I. What is schizophrenia?
Schizophrenia, called “thought disorder” in Taiwan, is a common mental illness whose cause is not fully understood, and is one of the most serious diseases in the mental health profession. It usually starts in young adults and often has disorders of perception, cognition, thinking, emotion and behavior. As the disease progresses, it becomes chronic, with a high relapse rate and disability rate. Approximately 75% of patients experience varying degrees of social deficits during the chronic phase and are unable to fulfill their responsibilities to family and society.
The etiology of the disease is still not well understood, but it is believed that genetic factors account for 80% and environmental factors for 20%. Prenatal infections, famine, low birth weight, poor urban environment, and childhood trauma may all be involved in the pathogenesis. The neurodevelopmental hypothesis suggests that schizophrenia is an encephalopathy in which causative factors interfere with the normal early developmental processes of the brain and that abnormal neurodevelopment leads to the onset of the disease in individuals in late adolescence or early adulthood.
There is also the hypothesis that it is a degenerative brain disease (a disease state with loss of neurons in the brain and spinal cord), and numerous imaging studies confirm the presence of structural brain damage in patients, with changes in whole brain gray matter, frontal gray matter, temporal and parietal gray matter, frontal white matter, decreased cortical thickness, and enlarged lateral ventricles. More than one disease, the brain parenchyma is bad once and full recovery is difficult.
The symptoms of the disease are diverse (patients can have only some of the symptoms), including: paranoia, thinking that others talk about or scold them, sudden distrust of loved ones for no reason, thinking that someone is against them or their family; suspicion that someone is following, watching or controlling them; sniffing words out of thin air; feeling that what they think others know and that they cannot help themselves; learning decline, attention and memory loss, dullness; significant personality changes, detachment from friends, laughing at themselves for no reason or The patient’s personality changes significantly, detaching from friends, laughing or losing temper for no reason; strange thoughts and behaviors; withdrawal, laziness, isolation, childishness, etc.
Patients often have more pronounced impairments in cognitive functions such as attention, memory, information processing speed, and executive functions, with impairments in information processing speed being the key feature, causing impairments in learning, work, interpersonal, and life functions, and these impairments gradually worsen over the course of the illness.
Nevertheless, we have to believe that schizophrenia can be treated, and more than 60% of patients can obtain clinical results through standardized comprehensive treatment, which includes medication, physical, psychological and industrial recreation, and also requires the care, attention, tolerance and support of family and friends. However, schizophrenia has its own disease pattern, and it takes some time to see obvious results, so doctors, patients and family members must have enough patience. Moreover, as with chronic diseases such as hypertension and diabetes, the idea of a “one-time cure” or “no more attacks for life” is not very realistic. Even after standard treatment, some patients may not have the desired effect, and there are great individual differences in response to treatment.
The disease has a high relapse rate, with studies showing that Chinese patients with schizophrenia have a relapse rate of 40.8% 1 year after discharge and an average relapse time of 6 months. 60% of patients are unable to study and work normally. Without treatment, 60%-70% relapse within 1 year and 90% relapse within 2 years. Even a 30-day interruption in treatment a year can increase the risk of relapse by 300%, and most patients will experience several relapses. If treatment is adhered to and maintained for 2 years without relapse, the chances of relapse will be reduced.
Second, what are the hazards of relapse
1. Progressive reduction of gray matter in the brain due to recurrence
The 5-year multiple seizure cranial magnetic images showed a significant reduction of gray matter in the brain compared to the healthy group at baseline.
Recurrent seizures can cause brain atrophy, ventricular and cerebral sulci enlargement, so that cognitive function, IQ progressive decline, learning, work ability reduced, life ability and social function is getting worse.
2.Recurrence prolongs the time of symptom relief
The more the number of relapses, the longer the recovery time. The recovery time of the first relapse is extended by 47 days, the second relapse by 76 days, and the third relapse by 130 days.
And with the increase in the number of relapses, it will require a greater dose of treatment than before to make the disease remit, and some even difficult to remit. Compared with the first relapse, 14.4% of relapsers resist treatment and the effect is poor.
3. Relapses can increase the economic burden on families Recurrent attacks of the disease can have the following consequences on life.
Recurrent attacks put a heavy financial burden on the patient’s family, and the costs incurred due to recurrence are much greater than the annual expenses for adhering to the medication. Recurrent attacks also bring heavy psychological and psychological burden to the family, the burden of care and missed work.
4. Relapses lead to poor long-term prognosis of the disease
The first relapse of schizophrenia brings about a serious impact on social functioning, and each subsequent relapse further impairs social functioning, as shown in the following figure.
Third, what are the causes of relapse
The causes of relapse are as follows, and interruption of treatment is the main cause of relapse!
Relapse prevention is the fundamental way to help patients improve their function to return to society!
Four, the prevention of recurrence of the six major treasures
1, adhere to drug therapy: patients relapse of the disease for many reasons, the most important reason is interruption of treatment. Adhere to medication is the most effective relapse prevention measures, please patients and family members must pay attention to this point!
2, family support and care: in the prevention of relapse, the family should bear more responsibility to help solve the difficulties in family and social life. For example: remind to take medication on time; observe emotional changes at any time; provide a quiet and comfortable living environment; take the initiative to maintain communication with the doctor; relieve anxiety and confusion in the patient’s mind, etc.
3.Rehabilitation or functional training: giving patients appropriate medication while carrying out systematic social function rehabilitation training can effectively prevent disease relapse and increase the possibility of rejoining society. For example, daily activity training, family life skills training, appropriate physical exercise and recreational activities, social interaction skills training, etc.
4.Regular follow-up: The disease cycle is slow, and areas of life that are not noticed may stimulate the patient and lead to relapse. Under the premise of maintaining treatment, regular follow-up visits to the hospital, under the guidance of professionals, can better maintain the stability of the disease.
5, identify early symptoms of relapse: relapse of the disease often does not occur suddenly, generally before the emergence of clear clinical symptoms, there may be some early symptoms, so early detection, early treatment, for the prevention of relapse of the disease is of great importance.
Common early symptoms of relapse are: difficulty in sleeping, easy to wake up, dreamy; emotional instability, irritability; worrying for no reason; dullness; lazy life; loss of appetite; refusal to take medication; reappearance of original mental symptoms, etc.
6, the use of a new monthly long-acting injection treatment:At present, about 50,000 domestic patients are using long-acting injection treatment, more abroad. Compared with the traditional long-acting injection, the new monthly injection of long-acting injection provides the core means and important guarantee for relapse prevention, which can significantly reduce the relapse rate, reduce adverse reactions, improve the social functions of patients such as study, work and interpersonal, and reduce the burden of care and psychological pressure on families.
Five, why do you need to receive long-term drug treatment, after the good can stop the drug
1, adhere to drug therapy is the most effective relapse prevention measures.
The relapse rate of patients who do not adhere to medication is as high as 80%, which is more than twice the relapse rate of patients who adhere to medication. The most likely period of relapse is 1-2 years after the disease is stabilized, so first-time patients should adhere to medication for at least 2-3 years. The longer the duration of the disease and the more relapses, the longer the time required for medication, and in some cases, the longer the time required for lifelong medication. If you intend to get pregnant, you should conceive after the standard course of treatment and stop taking medication for 3-4 months.
2.Adherence to treatment reduces the economic burden caused by hospitalization due to relapse.
3, adhere to treatment to allow patients to better return to society.
Sixth, why the long-acting injection can allow patients to better adhere to treatment and prevent relapse
Stable blood concentration brings better efficacy and safety, longer dosing interval reduces the risk of drug leakage, which helps to adhere to long-term treatment and reduce the risk of relapse, thus reducing the economic burden due to relapse hospitalization; at the same time, compared with similar original drugs, has a reasonable cost of treatment, no additional costs. Only 12 injections are required throughout the year, which can significantly reduce the number of medications taken, reduce the sense of stigma and improve the quality of life.