A psychological disorder. The common clinical types are manic depression, menopausal depression and reactive depression. Because these emotional and mental disorders may lead to suicidal thoughts and behaviors, the content of suicide is also discussed in this chapter.
First, manic depression
Manic-depressive psychosis is a kind of spirit, and its basic symptom is too high or too low emotional activity.
Disease, which is characterized by recurrent manic state or depressive state with monophasic or bipolar attack. There is only one emotion.
Obstacle performance, high or low, is called single phase; When manic and depressive symptoms appear one after another, it is called bipolar.
No matter unipolar mania or unipolar depression, or bipolar manic depression, it can happen only once or repeatedly in the same patient. If there are recurrent attacks, there is a clear interval between the two attacks, and the mental state can be completely normal during the interval. Therefore, although patients with bipolar disorder may have multiple episodes, their mental activity does not decline. However, because the excitement of manic patients and the suicidal tendency of depressed patients have great influence on patients themselves and social order, they should be actively prevented.
(1) Epidemiological characteristics and clinical symptoms
The incidence of bipolar disorder is mainly among young people. According to the data of collaborative epidemiological survey in China 12 region 1982, the total prevalence rate of this disease is 0.76‰, and women suffer from this disease more than men, especially depression. According to the survey of western countries, the risk rate of severe depression in the lowest class of society is twice that of the high class. On the contrary, it seems that there are more patients with bipolar depression in the high class. Manic depression has two main clinical manifestations:
1, manic state
The outstanding performance of this state, first of all, is the high mood. This is a strong and lasting joy and excitement. Patients are often very happy, talking and laughing, full of joy. Because the patient's happy mood and his whole behavior are harmonious and infectious. However, due to the weakening of self-control, people often overreact to the things they come into contact with, and they will fly into a rage because of the dissatisfaction of a little thing. But it was soon replaced by the original happiness and high spirits.
The second is the escape of thought. The patient's association process is obviously accelerated, and his speech is eloquent and endless, but his views are superficial and one-sided, and he is self-righteous. Lighter patients can also concentrate and speak coherently and completely; When the illness is a little more serious, attention will shift with the environment, and the concepts guiding the ideological process can also change from time to time with the changes around, especially new things. Before a topic is finished, turn to another topic; In more serious cases, there may be no sentences, only the phonetic association, semantic association and accidental connection with the surrounding things between voice fragments; And the lack of logical connection in meaning.
2. Depression
The obvious manifestation of this state is first of all depression. At first, the patient showed fatigue, listlessness, insomnia, early awakening, and decreased work ability. And then gradually become depressed, depressed, unable to show it; When things are negative, the past "mistakes" and the present "disappointments" will come to mind and linger. I often feel that the future is bleak, so I am pessimistic. Patients often sit alone in the corner and feel sad, avoiding relatives and colleagues. Laughing at others will only increase your own pain, and a serious sense of inferiority will make you ashamed to see others.
The patient feels dull and stupid. Severe depression makes patients always blame themselves, think that they have become waste or social parasites, and even exaggerate the common shortcomings in the past into unforgivable crimes and ask them to deal with them themselves. Patients may refuse to eat because of evil delusions, or take other means of self-punishment, or even commit suicide to end their "evil" life. On the basis of delusion of self-guilt, there may also be delusion of reference and delusion of being killed, thinking that everyone throws a disgusting look at him, talks about his sins and wants to convict him. In addition, patients may have some incurable diseases due to constipation, loss of appetite and abdominal discomfort.
Because the motor function is inhibited to varying degrees, patients move slowly and stay in bed for less time; It will be stiff in severe cases. Some patients with no depressive symptoms and pessimistic thoughts have a great risk of suicide.
3. Mixed state
Klypin, a German psychiatrist, regards high spirits, escape from thoughts and increased movements as the three basic symptoms of mania (so-called three highs) and low spirits, slow thinking and slow action as the three basic symptoms of depression (so-called three lows). The "three highs" in manic state and the "three lows" in depressive state are transformed and appear alternately, and even some manic symptoms and some depressive symptoms are mixed in patients at the same time, which is called mixed type. But this type is rare in clinic. More common is anxiety or excited depression, which is also a mixed type. It is characterized by depression and anxiety.
(B) the reasons for the formation
The etiology and pathogenesis of this disease are still unclear. Although medical genetics and biochemistry, psychodynamic school, behaviorism school and sociological factors provide clues from different aspects, it seems that manic depression, like schizophrenia, is the result of a variety of pathological factors, and each patient may be the result of a combination of individual susceptibility, external pressure and environmental factors in different proportions.
1, medical interpretation
(1) Genetic and somatotype factors
According to foreign data, the prevalence rate of the disease in the general population is less than 0.4%, and the prevalence rate of the disease in patients' families is 10-30 times higher than that in the general population, and the closer the blood relationship with patients, the higher the prevalence rate. For example, the prevalence rate of siblings, parents or children of patients can reach 12-24%, while the prevalence rate of cousins of patients is only 2.5%. The research data of twins also show that the comorbidity rate of identical twins can be as high as 69-95%, while that of fraternal twins is only 12-38%. According to the statistics of the psychiatric department of Shanghai First Medical College, 29% of bipolar patients have a family history of mental illness. It can be seen that genetic factors have played a certain role, but how to play a role can not be explained exactly according to the existing genetic theory.
In addition, it has also been reported that the disease is also related to a certain body shape, such as depression may be related to short and fat body shape. According to the original data of German scholar Kretschmer, 58 of 62 patients with depression are short and fat. But whether there is an inevitable connection is still inconclusive.
(2) Mental and physical factors
Before the first episode of manic depression, about half patients had mental factors, and a few patients had physical factors. Relevant studies have confirmed that major negative life events, namely unhappiness, sense of loss and depressive life events, are not only related to neurotic depression and psychogenic depression, but also can be the inducement or promoting factor of "endogenous" emotional disorder. For example, Peckel pointed out that those who had major life events in the past six months had a six-fold higher risk of depression and a seven-fold higher risk of suicide. Moreover, the severity of life events is related to the onset time. After experiencing life events that seriously threaten personal safety, the probability of depression within one year is higher than that of ordinary people.
(3) Dysfunction of diencephalon
Many brain organic diseases, such as trauma, vascular diseases and tumors, may cause mental disorders similar to manic depression. Although there are a wide range of brain structures related to emotional activities, including diencephalon, limbic system, neocortex and midbrain reticular structure, most people still think that the dysfunction of diencephalon, especially hypothalamus, may be more closely related to manic depression. Because diencephalopathy can cause periodic and opposite mental or physical symptoms, such as depression and euphoria, obesity and emaciation, polyuria and oliguria. It has also been reported in the literature that stimulating the third room or near the hypothalamus during operation can induce emotional euphoria and wandering thoughts. Therefore, although pathological anatomy can not prove any morphological changes in the diencephalon of manic depression, it is generally believed that its dysfunction is related to the occurrence of this disease.
(4) monoamine metabolism disorder
According to research, it is known that monoamines that play an important physiological role in mammals include catecholamine (such as norepinephrine and dopamine) and indolylalkylamine (such as serotonin). The changes of the concentration of these two monoamines in the brain are related to manic depression. Clinical studies have found that the urinary excretion of norepinephrine (ne) in some patients with depression is indeed significantly lower than that in the control group, reflecting the low activity of norepinephrine in patients. When depression turns into mania, the metabolites of norepinephrine in urine increase, indicating that mania and depression are related to the activity of norepinephrine in the brain. Other data revealed that autopsy found that the contents of 5- hydroxytryptamine (5-HT) and its metabolite (5-HIAA) in the brain stem of patients with depression were low, and the metabolites of 5- hydroxytryptamine in cerebrospinal fluid and urine of patients were significantly lower than those of the control group during mania and depression. These data suggest that the low update rate of 5-HT in the brain may be related to both mania and depression. According to the above data, there are many hypotheses of amine metabolism disorder: 5-HT deficiency is the same biochemical basis of the disease, which constitutes the quality and potential of the disease, excessive ne leads to mania, and insufficient NE leads to depression.
2. The explanation of psychodynamic school.
Bipolar disorder has many different psychodynamic explanations. Humanistic theory explains manic depression with dependence and independence: when people lose friends, jobs or health, depression may occur, because these "losses" force individuals to be independent, which is difficult for patients to deal with. Lost people or circumstances help patients support a false self-imagination. Once they disappear, the broken self will collapse, leaving only despair. Existentialist psychologists believe that depression is the result of individual's final helplessness.
Psychoanalysis holds that depression is a form of self-punishment. Freud discussed sadness and depression as early as 19 17, thinking that sadness is a normal and conscious response to loss, while depression is due to unconscious contradictions and hostility to the lost people. Now they turn to themselves. The "loss" that leads to depression is often a relative, or it may be an inanimate thing, such as the loss of a watch, personal failure, or even a symbolic event. For example, a woman who is extremely depressed because of the loss of her husband is actually born of her dislike for her husband. This kind of self-punishment in depression and mania is reflected in a person punishing himself for imaginary sins. Bipolar patients often admit that they have negative feelings about the lost person, which plays a role in their own despair.
3, the explanation of behaviorism theory
Behaviorists believe that depression is the result of the reduction of normal behavior and the increase of relative abnormal emotional reward. The causes of depression are concentrated on the "reinforcement rate", and the social return that individuals get depends on their abilities and requirements, social and economic status and the number of people who are "attached" to each other. If any of these reinforcement factors changes, such as the death of relatives and friends, incapacity or economic situation, the frequency and quantity of reinforcement will be reduced, and patients will be unbalanced, and then new low-level responses can be strengthened through social rewards such as sympathy, and even mania will occur for a long time. For example, a person who has suffered a loss may be less cheerful, less talkative and less interested, and may sit quietly and avoid peers. This new behavior can be strengthened through the deep concern and care of others. In this way, the strengthening of normal emotions is reduced, while the strengthening of abnormal emotional symptoms is increased, which is easy to cause a vicious circle. On the other hand, the weakening of reinforcement may also cause depression. For example, a pair of sisters have lived together for a long time, never married, and rarely associate with others. One of them died and the other suffered from depression.
4. Interpretation of cognitive theory
(1) Cognitive distortion. Cognitive theory holds that the same stimulus will have different effects on different people. The difference between depressed patients and normal people is that early traumatic events make them sensitive to depression and prone to depression. Through alternative demonstration and self-identification, patients with depression have formed cognitive types marked by several distorted thinking patterns. The characteristics of cognitive type distortion in patients with depression are as follows:
(1) The positive results are negligible;
2 exaggerate any problem as "hopeless";
(3) it is easy to "polarize", that is, look at things from two extremes;
④ It is easy to regard two isolated things or events as universal.
Because of these cognitive distortions, people with depression hold negative views on themselves, their surroundings and their future. For example, the concepts of "I need everyone's love" and "I can do what I do well", these irrational but attractive beliefs can easily make anyone have a depressive reaction, and. These beliefs are also the characteristics of patients with clinical depression.
(2) "learned helplessness". Learned helplessness refers to the feeling of "complete despair" and the consciousness that no one can change what is happening. This theory was developed on the basis of animal research. Dogs that have been unable to escape the electric shock many times before still passively endure the electric shock when they are locked in cages with obvious escape routes. Learned helplessness theory holds that when people's efforts to reduce painful events have no obvious effect, they will also feel helpless. Repeated failures made him realize that the efforts to control these events were useless, and finally compromised to the relevant conditions, because they felt that their efforts and other people's help were useless, that is, they seemed completely helpless, and this sense of "out of control" and "helplessness" attributed this failure to the characteristics of "stability" and "inner", such as "I am stupid" and "being bored with me.
5. Sociological interpretation
Sociological surveys have found that social crises can promote depression and sometimes trigger manic episodes. Unemployment, arrest, family breakdown, personal conflicts and many other environmental and psychological events have an impact on bipolar disorder. However, among several sociological factors that have been confirmed by scholars and are indeed related to bipolar disorder, the most interesting thing is that achievement needs to be separated from mother and child.
(1) The demand for achievement is high. It is reported that people with high IQ and social ambition are more likely to suffer from bipolar disorder. Because these people often have high expectations for success, they are full of energy in the process of pursuing success, and when they can't avoid failure, they will feel desperate and then suffer from depression. However, some people disagree with this, thinking that these motives are caused by the innate emotional state, rather than the emotional instability caused by the need for high achievement.
(2) separation of mother and child. Whether it is for children or mothers, the separation of mother and child has a serious impact on both mothers and children. Adults who lost their mothers in childhood because of death or divorce are prone to depression. The reason is that the lack of maternal love or a suitable substitute love can easily make children fall into extreme depression emotionally. For a mother, leaving her children, for whatever reason, can easily make her feel a little desperate.
(3) Diagnosis and prevention
1, diagnostic criteria
According to China's CCDM-2-R, manic depression is described as: the basic clinical manifestations are emotional changes-high or low, accompanied by corresponding changes in thinking and behavior, with a tendency to relapse, and complete remission during intermission. People with mild symptoms may not reach the level of mental illness.
The onset of this disease can be mania or depression, and its meaning and diagnostic criteria are as follows:
Diagnostic criteria for manic episodes:
(1) symptom criteria
The main manifestation is high mood or irritability, and the symptoms last for at least one week. During the period of high spirits, there are at least the following three items:
(1) Speech increased significantly than usual;
(2) With the acceleration of association or fugue, the speed of patients talking to themselves can't keep up with the speed of thinking activities;
(3) inattention or inattention cannot last long, and often changes with the environment;
4 feel good about yourself, consciously have a particularly flexible mind and quick response, or feel particularly healthy and energetic;
⑤ Self-evaluation is too high, boasting that he can reach the level of delusion;
6 awake sleep needs to be reduced without fatigue;
⑦ activities are obviously increased, nosy, or psychomotor excitement;
8 reckless behavior, frivolous behavior, pursuit of pleasure, extravagance and waste, reckless behavior and adventure;
Pet-name ruby hypersexuality, coquetry or chasing the opposite sex.
(2) Severity standard
Obstacles can cause at least one of the following situations:
(1) work, study or housework ability is impaired;
② Impaired social skills;
(3) causing difficulties or troubles to others and causing danger or adverse consequences to yourself.
(3) Exclusion criteria
The following diseases should be excluded:
① Schizophrenia;
② Mental disorders related to physical diseases;
③ Brain organic mental disorder;
④ Mental disorders caused by psychoactive substances;
⑤ Schizophrenia-affective disorder;
Diagnostic criteria of depressive episode
(1) symptom criteria
The main manifestation is depression, which lasts for at least two weeks. During this period, at least the following four symptoms appear:
(1) lose interest in daily life or have no pleasure;
(2) The energy is obviously decreased, and there is no reason for continuous fatigue and powerlessness;
③ mental retardation or agitation;
4 self-evaluation is too low, often with self-blame and guilt, which can reach the degree of delusion;
⑤ Association is difficult, or the ability of conscious thinking is obviously decreased;
6. Repeated thoughts of death or suicide;
⑦ Frequent insomnia, early awakening, and excessive sleep in some cases;
8. Loss of appetite, anorexia or obvious emaciation;
Pet-name ruby obviously decreased sexual desire, irregular menstruation or amenorrhea of women.
(2) Severity standard
Obstacles can cause at least one of the following situations:
① Impaired social function;
(2) Causing me pain or adverse consequences.
(3) Exclusion criteria
The following diseases should be excluded:
(1) with manic episode;
② Reactive mental disorder;
③ depressive neurosis;
④ Climacteric depression;
Mania:
Monomania:
(1) meets the diagnostic criteria of manic episode;
(2) There is no evidence of manic or depressive episode in the medical history.
Recurrent mania:
(1) meets the diagnostic criteria of manic episode;
(2) Have a history of manic episodes in the past, have no depressive symptoms after manic episodes, and have never had a single depressive episode.
depress
(1) meets the diagnostic criteria of depressive episode;
(2) There is no evidence of manic episode in the medical history.
Bipolar manic depression
Meet at least one of the following two items:
(1) had a manic episode in the past, and this episode was regarded as a depressive episode meeting the diagnostic criteria.
(2) There was a depressive episode in the past, and this episode was regarded as a manic episode, which met the diagnostic criteria.
Manic period: ① this is a manic episode, which meets the diagnostic criteria of manic episode;
② Previous depressive episode.
Depressive period: ① This is a depressive episode, which meets the diagnostic criteria of depressive episode;
② Previous manic episodes (including those induced by antidepressant treatment).
Mixed phase: ① In this episode, mania and depression are mixed or appear alternately. Including inducing manic episode in antidepressant treatment or inducing depressive episode in antimanic treatment;
② The remission period between manic symptoms or depressive symptoms is not obvious;
③ Mania and depression symptoms are mixed or appear alternately, and the course of disease is not less than two weeks.
Differential diagnosis:
(1), according to the current diagnostic criteria: if there are multiple episodes, some are schizophrenic manifestations and some are affective disorder episodes, the diagnosis should be made according to each episode, and it should not be diagnosed as schizophrenic affective psychosis.
(2) This disease should be differentiated from affective disorder and schizophrenia with affective disorder, which are inconsistent with psychopathological symptoms. The main difference is that the above two conditions will not meet the diagnostic criteria of two kinds of psychosis at the same time.
2. Prevention and control
The treatment of manic depression often faces the urgent need to relieve symptoms immediately. Patients with major depression are at risk of suicide and may harm themselves in other ways. Therefore, medical treatment is usually the first treatment, while psychotherapy such as psychodynamics or behaviorism is implemented after most acute symptoms subside. Medical practice has proved that the combination of various psychological methods and medical methods is very effective in treating depression; Even a simple project like a lot of physical exercise has great benefits.
(1) medical technology
If the drug treatment of psychosis has greatly changed the treatment of schizophrenia, then chemotherapy is a revolution in the treatment of bipolar disorder. Different types of bipolar disorder can be well treated by special drugs or a combination of several drugs. Monophasic depression can be treated with tricyclic drugs, including imipramine and amitriptyline. Tricyclic drugs directly act on biogenic amines in the brain to stabilize synaptic activity. The effectiveness of these drugs in the treatment of depression supports the hypothesis of catecholamine in the treatment of depression, but tricyclic drugs have obvious side effects, such as dizziness, palpitation and gastrointestinal reaction.
(2) Psychotherapy
Psychodynamic therapy: Psychodynamic therapists rarely use understanding therapy for patients with bipolar disorder, but most of them use support and comfort to try to reduce anxiety and feel relaxed and comfortable. Once the patient regains a stable mood, slowly reveal the root cause of mental illness.
Behavioral therapy: Through long-term practice and theoretical exploration, psychotherapists found that patients with depression have one thing in common: their views on themselves and the world are dim. As a result, many patients can't even understand the practices that can change their emotions. These patients need to gain self-awareness and understanding so that they can see how their expectations affect their emotions. Behavioral therapists are paying more and more attention to patients' distorted attitudes. Many behavioral therapists are trying to teach patients how to feel and react more truly and how to control their emotional and behavioral problems more effectively.
Cognitive behavior correction: Cognitive behavior correction method combines cognitive therapy with behaviorism therapy to form various treatment steps, and treats specific symptoms after the initial period of self-evaluation and self-monitoring.
(1) "Task Classification". The most basic objective means to treat depression is to make patients active again. Task classification decomposes goals or activities into small goals or smaller behavior patterns, which reduces the pressure on patients. Its purpose is to make tasks easier and enable patients to complete these tasks and obtain successful reinforcement. With the progress of treatment, the difficulty of the task will gradually increase.
② "Turn unpleasant activities into pleasant activities". The activity level of depressed patients is relatively low at first, and even no matter what activities they do, it seems that they can't bring much happiness. Their daily activities are often rigid and passive. They also like to make friends with other depressed patients, which is a tendency to aggravate depression. Because people with depression are used to treating all new suggestions negatively, strong encouragement and specific contracts (mostly written) are more conducive to allowing them to participate in more enjoyable activities. Therapists should emphasize to patients that any particular activity can only be evaluated after they have participated for a period of time.
③ "Change negative views". To challenge the negative outlook on life of depressed patients and change it, Ellis' rational emotional therapy and Baker's cognitive therapy are generally adopted. After a period of time, this method can be combined with self-confidence training or other methods to let patients go through the adaptation process again.
④ "Inducing incompatible emotions". Therapists try to induce patients' emotional reactions, such as humor or anger, because the characteristics of depressed patients are incompatible with these reactions, which destroys the continuity of the corresponding depressed emotional reactions.
⑤ "Change self-language". Eliminating patients' negative self-language, such as "I'm useless" or "I won't do that", is very helpful to treat depression. After the initial stage of self-monitoring, patients will list a typical negative self-statement, and generally list a second potential negative positive statement. Therapists should instruct patients to say these positive sentences at different times and say them as loudly as possible.
⑥ "Basic Image Method". This method was first used by Lazrus in 198 1. This method is a variant of the system desensitization method, which Lazrus calls "the conventional rapid reinforcement time projection method". The cognitive stereotype that patients with depression obviously lack is the absence or non-existence of expectations and hopes for the future. Time projection method combines the imagination of happy activities with the understanding of the future, which will produce positive expectations and hopes. Generally, it is to let patients imagine that they are doing pleasant activities they have done before, and then let patients keep their feelings, imagine future happiness, and then return to the present reality. This method is similar to the method from unhappy to happy, except that it requires imagination rather than a lot of behavior.
In short, the existing medical technology enables the cured to choose various treatment methods. If properly applied, almost 100% of patients can be significantly improved or completely cured. Psychotherapy is often used as an effective continuation of chemotherapy. Some patients must receive psychotherapy to establish a new coping model, while others need counseling to relieve personal emotional distress caused by emotional disorders.
Second, menopausal depression
(1) epidemiological characteristics and clinical manifestations
Involuntary depression is a mental illness that occurs in menopause. Its main features are:
(1) first occurred in menopause. Female menopause is around menopause, about 45~55 years old; Male menopause is about 55-65 years old.
(2) Psychological abnormalities are mainly depression, anxiety and nervousness, and there may be paranoia, self-blame and jealousy, but there is no mental retardation.
(3) Most patients are accompanied by insomnia, physical discomfort, autonomic nervous system dysfunction, and endocrine function, especially hypogonadism or aging.
(4) This disease accounts for about 1/3 of affective psychosis, and it is more common in women. The incidence rate of women is about 3-8 times that of men.
Generally, menopausal depression starts slowly, develops gradually and has a long course of disease. The main manifestations are anxiety, depression and nervousness, and there is no obvious thinking disorder and exercise inhibition. Patients are depressed, depressed, anxious and nervous, such as worrying about family misfortune, waiting for a catastrophe, or being at a loss, sitting still, worrying about unimportant things, recalling unpleasant things in the past repeatedly, and then blaming themselves for not fulfilling their responsibilities and sorry for their loved ones, and so on.
(B) the reasons for the formation
1. Genetic factors: Some people have investigated the families of twin patients and found that the comorbidity rate of fraternal twins is 6%, while that of identical twins is as high as 60.9%, indicating that there is a certain relationship between heredity.
2. Decline of endocrine function: Menopause is a transitional period from middle age to old age, and the metabolism of the body and the functions of various organs are undergoing corresponding changes, especially the function of endocrine system is gradually aging and degenerating, among which the decline of gonad function is the most obvious. For example, the function of women's ovaries has changed from unstable to inactive, showing changes such as menstrual disorder and menopause. Ovarian endocrine arrest will inevitably affect the functions of endocrine systems such as anterior pituitary, adrenal gland and thyroid gland, which are closely related to it, and then affect the activities of cerebral cortex and hypothalamus, making the nervous system function unstable, reducing its adaptability to the outside world, and leading to increased sympathetic stress, which is the physiological basis for the onset of female menopausal depression. Because most people can successfully pass through menopause, this is just a pathogenic factor of menopausal psychosis.
3. Psychosocial factors: This is an important cause of menopausal depression. Because, when people reach menopause, their bodies begin to show signs of aging, their energy drops, their working ability drops, they are about to retire, and they lose their accustomed working environment; At the same time, due to the decline of endocrine function, the body feels unwell, the health condition is affected, and worrying about one's health is bound to cause mental tension and stress. Because at this stage, children generally grow up and face problems such as work and marriage placement. Parents must be particularly concerned and often worried, which will also cause mental tension and stress. These psychology.
(3) Diagnosis and treatment
The diagnosis of menopausal depression is mainly based on its clinical manifestations and characteristics. If the onset age is in menopause, there is obvious depression and depression, and even suicidal thoughts, excluding other mental disorders, it should be considered as menopausal depression. The treatment of menopausal depression is mainly psychotherapy, including general psychological support, adjustment of negative cognition and encouragement of positive behavior, supplemented by certain drugs, such as sedatives and antidepressants.
Third, reactive depression.
Reactive depression is a mental illness of depression, depression, anxiety and self-blame, and it is also a common psychogenic psychosis. Its characteristic is that the experience and performance of emotional abnormality are closely related to the nature and content of mental stimulation; And with the disappearance of mental stimulation factors, psychological abnormalities have also been eliminated or alleviated. After proper treatment, the mental state can return to normal, so the prognosis is good.