I. Characteristics of mental illness
Psychosis is a general term for disorders in which brain function is disrupted, resulting in different degrees of impairment in mental activities such as cognition, emotion, behavior and volition. There are many factors that contribute to the disease: congenital genetics, personality traits and physical factors, organic factors, and social and environmental factors. Many psychiatric patients have delusions, hallucinations, delusions of grandeur, emotional disorders, crying and laughing, talking to themselves, feeling that their speech, thinking and behavior are not governed by themselves but by external forces; the patient perceives that something does not exist in the objective reality but does; morbid and erroneous judgments and reasoning, and therefore false ideas that do not correspond to the facts, but the patient is convinced and cannot correct them with personal experience and experience. Apathy, lack of concern for everything around them, etc. Bizarre behavior. The majority of patients lack self-awareness, do not admit that they are ill, and do not actively seek medical help.
Common psychiatric disorders
Common psychiatric disorders include: schizophrenia, manic-depressive psychosis, menopausal psychosis, paranoid psychosis and various organic lesions with psychosis. Patients and their families should actively cooperate with psychiatrists and seek early treatment in hospitals.
In daily life, some people often confuse psychosis with neurosis, but in fact, the two are different. People often refer to psychosis as severe mental illness, while neurosis is a group of mild mental disorders.
Treatment of psychosis
Psychosis must adhere to psychotropic medication as the main treatment, supplemented by psychotherapy. Medications include: antipsychotic drugs (such as haloperidol, methiodiazide, chlorpromazine, Vistone, fenadine, sulpiride, clozapine, aripiprazole, Qivi, etc.); antidepressants (Prozac, Sellett, moclobemide, Maprotiline, promethazine, chlorpromazine, amitriptyline, doxepin, etc.); antimanic drugs (lithium carbonate, carbamazepine) anxiolytics (Valium, clonidine, alprazolam, etc.).
Fourth, the relapse of psychosis
Relapse refers to the re-emergence of psychiatric symptoms specific to the original disease after a period of clinical cure and adaptation to social life. There are various factors for relapse, such as psychosocial factors and biological factors, but the most important reason for relapse is to stop the medication or reduce the dosage too quickly, so it should be taken seriously.
According to clinical statistics, the form of drug discontinuation, there are probably the following situations: many patients can often adhere to medical advice when they are first discharged from the hospital, the family can also seriously urge the patient to take medication on time, the patient’s mental state can remain normal, about 3-6 months, some patients think they have been cured, they do not want to take medication, some family members also think that mental illness and other diseases As long as the disease is well, there is no need to force the patient to continue taking medication. Such discontinuation accounts for about half of all discontinuation reasons. There are also families or patients who are always worried that long-term medication will endanger their health, fearing that the medication will affect the function of the brain, heart or liver and other important organs and automatically stop taking the medication; there are also patients who have certain side effects after taking the medication, such as dull facial expressions, stiff limbs, slow movements, etc., and think that if this continues, the patient will live more and more dull, fearing that he or she will become a fool and stop taking the medication; only a very small number of patients are forced to stop taking the medication because of financial difficulties or because they cannot buy the medication locally. Only a very small number of patients are forced to interrupt their treatment because of economic difficulties or the inability to purchase drugs locally.
V. Some precursors of psychiatric relapse
How can we find out if a patient has a relapse of psychosis? Generally speaking, before the relapse of psychosis often appear some aura symptoms, such as patients suddenly claim that they have never had psychosis, refuse to take medication for various reasons; or sleepless nights, depressed, physically thin, do not think about eating; or excited and talkative, more than noisy, running around, causing trouble; or withdrawn and less talkative, out of touch, dull, unresponsive, lazy life; or emotional impatience, good temper, sensitive and condensed, and Or the symptoms of hallucinations and delusions from previous episodes reappear, such as not seeing figures and hearing voices, or thinking that people around him are intentionally “hinting” and “stimulating” him again, and that someone is “stalking” him. For example, he may not be able to see and hear voices, or he may think that people around him are “suggesting” and “stimulating” him, or that someone is “stalking” him or “harming” him.
Once the above signs appear, as long as family members are aware of them in time, as soon as possible to the psychiatric hospital outpatient consultation or take the patient to review, under the guidance of a physician to take medication or increase the amount of medication, can often control the symptoms, only a very small number of patients need to be hospitalized again. It is important to note that psychiatric patients tend to have their onset in the spring and summer. Therefore, in spring and summer, family members should strengthen observation of the patient and adhere to drug maintenance treatment to reduce relapse of mental illness.
Prevention of relapse of mental illness
First of all, in order to prevent psychosis, it is necessary to find out what are the causes of relapse of patients? Studies have shown that in addition to objective factors such as pre-morbid character defects and family genetic history, the ability to regularly adhere to medication maintenance treatment and family environment treatment is an important factor affecting relapse of psychosis. Therefore, even after the treatment effect has improved significantly, it is still necessary to carry out drug maintenance treatment, and the dosage should be determined by the doctor, not to stop the drug or adjust the dosage without authorization. Although family members are responsible for the basic care of patients for a long time, they often do not know how to take care of patients, how to deal with abnormal speech and behavior of patients and how to provide a good home treatment environment.
It is also a very careful and deliberate and prudent burden for the family members of psychiatric patients to take care of their patients, but they cannot be neglected. Patients they often show emotional reactions such as anxiety, guilt, annoyance and frustration and fail to treat the patient’s abnormal behavior correctly. There is an excessive concern and protection of the patient, reducing the patient’s contact with society, so that the patient relapse rate increased significantly. Studies illustrate that patients who live with their spouses have a lower relapse rate, while those who are divorced and celibate have a higher relapse rate. Discrimination by friends, neighbors and family and reduced work opportunities can worsen a patient’s condition. To prevent relapse of psychiatric disorders, the family environment and help are very important. Family members must urge the patient to adhere to medication maintenance treatment, detect changes in the condition in a timely manner, provide early treatment, and visit the hospital regularly for follow-up. In addition, the patient’s family members must be counseled and educated about the disease and rehabilitation knowledge. In addition family members must communicate more with the patient and give him/her care. Patients should develop good living habits and actively participate in activities that are beneficial to the body and mind.
VII. Rational treatment of psychiatric relapse
In addition to the efficacy of the medication, the safety of the medication should be taken into consideration when using medication.
1. In principle, if a single drug can be used, use a full dose of a drug, use a full course of treatment, and if the effect is not good, then change another drug. After using the original effective antipsychotic drugs, consider combining the drugs if they are still not effective. The advantage of this type of medication is that the doctor is always in control of the treatment. Because of the single influencing factor, the dosage of drugs can be increased with more certainty, and the side effects can be observed in a targeted manner, and the variety and dosage of drugs can be adjusted according to the situation. This way of medication administration is also conducive to determining which drugs this patient is sensitive to, and according to the specific circumstances of the disease diagnosis, to target the treatment and in the long run, which drugs he is not sensitive to, so that the targeted maintenance treatment can be carried out after the disease has healed. Use atypical antipsychotic drugs if you have the conditions to do so, which can reduce the side effects caused by patients’ use of drugs, improve patients’ compliance and improve their quality of life.
2. Slowly increase or decrease the dosage: A sudden increase or decrease in the concentration of drugs in the blood can bring serious side effects to patients. For patients who have their first attack, the addition of drugs should be more cautious. For patients with recurrent attacks and long-term medication, the rate of addition and reduction of drugs can be accelerated as appropriate.
3, age factors: children or the elderly are more sensitive to drug reactions, and should generally be reduced by half.
4. Systematic medication: Use the full dose and course of each drug, and do not change medication frequently. The therapeutic dose of each antipsychotic drug has a range, for example, the therapeutic amount of chlorpromazine is generally 300-600 mg/day. Below this dose, the treatment effect is not sufficient, and above this dose not only has little effect, but also will add more side effects to the patient. The so-called “full dose” means that the drug should be added to the upper limit of the treatment amount, and only if the effect is still unsatisfactory, can it be replaced by other drugs. In other words, Thorazine should not be used only up to 300 mg/day and then changed if the effect is not good. Of course, if the disease is cured by using chlorpromazine up to 300 mg/day, there is no need to increase it to 600 mg/day. The duration of treatment for each antipsychotic is 6-8 weeks. The term “full course” means that a drug must be used for 6-8 weeks before it can be declared ineffective for the patient. It is not wise to change medication in a hurry when you see no improvement after only two weeks of use. Frequent medication changes are not only detrimental to the condition, but can also have serious side effects. It affects the patient’s compliance with the medication.
5, somatic conditions and organic brain disease: different drugs have different effects on the heart, liver, kidneys and other major organs. If a patient has previously suffered from or is suffering from a certain physical disease, attention should be paid to the choice of drug variety and dose. For patients with organic brain disease, the same attention should be paid to the selection of the variety and dosage of drugs, and appropriate treatment should be achieved for both the somatic disease and the organic brain disease itself.
As long as the treatment plan can be formulated according to the patient’s specific situation and treated reasonably, the patient will be able to recover and return to society better.