Schizophrenia is a group of severe psychiatric disorders of unknown etiology, most often with a slow or subacute onset in young adults, and often manifests clinically as a syndrome of varying symptoms involving multiple impairments in perception, thinking, emotion and behavior, as well as incoordination of mental activities. Patients are generally conscious and have normal intelligence, but some patients may develop cognitive impairment during the course of the disease. The course of the disease is usually prolonged, with recurrent attacks, exacerbation or deterioration, and some patients eventually experience decline and mental disability, but some patients can remain cured or basically cured after treatment.
Etiology
Schizophrenia is a clinical syndrome consisting of a cluster of symptoms, and it is a multifactorial disease. Although the etiology of schizophrenia is not well understood, there is consensus on the role of individual psychological susceptibility and external social environmental factors in the development of the disease. Both susceptibility and external factors may contribute to the development of the disease through a combination of intrinsic biological factors, and one aspect of the disease may be more important in different patients.
Clinical manifestations
1.Clinical manifestations
The clinical symptoms of schizophrenia are complex and diverse, and can involve perception, thinking, emotion, volitional behavior, and cognitive function, etc. The symptoms vary greatly among individuals, and even the same patient may show different symptoms at different stages or phases 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 disorder is mainly manifested by thought association process disorder, including thought association activity process (quantity, speed and form), thought association coherence and logic disorder. Delusions are the most common and important thought content disorder. 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 patients with schizophrenia 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 may engage in defensive or aggressive behavior. In addition, passive experiences are more prominent in some patients and have an impact on patients’ thinking, emotions and behavior.
(3) Affective disorders Affective indifference and incoherent emotional responses are the most common affective symptoms in patients with schizophrenia. In addition, affective symptoms such as incoherent arousal, 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 proper motivation and initiative, diminished 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 carry them out.
(5) Cognitive dysfunction There is a high incidence of cognitive deficits 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 the clarification of psychotic symptoms (e.g., prodromal phase), or decline sharply with the appearance of psychotic symptoms, or decline gradually with the prolongation of the disease, and it is tentatively believed that patients with chronic schizophrenia have more pronounced cognitive deficits than patients with first-episode schizophrenia.
2. Clinical typing
(1) Paranoid type This is the most common type of schizophrenia, with hallucinations and delusions as the main clinical manifestations.
(2) Youthful type Onset in adolescence, with significant thinking, emotional and behavioral disorders as the main manifestation, typically manifested by scattered thinking, broken thinking, emotional and behavioral reactions childish, may be accompanied by fragmentary hallucinations and delusions; some patients may show hyperactive instinctive activities, such as increased appetite, sexual desire, etc. Patients with this type have a low age of onset, rapid onset, and significant impairment of social function, and generally have a poor prognosis.
(3) Tension syndrome is the main manifestation of tension syndrome. Patients may exhibit tension stiffness, waxing flexion, stereotyped speech and behavior, as well as uncoordinated psychomotor excitement and impulsive behavior. Patients with this type generally have an acute onset, and some patients have rapid remission.
(4) Simplex type This type mainly develops in adolescence and mainly presents with negative symptoms, such as withdrawn and withdrawn, flat or indifferent emotions. The treatment effect of this type is poor, and patients have obvious decline in social function and poor prognosis.
(5) Undifferentiated type This type has some of the characteristics of one of the above types, or has some characteristics of each of the above types, but it is difficult to be classified as any of the above types.
(6) Residual type This type is the stage following the acute phase of schizophrenia, and is mainly characterized by changes in personality or decline in social function.
Diagnosis
Commonly used diagnostic criteria abroad include the American Statistical Manual of Disease Classification and Diagnosis DSM-IV-TR, WHO’s International Classification of Diseases Manual ICD-10, and the commonly used diagnostic criteria in China are the Chinese Classification and Diagnostic Criteria of Mental Disorders CCMD-3.
Differential diagnosis
Schizophrenia usually needs to be differentiated from organic disease induced mental disorders, drug or psychoactive substance induced mental disorders, mood disorders, paranoid mental disorders, obsessive-compulsive neurosis, and other disorders.
Treatment
Antipsychotic medication is the preferred treatment for schizophrenia, and medication should be systematic and standardized, emphasizing early, adequate dosage and full course of treatment, paying attention to the principle of single and individualized medication. Second-generation (atypical) antipsychotics such as risperidone, olanzapine and quetiapine are generally recommended as first-line drugs. First-generation and atypical antipsychotics such as clozapine are used as second-line drugs. Some patients in the acute phase or with poor outcome can be treated with a combination of electroconvulsive therapy. 10% to 30% of patients with schizophrenia are ineffective in treatment and are referred to as refractory schizophrenia.