Like hypertension or stomach ulcers, schizophrenia is a disease, a common disease.
Generally, it is said that about one in a hundred people have schizophrenia, which means that its prevalence is about 1%. In schizophrenia, there is a serious impairment of brain function, but we don’t know exactly what changes occur, only in general terms.
We know that in the human brain, there are more than 10 billion brain cells. From each cell, many branches grow, and brain cells are interconnected by these branches. From the end of the branch of the last brain cell, something is released, called “neurotransmitters”. In layman’s terms, they can be compared to a postman who is responsible for delivering information to the next brain cell’s mailbox, or “receptor. In this way, a complex network of information is formed between more than 10 billion brain cells by postmen and mailboxes.
Under normal circumstances, the postmen and mailboxes in the human brain work well together, that is, there are no errors in the transmission of information between neurotransmitters and receptors, and mental activity is normal. With schizophrenia, there may be too much of a certain neurotransmitter (perhaps dopamine) or there may be a problem with their quality; let’s say there are too many mail carriers, or incompetent ones, and they mess up and deliver the wrong mail. Too much information, too much chaos, and the mind becomes unhinged and exhibits all sorts of psychotic symptoms. The drugs currently used to treat schizophrenia symptoms do not treat the root of the disease, but rather act like a “lid” on these mailboxes, blocking the transmission of too much messy information so that mental functions can return to normal.
In this way, schizophrenia is a pathological change in the human brain. It is a disease like hypertension, pneumonia, or stomach ulcer, and is not a problem of thought, style, quality, or personality, and should not be discriminated against at all. We believe that with the progress of science, sooner or later the root cause of its onset will be found, and by then, it will be completely curable.
What are the symptoms of schizophrenia?
The first symptom is “lack of self-awareness and denial of illness”.
According to a survey, about 97% of people with schizophrenia, especially in the acute phase, do not admit that they have a mental disorder. Generally speaking, people who have abnormal mental states, such as anxiety, worry, depression, fear, insomnia, etc., are self-aware and realize that their current state of mind and behavior is different from before and from others, so they ask for help and treatment. In contrast, people with schizophrenia often lack self-awareness and simply do not recognize that they are not normal. Therefore, if a person shows signs of mental disorder, but denies it and refuses to seek treatment, this is evidence that he or she is suffering from schizophrenia.
The second type of symptom is “psychotic symptoms”.
The so-called psychotic symptoms are characterized by detachment from reality and the creation of something out of nothing. There are three main types of psychotic symptoms: hallucinations, delusions, and bizarre behavior.
Hallucinations are perceptions that are created out of nothing. The patient may hear a voice cursing him when no one is actually speaking (i.e., “hallucinations”), or ordering him to do something, or hearing voices commenting on his current behavior, or hearing a voice saying something when he thinks of it (called “thinking voices”). “). Some patients may see ghosts and gods out of nothing, or smell something special, which can be called “hallucinations” and “hallucinations” respectively. Some patients may taste strange flavors from food or drinks, or feel that their body shape has changed, such as a smaller head or shorter legs, which can be called “hallucinatory taste” and “somatic hallucination” respectively.
Delusion is a pathological false belief. It is characterized by
1. Not based on facts at all
2. It is incompatible with the patient’s religious beliefs or cultural background
3. but the patient is convinced of it. Some patients feel that they or their relatives are being persecuted, that someone is constantly following them, spying on them, that their rooms are bugged, that food and water are poisoned; these are all delusions of victimization. Some believe they are not born of their biological parents and absurdly claim to be descended from Japanese, which can be called delusions of non-ancestry. Some think they are leaders or rich people, which is called exaggerated delusion. Some feel that some apparatus or airwaves are controlling his thoughts or actions, which is called a sense of being controlled. Some feel that their thoughts are being broadcast so that everyone knows what they are thinking, called a sense of being inspected.
Patients with schizophrenia may also engage in a variety of actions and behaviors that are incongruent with the environment and situation, making others feel ridiculous, peculiar, or incomprehensible, called bizarre behavior. Some patients may make a lot of noise for no apparent reason, hurt people or destroy things out of the blue, or jump off a building or into a river when they are not depressed. Some patients do not say a word all day and night; some even refuse to eat …… some patients will lie down all day, do not eat, do not move, do not speak, like a wooden sculpture, called the state of wood stiffness.
The third symptom is “thinking disorder”
Because the transmission of information between brain cells is impaired, patients with schizophrenia may have problems with their thinking, including associative processes or reasoning logic. They may speak in a way that is not connected to what they are saying, or they may speak in a way that is so fragmented and incoherent that no one can understand them. Depending on the degree, the symptoms can be subdivided into: lax thinking, scattered thinking, and incoherent thinking (a mixture of words). In addition, some patients confuse concrete and abstract concepts, showing a situation called “symbolic thinking”. Another patient refused to eat apples, saying that he would “die of illness” if he ate them. These are all disorders in the form of thinking. In addition, there are some patients, all day long indulge in fantasy thinking, he thinks it is a new theory or invention, but in fact is ridiculous nonsense, can be called “solitary thinking”.
The fourth symptom is “emotional indifference and reduced will”.
The longer the disease lasts, the more serious the emotional indifference becomes. They are indifferent to the things that are of immediate interest to them. They lack expression on their faces, speak in a flat voice, and are very cold to their loved ones, hence the term “emotional indifference”. Some patients do not have a happy expression when they encounter good things, and they smile on occasions when they should be sad, which can be called “emotional discomfort”. They often give little thought to their studies, work, life, marriage and future, and spend all their time eating and not caring. This fourth symptom is often referred to as “negative symptoms”. However, it is important to note that if the patient has these complaints, they are not “negative symptoms”, but are often a side effect of antipsychotic medication. If the patient denies these symptoms and a family member finds out that he or she is having them, that is a “negative symptom.
Why do people get schizophrenia?
The key to schizophrenia is mainly endogenous, that is, the person has the pathological gene for schizophrenia. People who have this gene are prone to schizophrenia. The so-called psychological stress or shock is only the trigger; for the onset of schizophrenia, the trigger is dispensable. If your loved one has schizophrenia and you go to the trouble of finding these triggers, it is a waste of effort. If the trigger is a loss of love, and schizophrenia develops on that, even if she is told to get married quickly, the disease will not be cured. If you have schizophrenia, no matter how much you try to “untie the knot”, you can’t cure the disease. This is because these are only the triggers. Just like lighting a firecracker with a lighter, even if the lighter is thrown away, the firecracker will still explode in the air. Therefore, we say that the internal causes must be addressed, and the internal causes of the onset of schizophrenia must be addressed with medication or other methods in order for the disease to get better.
As mentioned earlier, people with schizophrenia have genes that predispose them to the disease. Some people have relatives who have schizophrenia, so the gene is inherited from a previous generation. Some people do not have these relatives, so where do the genes for schizophrenia pathology come from? We need to know that just like physical characteristics such as eye size, whether or not we have double eyelids, or personality traits such as whether or not we are introverted, are burned into the chromosomes in the nucleus of the cell, called genes, which can be compared to the blueprints for building a house. When our parents give birth to us, they let the cells of the fertilized egg, divide in two, divide in two, divide in four, …, just like making copies with a photocopier. Sometimes, for some reason, the handwriting appears blurred in certain places on what is copied. If the blurring is in an insignificant area, it does not matter; however, if it occurs in areas related to thinking, perception, etc., then it is a schizophrenia pathology gene, called a “gene mutation”.
Brain cells are connected to other brain cells by nerve endings, forming a network. But they are not as close to each other as an electrical plug and socket, and must rely on the last brain cell to release neurotransmitters to transmit information. There are many kinds of neurotransmitters, such as dopamine (DA), norepinephrine (NE), 5hydroxytryptamine (5HT), acetylcholine (ACh), and so on. The above mentioned schizophrenia pathology genes determine how much of this neurotransmitter dopamine is produced, but even if it is more, the onset is not immediate. However, under the “trigger” effect of a trigger (like pulling the trigger of a pistol with your finger), too much dopamine is released and the information is sent indiscriminately, and hallucinations and delusions are created out of nothing. From here, we can see that psychological triggers such as loss of love only play a “trigger”-like role, and even if we try to solve these psychological triggers, we cannot solve the problem of schizophrenia. The root cause of the problem of too much dopamine, a neurotransmitter, must be addressed in order to cure schizophrenia. Another approach is to repair or modify the schizophrenia pathology gene, called gene therapy; however, this level of science has not yet been reached, and we can only treat from the one doorway of reducing dopamine transmission.
How should I treat schizophrenia if I have it?
When you have schizophrenia, it is important to seize the opportunity to treat it. The first onset is the most critical moment, and an experienced doctor should be consulted first to confirm the diagnosis and then immediately put the patient on the best antipsychotic medication. This is the time when medication is most effective; the time is not lost. Generally speaking, within 2 years, the disease is easy to treat; after 2 years, it is more difficult to achieve good results, or even delayed to become chronic. Therefore, do not have the idea of “leaving the good drugs for later when you are seriously ill”, but should use the best drugs at the beginning. Some family members “rush to the doctor”, looking for herbal remedies everywhere, and even spend thousands of dollars. We advise you not to take hearsay at face value or trust treatments that have not been confirmed by experts, so as not to waste money and delay your loved one’s condition.
There are many kinds of medications for treating schizophrenia, and the most commonly used in China used to be the first generation of antipsychotics (or classical antipsychotics) that were marketed in the 1950s and 1960s, such as chlorpromazine, fenazepam, trifluoperazine, and haloperidol. The common feature of these antipsychotics is that they block dopamine receptors so that information is not passed down the line and psychiatric symptoms gradually improve.
As we can imagine, there are so many nerve cells in the human brain and so many dopamine receptors that need to be blocked that the antipsychotics taken must be at sufficient doses to be effective.
If the dose is too small, it will not be enough to block that many receptors, and it will be difficult to achieve a therapeutic effect even if you take it for several years. The therapeutic dose of chlorpromazine is about 300 to 600 mg per day; fenadine is 20 to 40 mg per day. Taking only one or two tablets a day is not helpful at all. Since these drugs have certain side effects, the dosage has to be increased only gradually until it works or until the above mentioned therapeutic dose is reached. They also block the dopamine transmission in the extra-pyramidal system (responsible for the coordination of muscle movements) in the brain, and in about 20-50% of cases there is an “extrapyramidal side effect” that appears to be slow movement, shaking hands, or fidgeting, when Benzedrine (Antan) is added, which can be taken in the morning and one at noon. Since the extraconal side effects will disappear automatically after going to sleep, it is not necessary to take Benzedrine at bedtime. In addition, a small number of patients may develop “delayed dyskinesia (TD)” after long-term use (often several years), which manifests as involuntary twisting of the face, lips, tongue, and hands and feet, a more serious side effect that is difficult to treat and often remains for life.
It is generally said that drugs such as chlorpromazine are not comparable in efficacy. Therefore, if the efficacy of chlorpromazine is not satisfactory, there is no need to switch to Endrin or combine the applications. In general, the efficacy of chlorpromazine or fenpropathrin is not very good, and patients often do not recover completely. Haloperidol has good efficacy, but the extraconjunctive side effects are more serious and have been used less often in recent years. Sulpiride is another antipsychotic drug, although the extraconjunctive side effects are less, but the absorption is irregular after oral administration; therefore, some patients have good results, some patients do not. In addition, sulpiride has the heaviest effect on menstruation of any first-generation antipsychotic.
Clozapine, which was introduced in the 1970s, outperformed varieties such as chlorpromazine. Some cases that did not work may have a rapid remission after switching to clozapine.
However, clozapine has many side effects and should be used with attention to.
1, clozapine basically has no extra-cone side effects, and can be used without benzhexol (Antan).
2. The drowsiness of clozapine is heavy at the beginning, but will be reduced by itself after several weeks of adaptation.
3.Clozapine dose will increase the secretion of saliva, even from the corners of the mouth when sleeping, but it is not harmful to the body.
4. A small number of patients may experience a decrease in white blood cells after taking clozapine.
Therefore, it is necessary to check the white blood cell count regularly during the medication period; in the initial stage, it should be checked once a week, then once every two weeks, and then once a month. Generally speaking, if you have not experienced leukopenia after six months or a year of taking the drug, then it is unlikely to occur in the following years.
5. Some patients (at least 15%) will experience obsessive-compulsive symptoms after taking clozapine.
Do not mistake this for an exacerbation of the disease; at this point you will have to switch to another drug only. The therapeutic amount of clozapine is usually 300-500 mg per day. Due to the numerous side effects mentioned above, the actual application often fails to reach the therapeutic dose, so the efficacy is not satisfactory.
In the 1980s, some new drugs were developed from the mechanism of clozapine. In the previous period, they were called “atypical antipsychotics” (recently renamed “second-generation antipsychotics”) and were considered to have three characteristics: 1) better efficacy than the first-generation drugs, especially for negative symptoms; 2) fewer extraconjunctive side effects and no TD; 3) no increase in prolactin, and no increase in the number of prolactin. ) no increase in prolactin and no effect on menstruation. After studies, it is now found that for the whole group (except for individual varieties), the efficacy is not necessarily better than that of the first generation drugs, with fewer extrathecal side effects.
Risperidone was one of the first to be marketed, and although the efficacy was slightly better, the side effects were not as few as advertised, and many patients also experienced extraconjunctive side effects after taking the drug, and all had to use Antan; there were also multiple cases of TD, because it would increase the secretion of prolactin by a large amount, the most for antipsychotics; female patients often experience amenorrhea after using the drug, nine out of ten. Clinical results show that risperidone is often not sufficiently complete, and once the dose is reduced, symptoms reappear.
Another newer drug is olanzapine, which is somewhat more effective. We found that 52% of cases that had not been treated with other drugs (including risperidone or quetiapine) for a long time actually improved significantly after switching to olanzapine, with half of them returning to full normalcy. Even patients who were fussing were seen to be quiet after 20mg of the drug. It is very popular among patients because it has few side effects and does not cause amenorrhea. Its effective dose is, shall we say, 25mg per day.
Newer drugs that came on the market later, such as quetiapine or ziprasidone, are not necessarily better in actual efficacy than, for example, chlorpromazine. The latter has a greater impact on heart function and care must be taken when applying it. As for aripiprazole, it is another new drug with average efficacy, but it does have fewer side effects. Amisulpride is a descendant of sulpiride, but its efficacy far exceeds that of sulpiride. Because it is similar to sulpiride, it is more difficult to cross the blood-brain barrier, so larger doses must be taken to be effective. It should generally be increased to 1200 mg per day over 3 to 4 days. The U.S. has not approved sulpiride for sale in the U.S. because of the “gateway view”; in fact, sulpiride has been used in Europe for more than a decade with excellent results. According to a study by the National Institute of Mental Health (NIMH), only amisulpride, olanzapine, and clozapine are more effective than standard antipsychotics (haloperidol or chlorpromazine). Risperidone was only comparable, not necessarily better. Quetiapine, aripiprazole, or ziprasidone are far less effective than the standard medications.
How long does a course of medication take?
Patients with schizophrenia will improve significantly after a few to ten days on medication. If symptoms completely disappear, one should also continue to take this therapeutic dose for at least 2 months to consolidate, and then gradually reduce it to about 1/3 to 1/4 of the original therapeutic dose over the next 1-2 months as a maintenance dose.
According to my clinical experience, it is more ideal to first treat with olanzapine more thoroughly, and then maintain with pentafluridol, which I call “fighting the world with olanzapine and keeping peace with pentafluridol” (before olanzapine was available, I used clozapine to “fight the world”). ). If olanzapine alone does not solve the problem, you should add amisulpride before it is too late. Some family members or patients themselves always ask if there is a cure for psychosis; unfortunately, there is not yet. It is clear from the principles mentioned earlier that antipsychotics work by blocking the receptors, that is, by temporarily blocking the overly disturbed message, and therefore are not a cure.
Without the proper amount of medication for long-term maintenance, the disease will often relapse. This is similar to the treatment of hypertension: if you take anti-hypertensive drugs, your blood pressure becomes normal, and once you stop taking them, no change is visible for a while, but within a few months, your blood pressure goes up again. From this point of view, it seems that the maintenance amount must be taken for 9, 10 years or longer, until there is a newer invention. The drug will not be effective until it reaches a certain concentration in the body. However, the body also destroys and excretes a certain amount of the drug, which must be replenished daily, which is the “maintenance dose”. Since the ability to excrete drugs varies from person to person, the amount of medication that should be replenished (maintenance dose) varies from day to day; that is, the maintenance dose can be large or small, depending on the person. Chlorpromazine is at least 100mg per day; clozapine may be 75mg; risperidone is 1mg; and olanzapine is 2.5-5mg. However, some patients may need more, and families must be aware of this and adjust it whenever necessary. According to my clinical experience, low-dose pentoxifylline maintenance, as little as 20 mg per week, without any adverse effects, absolutely no weight gain, no risk of hyperglycemia or hyperlipidemia, and no induction of obsessive-compulsive symptoms, is a more ideal approach.
Using the analogy of mailboxes and lids, the “lids” on those mailboxes will fall off every day and must be replenished at any time, otherwise the information will be passed around again, the psychiatric symptoms will reappear and the condition will worsen; this is why the maintenance dose should be taken for a long time.
If the patient refuses to take the medicine, what should be done?
1. Being in the onset of the disease, they do not admit that they have the disease, so they are neither willing to seek medical help nor to take medication.
2.After treatment, the patient thinks he/she is cured and does not need to continue taking medication.
3.The patient refuses to take the medication because of the side effects of taking the medication, which affects work and life.
4.Some drug side effects are very heavy and hard to tolerate.
As a family member, you should first analyze the reasons for refusing the medication and then take different countermeasures. For patients whose condition has basically improved, they should be frequently reminded that stopping the medication will lead to relapse again, which may cause serious consequences. If there are different degrees of side effects, you can change the variety or adjust the dose, or use some drugs that can reduce the side effects. For patients who really need to take medication for a long time and refuse it, they can switch to long-acting drugs. There are two types of long-acting antipsychotic drugs: one is injectable, such as fluphenazine enanthate, haloperidol aconitate, risperidone long-acting preparations, one injection can maintain the effect of 2-3 weeks; the other is oral long-acting drugs, such as pentafluoridol. Previously, it was mistakenly believed that the sedation of pentoxifylline could not have too many side effects, so it was not widely used. We found that the efficacy of this drug is actually quite good, as long as the weekly dose does not exceed 20mg, no serious side effects will occur. Especially after changing the dosing method from “20mg once a week” to “once every other day, 5mg each time”, there are no side effects, absolutely no weight gain, no risk of hyperglycemia or hyperlipidemia, and no compulsive symptoms; many cases that have been treated with other drugs for a long time have been effective. Another feature is that it is insoluble in water, colorless and tasteless, and can be mixed in food, which is suitable for patients who refuse medicine. Can be directly telephone 073-95270119 Liu Xi, express mail order
How should we judge the effect of treatment?
One is, whether the mental symptoms completely disappeared? Second, is self-knowledge restored? Some patients after treatment, symptoms may disappear completely, but some patients will remain more or less part of the symptoms, delayed into chronic. After the symptoms disappear, some patients may suddenly realize that they can correctly recall the onset of their illness, analyze and recognize the mental symptoms they had, such as hallucinations, delusions, and disorganized behavior, and admit that they had been mentally disordered, and cooperate with the doctor and obey the treatment. This is called “recovering self-awareness”. These patients will actively ask for relapse prevention and will voluntarily ask for maintenance doses. Some patients, however, do not recover as well.
But why do some patients recover their self-awareness when their symptoms have not completely disappeared, while others do not recover their self-awareness when their symptoms have disappeared? Unfortunately, this question has not been answered so far. It seems that there is no direct relationship with medication.
Can all schizophrenia be cured by medication?
Generally speaking, the effectiveness of medication is only about 70% of the total number of patients taking medication; patients for whom medication is ineffective should be treated with other therapies. Experience tells us that electroconvulsive therapy is a relatively effective treatment method, especially for cases of passive suicide or mute refusal to eat, and also for patients for whom medication alone does not work in time. Some family members shake their heads when they hear about electroconvulsive therapy, mistakenly believing that it will cause damage to the patient. In fact, electroconvulsive shock uses a very small amount of electric current to properly stimulate the brain for a very short period of time in order to achieve therapeutic effects. For the patient, there is no pain, it is only like a sleep. This treatment is generally said to be very safe; a course of treatment is 6-12 sessions. In particular, the modified electroconvulsive therapy is administered after the patient is put to sleep with medication, the patient does not feel any pain or fear at all, there is no danger, and the side effects are minimal, individual patients will have poor memory after the treatment, but can fully recover within 3 or 4 months. Therefore, it is worthwhile to try it in cases where drug treatment alone is not effective.
How should family members treat the patient?
1. He should be brought to the doctor early.
In the outpatient clinic, the family should first describe the patient’s abnormal performance to the doctor, and tell him the symptoms that have appeared before and after. However, there is no need to analyze the so-called “causes”, because what you think is the cause of the disease is not the real cause of the disease, and it is not helpful for diagnosis and treatment. Then, let the doctor examine the patient on his or her own, without the family interfering at this time. Each sentence of the doctor’s examination conversation with the patient has a purpose, and family members should never interfere, let alone answer on behalf of the patient. If family members have questions about the condition, future, or treatment, they should ask after the patient leaves.
2. Do not argue with the patient.
What should be the attitude toward the patient’s pathological manifestations (e.g., hallucinations) and wrong ideas (e.g., delusions)? We believe that one should never argue with them for this reason. This is because it is a pathological manifestation, not a problem of ideological understanding, and it is more than possible to persuasively correct it by presenting facts and reasoning. When patients talk about these hallucinations or delusions, we can only adopt a “non-committal” attitude; after active medication, these pathological manifestations and false ideas will disappear on their own.
3. Do not discriminate against patients.
Schizophrenia is a disease, definitely not a moral quality or ideological problem, so they should not be discriminated against; on the contrary, they should be given great care and sympathy. If early treatment with good drugs can be applied within 2 years of the onset of the disease, the vast majority of patients will be completely restored to normal and can live and work in a completely normal manner. If they recover from the disease, they can of course fall in love and get married. Since schizophrenia, like many diseases, has a certain degree of hereditary potential, the issue of having children or not should be treated with caution. Children born to ordinary people have a 1% chance of developing schizophrenia; children born to people with schizophrenia have a greater chance of developing the disease, about 5-10%. If a patient decides to have children, it is important to note that maintenance doses of antipsychotic medication must be maintained before and after pregnancy and childbirth. It is completely safe to assume that maintenance antipsychotics do not cause malformations. If the antipsychotic medication is stopped after pregnancy, there is a risk of relapse of the psychosis, which is too dangerous for oneself and the fetus.
4. Patients should be urged to take their medication.
If a patient’s condition is not yet under control, they will often refuse to take their medication. Even if the condition is in remission, the possibility of them spitting up the medication or pretending to take it should be fully estimated. So it is the responsibility of the family to supervise and check their medication; especially to supervise them to take maintenance doses for a long time. Even for patients who have recovered and have regained their self-knowledge, they also have to be reminded frequently to take their maintenance doses. To be honest, before science has advanced to a certain point, that is, before the pathological gene of schizophrenia has been found and the corresponding gene therapy has been developed, long-term medication is still the most reliable way to prevent relapse.
5. Patients should be persuaded not to take diet pills.
In addition, schizophrenia patients should never take diet pills. This is because almost all current diet pills secretly add drugs like “fenfluramine”. They increase the neurotransmitter dopamine, which reduces the appetite of the person taking them, thus leading to weight loss. But the key to the pathology of schizophrenia is too much dopamine, which leads to symptoms such as hallucinations and delusions. Even people who do not suffer from schizophrenia can have psychotic symptoms after taking fenfluramine; it is inevitable that people with schizophrenia will have episodes as a result, so families must be aware.