It is estimated that there are currently about 7 million people with schizophrenia in China. The lifetime prevalence of schizophrenia in the adult population is about 1%, with an annual prevalence of 0.26%-0.45% and a similar incidence in men and women. 50% of patients have attempted suicide and 10% eventually die from it. Patients with schizophrenia are also more likely to suffer from unintentional injuries than the general population, and the lack of productivity caused by this disease to the patient and his or her family is staggering and will place a serious burden on their families. The prognosis for the disease is poor, with approximately 2/3 of people with schizophrenia having significant chronic psychotic symptoms over time, significant impairment of social functioning, and high levels of psychiatric disability.
So how much do many people who are schizophrenia patients or their families know about the treatment and prevention of schizophrenia?
Treatment and prevention of schizophrenia
Currently, schizophrenia is defined as a group of severe mental illnesses of unknown etiology, most often starting in young adults, with significant abnormalities in perception (including cognition), thinking, emotion, behavior and other aspects of mental activity, and resulting in significant impairment of occupational and social functioning. There is generally no impairment of consciousness or significant intellectual impairment, and the course of the disease tends to be chronic and to show a tendency for mental decline.
However, the exact cause of schizophrenia remains unclear. What is clear is that factors such as having a schizophrenic in the family, viral infection of the mother during pregnancy, low economic and social class, exposure to adverse psychosocial stressors and an introverted, withdrawn, sensitive and suspicious personality are strongly associated with the development of schizophrenia.
Nowadays, for schizophrenia treatment, symptom control is not the ultimate goal, and comprehensive treatment that strives to bring patients back to society and be accepted by families and society again is the right direction for schizophrenia treatment. At present, the treatment of clinical schizophrenia is mainly based on medication, and medication can be divided into three treatment phases: the acute phase, the consolidation phase, and the maintenance phase.
I. The acute phase refers to the period when the mental symptoms are very obvious and severe
The goals of treatment in this period are
(1) To relieve the symptoms of schizophrenia as soon as possible for the best prognosis;
(2) To prevent suicide and impulsive behavior that endangers oneself or others. The treatment of the acute phase can generally achieve the goal with the joint efforts of clinicians, patients and family members, and the improvement of the condition is obvious during this period.
Second, the consolidation period refers to the acute phase of the control of psychiatric symptoms, the patient enters a relatively stable period
During this period, if the patient stops medication prematurely or encounters stress, he/she will face the risk of rekindling or fluctuation of symptoms. The objectives of treatment are to
①Prevent the relapse or fluctuation of symptoms that are in remission;
② Consolidation of the therapeutic effect;
③Control and prevent post-schizophrenic depression and obsessive-compulsive symptoms;
④Promote the recovery of social function;
⑤ control and prevent the occurrence of common adverse reactions associated with long-term medication use. The course of treatment generally lasts for 6 months.
Third, the maintenance phase of treatment refers to the maintenance phase of relapse prevention treatment after the consolidation phase of treatment has been stabilized
The purpose of this treatment is to prevent the relapse of psychiatric symptoms and to help patients improve their functional status. The duration of maintenance treatment depends on the patient’s condition, and is generally not less than 5 years.
In addition to pharmacological treatment, family education and social support also influence the prognosis of patients. As clinicians, we want patients to be able to live independently in society after medication; to be in close contact with family, friends and social support systems to help patients return to work. Psychologically, there is no cognitive decline; no emotional symptoms; and improved thinking disorders. Therefore, in order to restore the social function of the patients and to make them socially acceptable to their families and society, a combination of medication-based treatment is the way forward.
From the appeal information, it is clear that relapse prevention is much more important for schizophrenia patients than acute control of psychiatric symptoms, and long-term maintenance treatment is also crucial.
Therefore, preventing relapse in schizophrenia is an issue that needs to be taken seriously, with poor medication adherence as the most common cause of relapse in schizophrenia, with the inability to sustain medication being the largest single factor in the cause of relapse readmission in schizophrenia. The American Psychiatric Association (APA) principles of schizophrenia treatment state that “…without maintenance treatment, 60-70% of patients will relapse within 1 year, and approximately 90% will relapse within 2 years”.
The Canadian clinical guidelines for schizophrenia state that “the risk of relapse due to discontinuation of antipsychotic medication within one year is as high as 90%”. In addition, the emotional climate of the family has a significant impact on the course of schizophrenia and relapse, as excessive criticism, hostility, and other emotional expressions from family members are detrimental to the recovery of schizophrenic patients.
Each relapse will lead to the following outcomes.
1. delayed recovery and aggravation of the illness;
2. Increased hospital admissions;
3. Decreased sensitivity to antipsychotic medication;
4. increased risk of suicide and homelessness;
5. Difficulty in returning to the level of functioning before relapse;
6. Loss of self-esteem and impaired social and occupational functioning;
7.Increase the burden on family members and caregivers.
There are many reasons for poor medication adherence, including the view held by many patients and their families that, after acute treatment, psychiatric symptoms are fully controlled and do not require long-term maintenance treatment, and that relapses will not occur in the future. The relapse rate is indirectly increased by incorrect attitudes of patients and their families, difficulties in accepting the diagnosis of schizophrenia, or underestimation of the seriousness of the disease and the need for long-term treatment.
In addition, approximately 30% to 60% of schizophrenia patients live with family members, and family is critical to the recovery of patients and to achieving good long-term clinical outcomes.
The next section will focus on considerations for family intervention and its requirements.
First, to improve the patient’s and family members’ understanding of the illness, family members are required to.
① Understand the nature and characteristics of schizophrenia;
②Master the basic knowledge of mental illness and drug treatment;
③ Adopt a correct attitude toward the patient;
④ Understand how to provide certain support to the patient (e.g., supervision of medication).
⑤ Properly analyze and resolve family conflicts and contradictions. Secondly, families are required to.
① Accept the existence of the patient’s psychiatric symptoms;
② Identify stressors that may trigger psychosis;
③Prevent stressors that may lead to the next acute episode;
(iv) provide countermeasures to avoid or reduce episodes of illness, including the identification of recurrence precursor symptoms.
The appeals will enable patients and their families to acquire proper problem-solving skills and promote better communication between them, thereby improving the ability of schizophrenia patients to cope with various stressors, reducing the expression of anger and guilt in the family, reducing the psychological stress and burden on family members, reducing the adverse stress from family members’ lives, reducing the relapse rate, and improving treatment adherence.
It should also be mentioned that family economic situation is also one of the important factors affecting the outcome and prognosis of patients with first-episode schizophrenia. Families with lower economic levels have relative difficulties in treating and caring for patients, which may have a negative impact on the outcome of schizophrenia; in addition, patients with schizophrenia can have a negative effect on family situation, and the two are mutually beneficial, forming a vicious circle, which is a poor prognosis. Patients with good family economic status have relatively good outcomes.
It is not enough for patients to eliminate their psychiatric symptoms. The disappearance of clinical symptoms and the restoration of self-knowledge are only the criteria for clinical recovery. Ideally, the patient will have recovered the energy and physical strength lost due to the disease, achieved and maintained a good state of health, regained the original work and learning ability, and re-established appropriate and stable interpersonal relationships, in order to achieve full social rehabilitation. Therefore, combined treatment is inevitably indispensable and requires the joint efforts of the patient and his family as well as the physician, while the family assumes a more important role in the long-term relapse prevention process.