What is schizophrenia?
Schizophrenia is the most common type of mental illness characterized by basic personality changes, splitting of thinking, emotions and behavior, and incompatibility between mental activities and the environment.
The course of schizophrenia is often prolonged and progressive, but if early detection is given reasonable treatment as early as possible, most patients have a more optimistic prognosis. A small number of patients have delayed treatment due to untimely and unreasonable treatment, delaying diagnosis and treatment, causing the condition to progress slowly, or even losing good opportunities for treatment, developing mental decline and becoming mentally disabled.
Etiology of schizophrenia.
Schizophrenia, the cause of which is unknown so far, occurs in young adults, mostly between the ages of 16 and 40, without organic changes, and is a functional psychosis. Patients with this disease generally have no impairment of consciousness or intelligence, but the episodes not only affect their ability to work, but also have an impact on their families and society, and should be of concern to people from all walks of life.
1. May be related to genetic factors
Since rudin (1916) began a serious study of the genetics of schizophrenia symptoms, more than half a century of systematic family surveys have proved that genetic factors have a role in the occurrence of schizophrenia The prevalence of schizophrenia in the families of patients is much higher than that of the general population; and the closer the blood relationship with the patient, the higher the prevalence: 16.4%, 11.5%-14.3%, respectively, of the children’s siblings and parents are the highest. However, the role of heredity in pathology is relative rather than absolute, and not all hereditary psychiatric disorders are absolute in clinical practice.
2. May be related to human physiopathological-morphological factors.
CT, MRI found that some S have brain atrophy, atrophy site DA neuron reduction, more damage to the neurons inhibiting DA activity, DA activity is excessive. The mechanism by which antipsychotic drugs eliminate positive symptoms is by blocking DA receptor function; amphetamines and other DA-releasing drugs can cause schizophrenia-like symptoms in normal individuals. With increasing age, positive symptoms, negative symptoms, prefrontal and subcortical DA receptors MAO activity is lower in patients with chronic S than in normal subjects. Subcortical DA hyperactivity and glutamatergic system function as imbalance hypothesis: PCP mimics S symptoms frontal-striatal function defect hypothesis.
3, May be related to psychosocial factors.
4, May be related to the environment.
5. May be related to specific personality traits.
Schizophrenia patients before the disease that there are some special personality traits such as withdrawn and introverted, shy, bright and dark, more than a lack of logic in the thought of good fantasy and so called schizophrenic personality domestic Many scholars found that schizophrenia patients before the disease about 50-60% have a schizophrenic personality so that the transformative weakness to develop good character traits as well as healthy psychological quality is of great significance.
In conclusion, the occurrence of the disease is the combined result of the interaction of relevant factors in the human physiological-psychological and environmental systems, in addition to genetic factors.
Clinical features of schizophrenia
The prognosis for most patients is optimistic, but in a few cases, due to untimely and unreasonable treatment, the disease progresses slowly and even loses the opportunity to be treated, resulting in mental decline and mental disability. Therefore it is very important to recognize the clinical symptoms of schizophrenia.
1. Characteristic symptoms.
Characterized by a disconnection of mental activities from reality and the surrounding environment and a lack of coordination between thinking, emotion and volitional activities
(1) Lack of coherence and logic in the process of thinking and association is a characteristic manifestation of the lack of intrinsic meaningful connection between the patient’s utterance concepts or context in clear consciousness, i.e., loose or scattered associations, and in severe cases, fractured thinking, absurd and bizarre logical reasoning (logical inversion thinking), or the use of ordinary words, phrases, nouns or actions to express some special meaning that cannot be understood by bystanders (pathological symbolic Thinking) or to some symbols created or pieced together “words” to give special meaning (word new work) The patient’s thinking activity in the absence of external factors suddenly interrupted (thinking interruption) or a large number of forced thinking (thinking cloud)
(2) Thought property disorder: the patient believes that his or her thoughts have been taken away from him or her by an external force (thought taken) or that some thoughts have been inserted into his or her mind by an external force (thought inserted); feels that his or her inner experience has been known (thought insight) or broadcast (thought broadcast)
(3) Emotional dullness and indifference, inability to resonate or relate to the content of thought and external stimuli, lack of internal experience of external events and events of immediate interest (emotional indifference); laughing at joyful events or misfortune (emotional inversion), having two opposing emotional experiences at the same time (contradictory emotions); laughing and crying alone for no reason or angry outbursts
(4) loneliness and withdrawal, reduced activity and passive action often accompanied by emotional indifference to some things have opposing intentions (contradictory intentions); eat something that can not be eaten or hurt themselves (intention inversion); refuse to carry out all the requirements (disobedience) or mechanical implementation of any requirements (passive obedience)
2.Common symptoms
(1) hallucinations: verbal hallucinations are the most common patients hear two or more voices talking about themselves or commenting on themselves in the third person (controversial or commentary hallucinations) instructions to the patient (command hallucinations) voice speaks the patient’s thoughts at the time (thinking sound)
(2) Delusions: Delusions of victimization and influence occur most often in the context of existing mental disorders and are called secondary delusions; delusions of perception, delusions of state of mind, delusions of memory, etc. are all primary delusions that often occur suddenly without a psychological cause being found, and once they appear, they are convinced.
(3) Other common symptoms include perceptual syndrome or depersonalization, catatonic rigidity, waxy flexion, imitation of speech, imitation of behavior, or psychomotor excitement.
How to recognize the early symptoms of schizophrenia?
It is important to recognize the early symptoms of schizophrenia so that they can be detected and treated early. Early symptoms are difficult to detect or non-existent in patients with acute onset of illness. Most patients have a slow onset of the disease with no apparent cause, and careful observation and analysis generally reveals some early psychiatric symptoms as follows.
(1) Sleep changes: Gradually or suddenly it becomes difficult to fall asleep, easy to wake up or sleep deeply, nightmares, or excessive sleep.
(2) Emotional changes: indifference, loss of previous enthusiasm, lack of concern for relatives, lack of proper emotional communication, alienation from friends, lack of interest in surrounding matters, temper tantrums over trivial matters, inexplicable sadness, tears or joy, etc.
(3) Behavior abnormalities: behavior gradually becomes eccentric, secretive or incomprehensible, preferring to be alone, uncomfortably chasing the opposite sex, not knowing shame, talking and laughing to oneself, living a lazy life, dazed and dazed, sleeping in the dark, wandering out, not returning home at night, etc.
(4) Sensitive and suspicious: very sensitive to everything, linking some ordinary things around him with him, thinking that they are directed at him. For example, if others are talking, they think they are talking about him; if others occasionally look at him, they think they have bad intentions. Some even think that the contents of the radio, television and newspapers are related to him, and they watch what they say and pay attention to others’ every move. Some think that someone is trying to harm him and dare not drink, eat or sleep, and some think that their lover is unfaithful to them and stalk them.
(5) personality change: the original lively and cheerful, hospitable people, become silent, sitting alone seems to be thinking about the problem, do not interact with others; always clean and sharp people become unkempt, lazy life, loose discipline, do not focus; the original rules of people become often late, early, unexplained absenteeism, sloppy work, do not care about criticism; the original frugal people, become wasteful The person who was frugal and diligent becomes wasteful and uninterested in things that were of great interest.
(6) abnormal language expression: not much talk with the topic, simple statements, monotonous content, the content of the conversation lacks the center or in the conversation to say something unrelated to the conversation, so that people can not understand, feel that the conversation is laborious or inexplicable, or talk to themselves, repeatedly repeat the same content, etc. Dissociation from reality, indulging in fantasy, and “daydreaming”.
Diagnostic criteria for schizophrenia
I. Symptom criteria: At least two of the following, not secondary to disorders of consciousness, intellectual disability, high or low affect, or simple schizophrenia, as otherwise specified.
1, recurrent verbal hallucinations.
2. apparent laxity of thought, rupture of thought, incoherent speech, or paucity of thought or content of thought
3, thought insertion, withdrawal, broadcast, thought interruption, or compulsive thinking.
4. passivity, being controlled, or being experienced with insight
5. primary delusions (including delusional perceptions, delusional states of mind) or other absurd delusions.
6. logical inversions of thought, pathological symbolic thinking, or verbal neologism.
7. emotional inversions, or apparent emotional indifference.
8. catatonic syndrome, bizarre behavior, or stupidity
9. marked hypoactive or lack of will.
II. Severity Criteria: Self-awareness impairment with severe impairment of social functioning or inability to converse effectively.
III. Criteria for disease course.
1, meet the symptom criteria and severity criteria for at least 1 month, simplex otherwise specified.
2, if both schizophrenia and affective psychiatric disorder criteria are met, when affective symptoms are reduced to the point that the symptom criteria for affective disorders cannot be met, schizophrenic symptoms need to continue to meet the symptom criteria for schizophrenia for at least 2 weeks before the diagnosis of schizophrenia.
Fourth, exclude organic disorders, and psychotic disorders due to psychoactive and addictive substances. Patients with schizophrenia not yet in remission who also suffer from the two types of disorders mentioned earlier in this item should be diagnosed side by side.
Clinical classification of schizophrenia
I. Simple type
It starts slowly in adolescence, usually without obvious causative factors, and is characterized by isolation, laziness, apathy, paucity of thought, and lack of will. The course of the disease develops slowly, often l-2 years in short cases and 3-5 years in long cases; therefore, it is easy to be mistaken for personality or thought problems in the early stage. If not diagnosed and treated in time, it is easy to gradually extend into chronic mental decline.
Youthful type
It starts in adolescence between 16-23 years old, mostly with acute sudden onset of insomnia and excitement. Behavior disorder, childish, often impulsive hitting and destroying things. Emotional instability, no external triggers and alone change of joy, anger and sadness, instantaneous transformation. There is an obvious breakdown in thinking, increased speech, whether singing or speaking is disorganized, there may be a piece of bizarre hallucinatory delusions. This type focuses on early control of excitatory symptoms, and is difficult to control if it develops into the full stage of the disease. Most of the episodes of this type are recurrent, and tend to mental decline after many episodes.
Stress type
It occurs in young adults, with acute or subacute onset, and is characterized by indifferent expression and behavioral inhibition. At the beginning, speech and movement are obviously reduced, and when it develops to a serious state, it becomes a wooden stiffness, lying without speech, movement or food, without expression, like a wooden person. However, we should be alert to the fact that sometimes the inhibition can be suddenly lifted to an excited state, and suddenly get up to hit, destroy or escape, often for a short period of time, and then turn back to a wooden rigid state. This type has a good prognosis, and can recover completely after treatment.
Delusional type (paranoid type)
The onset of the disease is slow in young adults, with early sensitivity and suspiciousness or intermittent auditory hallucinations, and then gradually develops into delusional ideas, mostly delusions of victimization, relationship, exaggeration, jealousy, suspicion or influence. The delusions and hallucinations affect the abnormalities of speech and behavior, but the emotional reactions are often incompatible with the content of thinking and the environment, and the delusional content is absurdly detached from reality. The development of the disease is slow, and it is not easy to be detected because it can still work normally in the early stage. The disease is often detected only when it affects working life and produces abnormal behavior. The prognosis of this type is good, and most of them can be cured after treatment. Only a small number of them will leave behind personality changes, and very few of them will develop into chronic mental decline.