Schizophrenia is the most common group of mental diseases, and its patients account for about 2/3 of psychiatric outpatients and inpatients. Most of the patients began to get sick in the prime of life, mostly around the age of 25, and most of them started to get sick in young adults between 15 ~ 40 years old, mostly slowly, and a few were acute or subacute.
The course of disease is mostly long, from a few months to decades. If not treated in time, it will often recur or last. When the illness is at its peak, the patient's work, study, life, social interaction, etc. are not suitable, and objective examination reveals that emotion, thinking and will are not harmonious, that is, mental activity is split.
Patients know nothing about their own diseases and often refuse to seek medical treatment. Even if family members are reluctant to take them to the hospital, most of them are reluctant to approach doctors and complain about their feelings. They all think that they are not ill and do not need to see a doctor, let alone take medicine or receive other treatments.
At this time, if the family gives accommodation, it will often delay the treatment of the disease, and if it is delayed for a long time, it will recur or gradually develop into a chronic disease. At the end of the disease, it will gradually become a mental decline. At this time, the patient will wander all day, or sit alone in the corner. He is not interested in anyone or anything, does not associate with relatives, has no requirements and plans for study and work, and even needs others to take care of the food, water and personal hygiene necessary for life.
Therefore, schizophrenia has taken away the golden age of being the most energetic and making the greatest contribution to society. In addition to causing huge losses to the patient's own health, it also brought mental and economic burdens and mental pain to his family members and comrades in the unit. Therefore, once the disease is found, it should be treated in time to reduce the delay and recurrence of the disease. Schizophrenia is the most worthy of our attention and research in abnormal psychology and mental illness.
The symptoms of schizophrenia are all psychological abnormalities, and the manifestations are diverse and complex, which can be said to be "ever-changing". Not only the symptoms of different patients are different, but also the performance of the same patient in different periods and at different times of the same disease is different. However, if we can master the essentials of "ever-changing", we can distinguish this disease. The disease is mainly manifested in that mental activity (also called psychological activity) is divorced from reality, and there is disharmony and mutual influence among perception, emotion, thinking and will behavior, which leads to the decline of adaptability in study, work, life and social interaction, the original ability to study and work can not be maintained, and the original lifestyle becomes abnormal. Let's talk about the manifestations of the disease in various periods:
First, the early stage
Most patients have a slow onset without obvious inducement, and many symptoms are gradually formed unconsciously. For the first time, I found that many times sitting alone seems to be thinking about problems. Life is lazy, discipline is slack, attention is not concentrated, and academic performance is declining. There are not many topics to talk about, the sentences are simple and monotonous, people are gradually cold and distant, and they are not interested in what was originally very interesting.
Occasionally, I can find a sentence or two that people can't understand or "the bull's head is not right for the horse's mouth", or sometimes it's a bit strange. For example, suddenly angry and throwing things, or stubbornly pestering others for a little thing, making trouble without reason, crying or being happy for no reason. At this time, it is often misunderstood as "ideological problems" or personality changes. Some patients will complain of dizziness, headache, insomnia, poor memory, inattention, fatigue and weakness. And fear of being dirty, washing hands repeatedly, inexplicable panic and fear, upset, etc. , and often misdiagnosed as neurasthenia.
Some patients may be induced by physical illness or mental stimulation, and suddenly appear insomnia, excitement, obvious abnormal speech and behavior and other symptoms. A few patients may have short-term unconsciousness, incomplete hallucinations and delusions, or stay still and become numb.
Second, sufficient period.
This period is a period when schizophrenia clearly shows its characteristic symptoms, which are as follows:
1. Thinking disorder is also called association process disorder, and it is lax when the symptoms are mild. When the patient speaks or writes an article, the grammatical structure of each sentence is fairly smooth, but there is a lack of coherence between the upper and lower sentences or between contexts, so the whole speech or article makes people unable to understand its central content. When the illness is serious, it will aggravate the collapse of thinking. Not only are there no connections between sentences, but each sentence is also incomplete. It seems that the words are mixed together or the sentences are piled up together, which is chaotic and fragmented. It's like an article typed by an illiterate person at random.
Some can be manifested as thinking interruption, suddenly stopping for a moment when talking with people, and then changing the subject when talking.
In addition, there is the emergence of thinking, that is, a series of unrelated sentences come out involuntarily in the brain, pouring out like spring water, and patients can't restrain it if they want to. Sometimes I feel as if I have been forced to insert or squeeze some thoughts into my mind by others, which was imposed on me by others. This feeling is called compulsive thinking. There is also a lack of thinking. Sitting with him without asking questions will only be relatively speechless. The answer to the question is simple, and the monotonous answer is "yes" or "no". Other patients think that they have already expressed a lot of meaning by telling you one thing in a few words, and others have understood what they want to say in detail. It's called a pathological brief.
The patient's thinking and reasoning about things are often illogical, and his judgment and analysis of things do not conform to the laws of reality and general reason, but he thinks it is very reasonable. The illogical manifestations are neologisms and morbid symbolic thinking. The patient creates some patterns, symbols, words or actions to express concepts that he can only understand. If you write "female and male" as a sign of marriage, hold up the bent last finger to welcome you.
Pathological symbolic thinking is because patients confuse abstract concepts with concrete things. For example, a young man often keeps his knees unyielding to show his strength. Strength is an abstract concept, and the position of his knees is a concrete thing. The two are confused. There is also a middle-aged worker who is not allowed to buy black wool for his daughter to knit a sweater at home. She can only buy red wool if she buys it properly to show that his family is taking the "red line" (revolutionary route), not the "black line".
Thinking disorder also includes the disorder of thinking content. Some patients will have various delusions, among which the delusion of being killed and the delusion of reference are the most common, followed by the delusion of exaggeration and jealousy. These delusions can coexist and influence each other. For example, a young man took a bus and sat next to two PLA men. After getting off the bus, there were motorcycles walking around on the road, so he assumed that he was a big shot. Otherwise, why did the People's Liberation Army protect him and the motorcycle cleared the way? At home, I heard my neighbors playing poker, and there was an intermittent voice saying, "Shoot ... Oh, no ... something happened ...", and concluded that "they were jealous of me as a big shot and accused me of making a mistake and wanted to drag me to shoot". The patient has three delusions at the same time: delusions of exaggeration, delusions of delusion of reference and delusions of murder, which are interrelated and permeated with each other.
2. Emotional disorder is one of the main symptoms of schizophrenia. The patient is indifferent when he is quiet, indifferent to the things around him, alienated from his relatives, indifferent when he is told of important events, and likes to sit alone in the room and even not eat with his relatives. Sometimes there will be reactions such as excitement, anxiety and depression, but most of them have nothing to do with the surrounding environment but are mainly hallucinations and delusions. Sometimes his mood is out of harmony with his surroundings, but when he holds a memorial service for his relatives, he stands aside and laughs. Her emotions are often not in harmony with the content of thinking, such as smiling and describing her tragic experience.
3. Will Behavior Disorder Each of us is subject to our own will. If we want to accomplish a task, we must make up our minds to overcome all difficulties. Patients have no sense of responsibility for study or work, and they are indifferent, regardless of short-term or long-term plans. They just do nothing all day, lie in bed or wander aimlessly, even eat, wash their faces, change clothes, comb their hair and get a haircut in their daily life. Sometimes I talk to myself, laugh at myself, hit people, destroy things, hurt myself and so on because of the influence of hallucinations and delusions.
The disharmony in thinking, emotion and behavior of the above patients is also the main feature, which can often be found in patients' daily cases.
Third, the later period
After active treatment, patients may have several different outcomes: some of them gradually get better and recover after treatment, and they can return to their original jobs after rehabilitation. Although some patients have undergone arduous treatment, it is not easy to completely control their symptoms, and they often have recurrent attacks. Although the condition of some patients has improved, they have left behind symptoms such as indifference, withdrawn, little talk and no initiative in study and work. There are still some left-over personality changes, taking an indifferent attitude towards everything and being irresponsible to society and family. A small number of them gradually develop into mental decline, that is, they want nothing but to take the initiative to eat when they feel hungry instinctively. They sit in the corner or sleep with their heads covered all day, without contact with anyone, and all their lives need the care of others.
In the whole period of schizophrenia, clinicians often divide patients with typical manifestations into four types for the convenience of treatment and nursing.
First, the simple type
The onset of youth is slow, and there is generally no obvious inducement. Mainly manifested as loneliness, laziness, lack of thinking, lack of will, and there may be fragments of hallucinations and delusions. Symptoms of neurasthenia such as headache, dizziness, insomnia and general weakness often appear in the early stage, and are often misdiagnosed as neurasthenia. The course of the disease develops slowly, often as short as 1-2 years, and the elderly can be as long as 3-5 years. Therefore, it is easy to be mistaken for personality or ideological problems in the early stage. If not diagnosed and treated in time, it is easy to gradually delay to chronic mental decline.
Second, the youth type
16 ~ 23 years old, the onset of puberty is mostly acute insomnia and excitement. Behavior disorder, childish, often impulsive to hit people and destroy things. Emotion is unstable, there is no external stimulus, and it changes instantly only by changeable emotions. Thinking is obviously broken, and speech is increasing. No matter singing or talking, it is chaotic, but there are some bizarre illusions and delusions. This type focuses on the early control of excitement symptoms, which is difficult to control if it develops to the whole stage of the disease. This type is mostly recurrent, and tends to decline in intelligence after repeated attacks.
Third, the tension type
It occurs in young people, showing acute or subacute attacks, characterized by indifference and behavioral inhibition. At the initial stage, speech movements are obviously reduced, and when it is serious, it is in a state of stupor, lying still, not moving, not eating, and expressionless, just like a Woodenhead. However, we should be alert to the sudden release of inhibition and excitement, which suddenly rises to hitting people, smashing things and running away, often for a short time, and can be turned back to a coma. The prognosis of this type is good at first diagnosis and can be fully recovered after treatment.
Fourth, paranoia (paranoia)
Young people are slow to get sick. Sensitive and suspicious at the beginning or accompanied by auditory hallucinations. Later, it gradually developed into delusions, mostly delusions of victimization, relationship, exaggeration, jealousy, hypochondriasis or influence. Because of delusions and hallucinations, his words and deeds are abnormal, but his emotional reaction is often out of harmony with his thinking content and environment, and his delusions are absurd and divorced from reality. The course of the disease develops slowly, and it can work normally in the early stage, so it is not easy to be found. It often develops to affect work and life, and abnormal behavior is found to be sick. This type has a good prognosis, most of them can be cured after treatment, only a few will leave personality changes, and a few will gradually develop into chronic mental decline.
Neurasthenia does not lead to mental illness.
Neurasthenia is mainly manifested as the symptoms of brain weakness. Patients often feel lack of energy, poor brain use, or lethargy, especially when studying or working for a long time, that is, they feel unable to concentrate, have difficulty thinking, and their study or work efficiency is obviously reduced, and their memory is also obviously reduced. At the same time, it may be accompanied by symptoms such as tension headache, insomnia and easy temper.
Neurasthenia mostly occurs among intellectuals, college students and middle school students. Treatment is not difficult, as long as we pay attention to the rest of the brain, avoid using the brain for a long time, and properly apply some symptomatic drugs, it is not difficult to cure. But in clinic, there are often some patients who may not be cured for many years, even lose confidence in treating diseases, and some even fear that they will become mentally ill.
What we usually refer to as mental illness mainly refers to schizophrenia. Under the control of the disease, patients have obvious abnormalities in cognition, emotion, will and behavior, so that they can't correctly reflect the objective reality, can't work and study normally, or have behaviors that endanger themselves and the social collective. This kind of patient has no self-knowledge, refuses to admit that he is sick, and is forced to go to the hospital. The etiology and pathological changes are not clear at present, so the therapeutic effect is not ideal. This is a completely different disease from neurasthenia. People with neurasthenia don't have to worry about schizophrenia.
However, in some patients with schizophrenia, due to the slow onset, there are clinical symptoms similar to neurasthenia in the early stage, and after several years of course evolution, typical symptoms of schizophrenia gradually appear. Such patients may be diagnosed as neurasthenia when they seek medical treatment in the early stage, and then they will be diagnosed as schizophrenia after symptoms appear. Therefore, although this patient has had symptoms of neurasthenia, it cannot be said that he is schizophrenia caused by neurasthenia.
Because neurasthenia is a kind of neurosis, although it will not lead to schizophrenia, serious patients may develop into other types of neurosis if they are not actively treated, such as obsessive-compulsive neurosis, panic neurosis, anxiety neurosis, depressive neurosis and so on. Although these diseases are not mental diseases, they may also affect people's social functions, and in severe cases, they have to be hospitalized.
Nursing care of mental patients taking medicine
It is a key problem in family rehabilitation and an important measure to prevent the recurrence of mental patients. Mental patients with different symptoms in different periods have different nursing methods. How to do a good job of medication nursing in the acute stage of psychosis?
Patients with acute attacks generally don't know themselves and don't admit that they are sick, so most people are reluctant to take medicine. Generally, we can only take patient persuasion, and we can find the most trusted or authoritative person to persuade patients. Be careful not to say "mental illness should take medicine" when persuading, but try to put it another way, or take him to the doctor who usually treats him according to his usual illness, and then change the medicine quietly before taking it. Some patients can identify the antipsychotics they have taken in the past and can take capsules. Some patients refuse to take all drugs, but they can mix odorless drugs (clozapine, droperidol, etc. ) in meals or drinks and milk. However, it must be noted that this method is not suitable for paranoid patients, because once it is discovered by patients, it will make them more suspicious that someone has poisoned the food and refuse to eat.
If the above methods can't make the patient take the medicine, he should seek medical treatment and change the medicine to intramuscular injection. After the acute symptoms are controlled, patients are generally willing to take medicine.
Secondly, it is medication nursing in recovery period. Medication nursing of convalescent patients focuses on strengthening patients' understanding of the importance of insisting on medication. The purpose of maintenance drug therapy is to treat diseases and prevent and reduce the recurrence of diseases. Generally speaking, patients should continue to take medicine for 2-3 years after their condition is stable. Many patients often stop taking drugs for a while after leaving the hospital because they think their illness has been cured. There are also family members of patients who agree to stop taking drugs without authorization because they lack a clear understanding of the importance of insisting on taking drugs. There are even family members who object to the patient's continued medication, fearing that patients taking antipsychotic drugs will become dull or affect their liver function. In fact, these worries are completely unnecessary. Some patients are unwilling to take medicine because of the side effects after taking medicine. It should be noted that only drowsiness, stiff movements, constipation, tape casting and obesity are minor side effects after taking medicine and do not need treatment. Symptoms such as head and neck askew, fidgeting and limb trembling are serious side effects. At this time, the dosage must be adjusted or reduced under the guidance of a doctor, and it will get better soon after taking the medicine. We advocate that patients must go to the outpatient clinic regularly during the maintenance treatment during the recovery period, so that doctors can adjust the drugs according to the condition, so that the effects of the drugs are "just right" and the side effects are minimized, so that patients are willing to insist on taking the drugs. Those who take clozapine, lithium carbonate and other drugs should also go to the clinic regularly to check their blood routine and blood lithium concentration. In addition, the method of medication must be in accordance with the doctor's advice, and it is not allowed to increase or decrease or take drugs irregularly. Sudden withdrawal of drugs can lead to withdrawal reaction, and sudden withdrawal of drugs after withdrawal will have great side effects and be prone to accidents. Some patients often change from being willing to take medicine to refusing to take medicine when their condition recurs, saying that they have recovered and do not need to take medicine. At this time, family members should closely observe the changes of the condition and send them to the outpatient clinic for examination and treatment in time to prevent the condition from getting worse. In addition, family members should watch the patient take the medicine before leaving, and check the patient's mouth (under the tongue or between the teeth) if necessary to prevent the patient from taking it suddenly after hiding the medicine, so as to achieve the purpose of suicide.
Mental health 1. Mental patients lack self-confidence, and inferiority complex exists. Psychological nursing is very important. Give mental health education to people around you, so that they can eliminate their prejudice against mental illness.
2. Life skills training: For patients in rehabilitation period, their families should encourage them to strengthen life skills training, help them to make a suitable schedule of work and rest, and gradually start a regular life, do some housework, listen to music and watch TV. Young and strong people can take part in some fitness activities. Don't lie in bed all day, with food to eat, clothes to wear and nothing to do.
3. Recovery and development of interpersonal relationship: Mental patients have different degrees of emotional apathy, behavioral withdrawal, strong dependence and other factors that are not conducive to the recovery of interpersonal relationship. People around you also look at patients with new eyes, including prejudice and misunderstanding. Family members should help patients restore their original interpersonal relationships and develop new ones. Family members, colleagues and neighbors give care and help.
It is of great significance for patients to learn more about mental health and arrange appropriate work according to the situation.
5. Prevention of recurrence: It is very important to insist on taking medicine to prevent the recurrence of mental illness. During this period, avoid tobacco, alcohol and strong tea, and live a regular life. At the same time, carefully observe the changes of patients' sleep, mood, behavior and drug reaction, and take preventive measures in time in case of psychological, social or other emergencies.
Rehabilitation of patients
Neuropathy and psychosis
The words neuropathy and psychosis are basically common in folk languages and have the same meaning. But in medical language, there are obvious differences between them.
The so-called spirit refers to people's feelings, perceptions, memories, associations, emotions and other aspects. Mental problems are manifested in the disharmony between mental activities and the surrounding environment, that is, the changes of patients' own vision, hearing, thinking and feeling are quite different from those of normal people. For example, there is no problem in a room full of people, but he insists that a big tiger came in, turned three times on the ground and went out again; Or life is normal, but he is inexplicably worried, has no desire for tea and rice, does not think about work, and lies in bed all day.
Because mental activity is the function of the brain, when diseases in the nervous system or other parts of the brain affect it, sometimes there will be certain mental abnormalities, which we call mental symptoms. On the contrary, when there is no specific problem in the brain, there is a serious mental abnormality, which is called psychosis.
The relationship between the two, I use the table below to illustrate. To sum up in a popular way: if people with abnormal mental performance find lesions through objective examination by doctors, it is enough to directly treat the primary disease with mental symptoms; If no pathological changes are found, it is probably a mental illness and needs the treatment of a psychologist.