for this reason often wanders off, even unable to take care of himself or herself and unable to control his or her bowels.
Anxiety disorder
The performance of sudden onset of extreme tension, fear, palpitations, choking feeling, fear that they will go crazy or die, near-death feeling, so that the alarm, call for help (panic attacks); or performance of frequent, continuous, no reason, and do not know what for the tension, worry, rubbing hands and feet, walking back and forth, etc..
[Insomnia].
It is a condition of dissatisfaction with the quality and quantity of sleep for a long period of time, which can be difficult to fall asleep, poor sleep, easy to wake up, dreamy, waking up early, not easy to fall back to sleep after waking up, discomfort after waking up, fatigue, or daytime sleepiness. Insomnia can cause anxiety, depression, or fear in patients, and lead to a decrease in the efficiency of mental activities and hinder social functions.
Mania]
Mania is characterized by: (1) high mood and/or irritability; (2) racing thoughts; (3) increased volition. There is often a reduced need for sleep, increased appetite and sexual desire. The duration of the disease is more than one week.