Serious mental illnesses, especially schizophrenia, are detected relatively late (also known as: first untreated interval DUP), and because schizophrenia is currently considered a neurodevelopmental disorder brain disease and may gradually have a pathological process of neurodegenerative neurological microdamage leading to irreversible impairment of cognitive function and gradual worsening of personality changes during the disease episodes, only early detection can prevent neurological damage to the maximum extent possible and The goal of complete clinical cure and return to society can be achieved as far as possible.
Early detection and early treatment of mental illness is crucial, and must not be mistaken for simple personality problems, and even some patients with early emotional symptoms are misdiagnosed as depression and other affective disorders, resulting in failure to provide early and effective long-term treatment, resulting in the delay of the child’s condition.
I. Symptom expression in the early stages of severe mental illness (prodromal phase of schizophrenia).
It is currently believed that there is a long prodromal phase (prodromal phase) before the first episode of schizophrenia. The prodromal phase refers to a period of time from the appearance of inconspicuous abnormal psychiatric symptoms to a clear diagnosis of schizophrenia, generally averaging about 3 years. It is characterized by patients exhibiting nonspecific and psychotic-like symptoms before the emergence of a full-blown positive group of schizophrenic symptoms.
Risk factors associated with the development of schizophrenia include family genetic history, perinatal complications, premorbid social functioning, premorbid personality, and recent life events. It has been established that there are often some early warning symptoms in ultra-high-risk populations that can help improve identification of the disease. In one study, bizarre beliefs and fantastical thinking were shown to be significant predictors of future conversion at baseline assessment. Another study found that ultra-high-risk individuals who converted to schizophrenia had more pronounced social withdrawal, introversion, and bizarre thinking. Therefore, it can be assumed that ultra-high-risk populations tend to have characteristics of schizotypal personality disorder. Often, during the prodromal phase of schizophrenia, patients are often accompanied by unusual changes in behavioral patterns and attitudes. Because these changes are slow and may last for months or even years, or because they are less dramatic, they are not usually seen as illnesses right away, and most are only detected when the medical history is reviewed. Huber et al. added a third type of “prodromal syndrome”: (1) nonspecific changes with specific prepsychotic symptoms and psychosis; (2) specific changes with neurotic reactions (symptoms) to these changes; and (3) prodromal syndrome in which the prodromal symptoms These prodromal symptoms may resolve spontaneously and do not progress directly to psychosis. The major prodromal symptoms are decreasing in frequency: diminished attention, decreased motivation and drive, lack of energy, psychotic symptoms, sleep disturbance, anxiety, social withdrawal, suspicion, impaired role functioning, and irritability.
The following are commonly used to describe the prodromal features of schizophrenia: neurotic symptoms (insomnia, headache, dizziness, weakness, etc.), mood-related symptoms (depression, anxiety, lack of pleasure, self-guilt, suicidal ideation, etc.), changes in volition (apathy toward people, detachment from people, lack of interest in external things, laziness in life, sensitivity and suspicion, personality changes, etc.), changes in cognition (decreased motivation and ability to work, student decreased academic performance, inattention, unresponsiveness, etc.), physical symptoms (somatic complaints, decreased appetite, sleep disturbances, etc.), weak positive psychotic symptoms (fragmentary hallucinations, delusions, thought disorders, etc.), behavioral changes (social withdrawal, bizarre, sudden behavioral impulses, aggressive behavior, etc.), and other symptoms (compulsions, dissociation, etc.). However, the specificity of these symptoms in the prodromal phase of schizophrenia is low, and it is not possible to diagnose the prodromal phase alone clinically, and only helps to raise awareness of early warning of schizophrenia.
II. Diagnosis of early stage of serious mental illness (prodromal phase of schizophrenia)
Currently, the most important diagnostic modality for the prodromal phase of schizophrenia is with the help of screening and identification tools. Screening for psychosis risk syndromes is generally a scale interview, with the aim of identifying people who may be at risk and improving the efficiency of identification. Commonly used screening tools are: a screen for prodromal symptoms of psychosis (PRODscreen), PRODscreen was developed by Heinimaa et al. in Finland based on SIPS and BSABS, and includes 9 items for general symptoms, 12 items for negative and positive symptoms, and 7 items for social functioning, which can be used for self-assessment or telephone interview, this scale is not applicable to people with mood This scale is not applicable to people with mood disorders. The Prodromal Questionnaire (PQ), a 92-item scale based on the SIPS, was developed by Loewy et al. to screen people for possible psychiatric risk syndromes. The PQ-B (a simplified version of the prodromal state questionnaire) is now more commonly used clinically to improve screening efficiency and accuracy, focusing on positive symptoms and assessing frequency and severity, with a sensitivity of 89% and specificity of 58% of the study results. Risk factor identification, management and education program (prevention through risk identification management and education, PRIME), PRIME screening questionnaire (PS-R) developed by Miller et al. of the McGratham group, a total of 12 positive symptom entries, often used in conjunction with SIPS, has comprehensive content, wide applicability, streamlined and relatively high sensitivity and specificity, the operation of which requires Standardized training is required. The Youth Psychosisat Risk Questionnaire (Y-PARQ), developed on the basis of CAARMS, has 92 questions on positive, negative and affective symptoms and is suitable for the prodromal screening of children and students.
The CAARMS is a semi-deterministic tool for assessing psychotic symptoms at the threshold of ultra-high-risk populations (UHR), covering positive, negative, and other symptoms, including thought content disorders (e.g., delusional state of mind and hyperbolic ideas), perceptual abnormalities (e.g., hallucinations and delusions), and emotional symptoms. (e.g., hallucinations and delusions), conceptual disintegration (e.g., subjective experiential difficulties and objective evaluation impairments), movement disorders (e.g., subjectively experienced movement difficulties and objectively expressed catatonia), attention and memory impairments, affective disorders (e.g., subjectively experienced mood changes and objective emotional flatness), decreased energy, and decreased stress tolerance in eight areas. The severity, frequency and duration of episodes of each symptom were rated on a scale of 0-6.
The structured interview for prodromal syndromes (SIPS), developed by the PRIME research group at Yale University, is a semi-structured interview instrument for identifying psychiatric risk syndromes, and is most widely used in China and abroad because of its good reliability and validity. Its scale of prodromal symptoms (SOPS) consists of four components: positive symptoms (P), negative symptoms (N), disintegrative symptoms (D), and general symptoms (G), which mainly describes and assesses psychotic risk symptoms and other symptoms in the past months, and is rated on a scale of 0 (no abnormality) to 6 (severe psychotic symptoms) according to the intensity, frequency, and duration of symptoms. The Presence of Psychotic Syndrome Questionnaire (POPS) excludes previous or current psychotic syndromes, and the diagnosis requires the establishment of both (A) and (B). (A) means that positive symptoms are manifested at a certain level (rating of 6), such as abnormal thought content (suspicion, delusions of victimization, exaggerated delusions, etc.), perceptual abnormalities to a lesser degree of hallucination, and incoherent or incomprehensible speech; (B) means that at least one of the symptoms meeting the criteria of (A) occurs for an average of four days per week and lasts for one hour, with a duration of illness greater than one month, or the symptoms are of a severely disorganized and dangerous nature.
Diagnostic criteria.
(i) Attenuated Positive Symptom Syndrome (APSS), which means that the patient has received a rating of 3, 4, or 5 on one of the SOPS P1-P5, and the symptoms have appeared in the past and currently occur at least once a week or at a level at least 1 level higher than the rating one year ago.
(ii) Brief Intermittent Psychotic Syndrome (BIPS), which is established on the basis of recent and briefly apparent psychotic symptoms, i.e., psychotic symptoms (SOPS score = 6) must have occurred within the past three months and lasted for at least a few minutes each day for a month and did not meet the criteria of POPS (B).
(iii) Genetic Risk and Deterioration Syndrome (GRDS), based primarily on genetic risk in combination with schizophrenia spectrum disorder and recent manifestations of functional deterioration. A history of a psychotic disorder in a first-degree relative suggests that the patient meets the criteria for genetic risk. Functional deterioration was established by a decrease in GAF score of at least 30% in the most recent month compared to 12 months earlier. The Early Recognition Inventory (ERIraos), among others.
Among them, CAARMS and SIPS are assessed in a similar way, using the high-risk factor method, with high reliability and validity, and are currently used by most investigators.
Third, the association between the early stage of severe mental illness (prodromal schizophrenia) and self-abnormality
Current scholars believe that the prodromal phase of schizophrenia is the presence of a subtle, subclinical nature of abnormal self-experience that underlies the production of other symptoms of schizophrenia (positive symptoms, negative symptoms, disintegrative symptoms, etc.). Researchers, mainly PaRnas, have attached great importance to the phenomenological aspects of schizophrenia, as it can reveal the main symptoms of the pre-disorder (abnormal subjective experience) that precede the appearance of the typical symptoms of schizophrenia.PaRnas believes that the disappearance of the entire domain of abnormal experience (e.g., abnormal self-awareness, sameness, various delusional experiences, abnormal emotional, perceptual and cognitive experiences) is associated with schizophrenia The early differential diagnosis is highly relevant, and if it is based purely on an operationalist approach and does not pay attention to phenomenological concepts, it is easy to overlook the main symptoms of the pre-onset of schizophrenia (abnormal subjective experience) and thus easily dismiss the diagnosis of schizophrenia.
In order for us to recognize the problems that exist during the prodromal phase of schizophrenia from different levels of the self, PaRans proposes three levels of the self from a phenomenological perspective. The first is the pre-reflective level, which refers to the first-person-potential consciousness given to the experience as the “I” experience, or sometimes as the “basic” or “minimal” self, or “ipseity” (the Latin word for “self” or “self (the Latin word for “self” or “self”). It can perhaps be described as the self-presentation of the self-subject. Second, on a more complex level, it involves reflective self-awareness, a relatively more explicit sense of self that can be seen as an unchanging and eternal theme of experience and action – for example, a sense of self that changes over time and can still be seen as the same person. Finally, there is the social or expressive self, which refers to the individual’s character traits such as personality, habits, style, etc. (e.g., I am a flexible person who often helps to meet the needs of others). From a neurobiological research perspective, the ego hierarchy has also been defined. It mainly includes the “primitive self” or “somatic self” (referring to pre-reflective, sensory processes), “core self” (self-referential processes), ” autobiographical self” (higher cognitive processes). Phenomenological models of self-abnormality in schizophrenia spectrum disorders suggest that self-abnormality occurs at the first level (most basic) sense of self, in contrast to non-schizophrenia spectrum personality disorders such as borderline personality disorder or narcissistic personality disorder, where self-abnormality in these disorders occurs at the level of the expressive self, where the basic sense of self remains intact.
The main clinical manifestations of ego abnormalities in the prodromal phase of schizophrenia are a diminished sense of basic self, a sense of inner emptiness, lack of sameness, and difference from others, which may manifest as negative symptoms (including verbal poverty, emotional indifference, lack of volition, and social withdrawal); distorted first-person perspective, such as a diminished or temporarily delayed sense of self-experience (often involving the process of knowing rather than knowing itself), a generalized sense of self-experience distance between self and experience, spatialization of self (various personality disintegrations); reduced ability to perceive objects, people, events, and events as if one could no longer participate fully or be fully present in the world; loss of sense of reality (feeling that the surroundings have somehow changed, become unreal or unfamiliar); intense reflection, a tendency to take oneself or a part of oneself or some aspect of the environment as the object of intense Stanghellini et al. screened 39 first-episode schizophrenic patients out of a sample of 393 psychiatric cases and found that 30 of them (76.9%) had abnormal somatic experiences (ABEs), including somatic boundary and somatic construct abnormalities, distorted and painful experiences, etc. In addition, the best-known positive symptom was SchneideR’s “first-order symptoms” of schizophrenia, most of which can actually be defined by a decrease in self-experience – i.e., a lack of the ability to inhibit one’s own behavior, thoughts, feelings, impulses, bodily sensations, or perceptions, and this self-experience usually refers to those feelings that actually have or can have control over the experience of the other.
Phenomenological studies suggesting that one of the schizophrenia spectrum disorder phenotypes is a basic self-perception abnormality and that it is manifested in the frontal prodromal phase of the illness have attracted further research, especially prospective research, on self-abnormality as a phenotypic marker of psychotic susceptibility in schizophrenia (including the prodromal phase).
IV. Early resolution of severe mental illness (prodromal schizophrenia)
After the prodromal phase of schizophrenia is identified, interventions should be taken: Currently, the more affirmed interventions include pharmacological interventions and psychosocial interventions.
Pharmacologic interventions: Prodromal symptoms can only serve as risk factors for the onset of schizophrenia and do not preclude the possibility of self-remission, so there is an ethical issue with the use of antipsychotic medication for these “quasi-schizophrenic” patients. The patient or family should be fully informed prior to pharmacological intervention. Psychosocial interventions: These include supportive psychotherapy, psychological and health education, family interventions, cognitive-behavioral, and vocational and social skills training. The aim is to bring the patient’s psychiatric symptoms under control, increase family members’ and patients’ compliance with treatment, overcome adverse psychology, effectively avoid the stigma associated with hospitalization, and achieve the goal of preventing relapse and maintaining good social functioning.
Because neurodevelopmental disorders run through the four stages of schizophrenia, and the severity of such neurodevelopmental disorders becomes increasingly severe as the disease stages extend from anterior to posterior, current pharmacological treatment for schizophrenia is mainly aimed at symptomatic treatment during the disease and decline stages, when the severity of neurodevelopmental disorders is often more severe, and thus the efficacy is often unsatisfactory. Because the severity of neurodevelopmental abnormalities in the prodromal phase is less severe than in the onset phase, early identification interventions for schizophrenia in the prodromal phase have the potential to improve the efficacy of schizophrenia treatment.
Early self-awareness of detection suggests.
1. Contact a psychiatrist at a public hospital as early as possible for a clear diagnosis and treatment recommendations.
2. Possible use of low-dose antipsychotics and antidepressants.
3.Supportive psychotherapy and cognitive-behavioral psychotherapy.
4.Deep sea fish oil 1-2 grams daily orally.
Vitamin B12, folic acid, carotenoid, etc. may be helpful. Many of the single are still inconclusive.
You also need to go to the local authority psychiatric institutions face-to-face diagnosis and treatment is the best way. Early prevention, early detection, early treatment is the essence of treatment.