Schizophrenia is the most common, and it is difficult to describe and completely define. In the related records of more than 1000 years, Krapirin in Germany did not describe it as an independent disease (early onset dementia) until 1896, and191year, Ebuller in Switzerland suggested adopting schizophrenia. The total prevalence rate of the general population is 3-8‰, and the annual incidence rate is 0. 1‰. 1982- 1985 the epidemiological survey of mental illness in the whole country 12 area showed that the total pain and * * * prevalence rate of schizophrenia in people over 15 were 5.69‰, and the time-point prevalence rate was 4.75‰. Among them, the time-point prevalence rate of 6.06‰ in urban areas is significantly higher than that of 3.42‰ in rural areas. The lifetime prevalence rate of schizophrenia is 7.0-9.0‰, with an average of 8.6‰(shields and slater 1975).
[Etiology and pathogenesis]
1. Etiology: unknown, only some possible pathogenic factors have been found in the research results in the past hundred years.
biotic factor
1. Heredity is the most likely quality factor of schizophrenia. Domestic family survey data show that the prevalence rate of relatives of schizophrenia patients is 6.2 times that of ordinary residents, and the closer the blood relationship, the higher the prevalence rate. Twin research shows that the comorbidity rate of identical twins with almost identical genetic information is much higher than that of identical twins with incomplete genetic information. Based on the data of 1 1 in recent years, the comorbidity rate of monozygotic twins (56.7%) is 4.5 times that of monozygotic twins (12.7%), which is the same as that of the general population. It shows that genetic factors play an important role in the occurrence of this disease, and the study of foster children also proves that genetic factors are the main factors of this disease, and environmental factors are not very important. Previous studies have proved that diseases are not inherited according to types. At present, it is considered that polygenic inheritance is the most likely, and some people think that it is autosomal monogenic inheritance or polygenic inheritance. Shields found that the milder the disease, the more complicated the cause and the stronger the polygenesis. Prospective research on high-risk families combined with molecular genetics research may clarify some problems. It is reported in China that human proto-oncogene Ha-ras- 1 is used as a probe to analyze the limited fragment length polymorphism of the genome of psychotic patients. The results suggest that there may be a DNA sequence related to schizophrenia and bipolar affective psychosis on chromosome 1 1.
2. Personality characteristics: About 40% patients' pre-illness personality is withdrawn, indifferent, sensitive, suspicious and full of fantasy, that is, introverted personality.
3. Others: The onset of schizophrenia has a certain relationship with age, mostly in young adults. About 65,438+0/2 patients developed schizophrenia at the age of 20 ~ 30. The onset age is related to the clinical types, and the onset of paranoia is late. Some data suggest that the average onset age of paranoia is 35 years old, while the average onset age of other types is 23 years old.
The survey data of China 12 area in 1980s: the total prevalence rate of women (7.07%. ) and time-point prevalence rate (5.9 1%). ) is significantly higher than that of men (4.33%). And 3.68%. )。
When describing the relationship between personality and schizophrenia, Kretschmer pointed out that 6 1% patients were lanky and strong, 12.8% patients were obese and1.3% patients were stunted.
Schizophrenia is a common phenomenon after physical illness or delivery, which may be the non-specific influence of psychological and physical stress. Some patients suffer from traumatic brain injury or infectious diseases; It is reported that viral substances have been found in cerebrospinal fluid of schizophrenic patients. Physical factors such as aggravation during menstruation may be inducing factors, but its value in the pathogenesis of schizophrenia needs to be further confirmed.
Psychosocial factors
1. Environmental factors ① Parents' personality, words and deeds, manners and education methods (such as doting, doting and being too strict) in the family will affect children's physical and mental health or make their personality deviate from the normal state. ② The relationship between family members and the obstacles to their spiritual communication. ③ Unstable life, crowded living, unstable occupation, bad interpersonal relationship, noise interference and environmental pollution all play a role in the pathogenesis. The incidence of schizophrenia in rural areas is significantly lower than that in cities.
2. Psychological factors It is generally believed that life events can induce schizophrenia. Such as dropping out of school, lovelorn, nervous study, family disputes, marital discord, accidents and so on. , have a certain impact on the onset, but the nature of these events is not special. So psychological factors are only inducing factors.
Second, the pathogenesis
(1) Biochemical metabolic disorder Long ago, people suspected that mental illness was caused by toxic substances and conducted extensive research. With the development of psychopharmacology, great progress has been made in the study of biochemical pathogenesis of schizophrenia, and the following hypothesis is more meaningful.
1. dopamine hypothesis In recent years, it has been found that amphetamine can promote the release of dopamine into synaptic cleft, and it can also make normal people produce a clinical manifestation similar to schizophrenia; Various antipsychotics can antagonize dopamine-sensitive cyclic adenylate and block postsynaptic dopamine receptors, and this effect of drugs is consistent with its clinical potency. The density of dopamine receptors in caudate nucleus, putamen nucleus and nucleus accumbens of schizophrenia patients increased; It is suggested that the occurrence of schizophrenia is related to excessive dopaminergic activity in some parts of the brain However, the direct evidence of this hypothesis is still insufficient and there are still defects. Some patients have poor drug efficacy, which can not be explained by dopa hypothesis.
2. Hypothesis of methyl transfection: The psychotropic drug cactus poison is a 3- methylated product of catecholamine, and dimethyltryptamine is a nitromethyl derivative of tryptamine, which can cause schizophrenia-like symptoms in healthy subjects. It is speculated that the occurrence of schizophrenia may be related to the hypermethylation of neurotransmitters such as dopamine or serotonin, which leads to the accumulation of methylated toxic products in the body.
3. In recent years, it has been found that the activity of platelet monoamine oxidase in patients with chronic schizophrenia is decreased, and the activity of platelet monoamine oxidase in proband and uninfected identical twins is decreased. It is considered that the change of enzyme activity is a sign of individual genetic vulnerability. Those who put forward the hypothesis of 5- hydroxytryptamine (5-HT) transmission disorder found that the content of 5- hydroxyindoleacetic acid (5-HIAA) in brain fluid of schizophrenic patients was low, and the synthesis and degradation of 5-HT in blood were reduced, suggesting that the onset may be related to the decrease of 5-HT activity in patients' brains. Some people think that the occurrence of schizophrenia may be related to the imbalance between dopamine system (hyperactivity) and 5-HT system (inactivity) in the brain.
(II) Physiological Hypothesis of Higher Neuroactivity Pavlov School believes that the symptoms of schizophrenia are produced on the basis of chronic hypnosis in the cerebral cortex, and different parts, ranges and degrees of inhibition can lead to different mental symptoms. When the inhibition process spreads to the subcortical emotional reflex arc, emotional apathy and dullness will appear. We use pathological excitations and negative induction in the cerebral cortex to create delusional beliefs and lack of criticism.
(3) The immunological hypothesis holds that schizophrenia is an immune response produced by abnormal antigens. According to his research findings, Heath suggested that schizophrenia is caused by the damage of special parts of the brain caused by antibodies, but Heath's findings have not been confirmed by other studies. Another study found that there were no antibodies in serum and brain fluid, and the content of immunoglobulin in abnormal lymphocytes was abnormal, suggesting that schizophrenia was the result of abnormal immune response. However, the specificity of these changes is still uncertain.
(4) Psychodynamic theory of psychological pathogenesis holds that schizophrenia is "libido" retreating to the point of attachment to the self, which makes the outside world meaningless and will not produce empathy. M.klein believes that the source of schizophrenia is in early childhood, during which the incarnation of self and mother is often divided into two parts: "completely good" and "completely bad". If you can't get through this period smoothly, you may suffer from schizophrenia in the future. Psychophysiological hypothesis holds that schizophrenia patients have specific defects in perception and cognition besides quality-stress. A considerable number of patients are "overexcited", especially in chronic withdrawal cases. Both Kraepelin and Bleuler believe that most symptoms of schizophrenia can be traced back to the weakening of attention and perception.
(5) The theory of cerebral hemispheric dysfunction is a new etiological theory based on the development of neuropsychology in recent 20 years. Its contents are as follows: ① The thinking disorder of schizophrenia is the result of dysfunction of the left hemisphere. ② The function of the right hemisphere is weakened and the function of the left hemisphere is overactive. ③ The functional defect of the corpus callosum blocks the information communication between the left and right hemispheres, or the left hemisphere is overactive due to overactivity and excessive information transmission. ④ Schizophrenia can be divided into two types: left hemisphere dominance syndrome equivalent to delusional performance and left hemisphere hypofunction syndrome equivalent to non-delusional performance.
[Clinical manifestations]
The disease can occur at any age, mostly in young adults, of which about 1/2 is 20-30 years old. Children's symptoms are atypical and difficult to diagnose. The incidence of male and female is roughly the same. Generally, the onset is slow, the date of onset is difficult to determine, and there are also acute or subacute onset.
(a) early symptoms may appear neurasthenia syndrome or obsessive-compulsive symptoms, but do not take the initiative to ask for treatment; Some are gradually withdrawn, cold and lack of initiative; Some become sensitive and suspicious, think too much, fear, etc. There are also some inexplicable strange behaviors that suddenly appear, such as aimless switch, shouting in class, standing outdoors for no reason when it rains, or suddenly impulsive, destroying things and so on. With the development of these symptoms, the characteristics of symptoms and disease types of schizophrenia are gradually revealed.
(2) There are many symptoms in the developmental stage, which almost involve most of the contents of symptomatology. Although there are differences between different types of people, they have the same characteristics:
1. Thinking disorder: it is an indispensable symptom of schizophrenia in the whole course. It is often not obvious in the initial stage, but it is highlighted in the development stage. Thinking disorder includes association disorder and thinking content disorder. At first, the obstacles of association were mostly the relaxation of association, the content of conversation was not compact, and the response was often irrelevant. Then association was rambling, even thinking was broken, and association was interrupted. Or symbolic thinking, creating new words or words, etc. The obstacles of thinking content are mostly delusions, and its logical reasoning is absurd, unsystematic, divorced from reality, and often generalized, involving everyone. The content of delusion is mostly murder, jealousy and so on. And there may be delusions such as exaggeration and sin. You can also feel controlled, diffused, inserted or taken away.
2. Perceptual disorders: Auditory hallucinations are the most common and often subjective auditory hallucinations, such as critical, controversial or imperative auditory hallucinations, or thinking voices. Other hallucinations are second.
3. Emotional disorder: it is the most obvious symptom of schizophrenia. Emotional expression is not in harmony with thinking activities and will behavior, and it is also out of harmony with the surrounding environment, which is the characteristic of this disease. Emotional disorders are mostly dull and indifferent, indifferent to people and things. With the development of the disease, emotional disorders become more and more serious, and I am at a loss all day. Others may have irritability, impatience, emotional outbursts and emotional conflicts. With or without obvious motives. The change of mood makes people feel completely different.
4. Will-behavior disorder: most of them are psychomotor inhibition, such as doing nothing all day, being taciturn, retreating alone, living alone, not interacting with close friends, and even being cautious. On the contrary, there will be uncoordinated excitement, such as fidgeting, impulsive destruction of things, self-mutilation, hitting people or tension syndrome. Some are naive and stupid.
5. Mental retardation: the intelligence is still good, but some of them may have mental retardation and personality changes in the later stage with the development of the disease.
6. Clear consciousness and poor self-knowledge.
(3) If the symptoms are not relieved in the later stage of development, or the disease recurs many times, it can be called chronic or degenerative schizophrenia after many years. At this time, most of the symptoms in the later stage of development have subsided, and there has been a decrease in childish personality and mental activities, such as poor thinking, low voice, indifference or empty laughter, lack of spontaneity, loneliness and retreat in will and behavior, and people need to take care of their own lives, memory, calculation ability, pre-illness skills and some.
[Clinical type]
Schizophrenia can be divided into several types according to its clinical manifestations in addition to the above-mentioned characteristic symptoms. Classification has certain guiding significance for estimating treatment response and prognosis. The common clinical types are paranoid type, simple type and adolescent tension type. Besides, there are other types.
First, paranoid: also known as paranoid. This type is the most common. The onset age is mostly in middle age (25 ~ 35), and the onset is slow or subacute. The main symptoms are delusion, delusion of reference and victimization delusion are more common, followed by exaggeration, self-blame, influence, love and jealousy. Delusions can exist alone or accompanied by hallucinations. Emotional disorder is not obvious on the surface, and intelligence is usually unaffected. Patients' attention and will are often enhanced, especially those with delusions of victimization, who are alert, suspicious and sensitive. Under the influence of hallucinations and delusions, the patient kept silent at first and observed the surrounding movements with calm eyes. Later, doubts gradually increased, and there could be positive resistance, such as repeatedly complaining to the relevant units or asking for protection, and even hurting or killing people in serious cases. Patients may also feel that they have become "the target of public criticism" and have no choice but to take passive self-injury or suicide. Therefore, such patients are likely to cause social security problems. The course of the disease is slow, and he can still maintain his working ability for a long time after several years of onset, and his personality has changed slightly. If patients conceal their manifestations or emphasize the reasons, it is often difficult to find them early, which leads to difficulties in diagnosis.
[case]
Patient, male, 34 years old, married, engineer. He was hospitalized for half a year on suspicion of poisoning. Personality before illness: withdrawn, suspicious, silent and sensitive. Usually healthy, no serious medical history. My mother has been mentally ill for 20 years.
Six months ago, the patient had an academic argument with others at work. Later, I lost sleep and ate less. He suspected that the unit leader was deliberately targeting him. Every time I eat at work, I feel dizzy, my hands are swollen and my throat is stuffed. Some people suspect that the leader poisoned the food to harm him. In order to find the antidote, I read a lot of medical books and bought seaweed essence, which was very effective. In recent months, the suspected leader colluded with doctors in the infirmary to control his thoughts and behaviors with neutron rays. Sometimes he heard neutron rays talking to him, commenting on his "honesty and knowledge" and ordering him not to resist. Walking in the street, I found that "people are following everywhere". Suspected poison failed, so I bought two steamed buns and sent them to the epidemic prevention station for testing. I was very excited when I mentioned the company at home, accusing my family of "you don't know, be careful to be taken in by them!" . Smoking too much will make you look sad, and it will be even more disgusting for colleagues to comfort you. Seek medical advice everywhere, check liver function, electrocardiogram, and take chest radiographs, thinking that the body has been abolished. Recently, I wrote a letter of accusation continuously and went to the public security bureau to ask for protection.
No abnormalities were found in physical examination and nervous system examination. Mental examination, correct behavior, clear consciousness, normal intelligence, pertinent answer, nervous expression, mostly talking about the above content, but further questioning makes no sense, denying illness.
Diagnosis: paranoid schizophrenia.
Second, the onset of puberty is simple. Go slowly. Headache, insomnia, memory loss and other similar complaints of neurasthenia are common in the initial stage, but the mood of seeking medical treatment is not urgent, even if seeking medical treatment, it is easy to be ignored or misdiagnosed, and it will not be taken seriously until the condition develops obviously after a period of time. The main symptom of this type is the gradual decline of mental activity. Emotions gradually become indifferent, losing the sense of closeness to family and relatives. The efficiency of study or work is gradually decreasing. Behavior becomes withdrawn, lazy, passive, and even too lazy to take care of themselves in daily life. Generally, hallucinations and delusions do not occur. Although there are some, they are all fragmentary or short-lived. There are few people who automatically relieve, and the treatment effect and prognosis are poor.
[Case] Male, 2 1 year. Unmarried, military. I was in hospital for one year because I was lazy and didn't obey discipline. The patient was timid, taciturn and unsociable since childhood. It is said that his academic performance used to be behind Maotai. After graduating from high school, he worked in a local factory. In his first year in the factory, he was rated as an advanced worker in the workshop. In the second year, his grades were average, and he joined the army soon. On the day of enlistment, he found himself distracted and absent-minded when he went out to exercise. If he learns an action, others will learn it, and he has to learn it several times. Being lazy in the morning, often being late for sports, and criticizing leaders as if nothing had happened. Usually, he seldom contacts with his comrades. He is always pacing back and forth alone. Everyone says he is a "freak". After half a year, I became lazier, slept at night and was not interested in entertainment. Parents are too lazy to read letters and don't reply. Get a haircut, take a bath, change clothes, etc. Everyone needs my comrades to urge me again and again, and washing clothes is only done in the water. Sit on the ground and close your eyes when standing guard. On one occasion, he went out on patrol, passed by the melon stall, took a watermelon without authorization, put it down and left, saying "not sweet". He insisted on paying the tour fare, saying that "paying is the same as not paying." I often look in the mirror and feel that my nose is getting taller and my eyes are getting bigger. Laugh alone often.
There are no mental patients at home.
No abnormalities were found in physical examination and nervous system examination. Mental examination: clear consciousness, good orientation, untidy manners, dirty clothes, passive contact, and many smirks. Say "no problem, it doesn't matter if you stay for a long time" and be hospitalized. He has no consideration for his parents and his future, saying, "It doesn't matter if people are lazy and don't discipline well." Indifferent feelings, no initiative, poor thinking, but firmly believe that "eyes get bigger, nose gets higher." General memory, computing power, judgment and common sense are good, but I lack self-knowledge.
Diagnosis: simple schizophrenia
Third, the youth type: generally occurs in adolescence, and the onset is more urgent. The main symptoms are mental activity and disorder. It is characterized by increased speech, loose association, rich hallucinations, vivid content, absurd delusion, disintegration of personality, symbolic thinking, changeable emotions, childish, weird or impulsive behavior. This kind of disease develops rapidly, with obvious symptoms and absurd content. Although it can be relieved, it is easy to relapse.
[case]
Female, 17-year-old high school student. I have been in good health. Personality before illness: meditative, few friends, timid and shy, unsmiling. No love history. His mother is hospitalized for schizophrenia, and his father suffers from neurasthenia and often goes to psychiatric clinics.
The patient has a good academic record and is an excellent student in the class. Three months ago, I lost sleep inexplicably and didn't concentrate in class. I volunteered to ask my parents to introduce me to my boyfriend. Two months ago, I didn't go to school and wandered in the street. One month before I was hospitalized, I often sang in the middle of the night, talked to myself, made faces, made strange moves, looked in the mirror, smirked, and sometimes put flowers in my head, even naked, broke the glass window at home, drank the urine in the spittoon, slapped myself, cried and laughed.
No abnormalities were found in physical examination and nervous system examination. Mental examination: clear consciousness, good orientation, slovenly, giggling constantly, sometimes singing and dancing, but the song content is fragmented and the dance steps are chaotic. Words are scattered, such as "today's sweetness, I want to pass it on to the next generation, that is, people who like pandas." Eating chocolate is a pigsty, and Huangyan tangerine is a descendant of the emperor. When the emperor left, he carried me to Japan like a panda. " Without self-knowledge.
Diagnosis: adolescent type of schizophrenia
4. Tension type: onset is more urgent in adolescence or middle age, with nervous coma and/or nervous excitement as the main manifestations. These two states can appear independently or alternately. The course of disease is mostly paroxysmal. The prognosis is good.
(1) Tension stupor: The prominent performance is the inhibition of hair movement. Lighter people move slowly, talk less and move less, or keep a certain posture for a long time. Serious people sit in bed all day, don't move, don't eat, don't talk, don't respond to external stimuli, and stay in saliva and urine. Eyes big or closed, limbs stiff, resistant to luck. Slightly lighter people may have tension syndrome such as wax figure buckling, involuntary obedience, imitation of actions and words, repetitive actions, etc. Consciousness is barrier-free, even with severe motor inhibition, you can perceive things around you and remember after illness. It usually lasts for several days to several weeks. Coma can be relieved or turned into excitement at night.
(2) Nervous excitement: Sports excitement is an outstanding performance. Impulsive behavior, rigid speech, loose communication and obvious emotional fluctuation. It can last for several days to weeks, and the condition can be relieved or turned into a coma.
[case]
Female, 30 years old, married, worker. Personality before illness: gentle, timid and taciturn. Good health, no serious medical history. No family history of mental illness. Family harmony.
Three months before admission, there was no obvious mental stimulation, and I suddenly lost sleep, becoming particularly silent. I couldn't say three words a day, doing nothing all day, keeping a posture, eating passively, and living in need of care. At night, in the dead of night, I got up and swallowed all the food in the cupboard, talking to myself and giggling. In recent weeks, I have become silent, don't cry, don't laugh, don't push her, don't feed her, there is a lot of saliva in my mouth, and my bladder is full.
Physical examination and nervous system examination found no special findings. Mental examination: stiff expression, silence, rigidity, anti-passive movement, waxing and air pillow, occasional pattern of speech and action.
Diagnosis: Schizophrenia and catatonic stupor disappeared after 6 times of electroconvulsive therapy, and the patient had auditory hallucinations.
Verb (abbreviation for verb) Other types:
(1) Undifferentiated: Symptoms cannot be classified into the above types.
(2) Residual type: After the acute symptoms of development are relieved, there are still some irrelevant hallucinations and delusions, or some mild symptoms, but they are not serious, and daily work can still be carried out.
(3) Declining type: the illness lasts for a long time, the thinking is extremely poor or broken, the emotion is indifferent, the will is lacking, the behavior is withdrawn and naive, the illness is fixed, and the fluctuation is less.
[Course of disease and prognosis]
The onset is slow, progressive and the course of disease is prolonged. Some symptoms fluctuate. After treatment, it can be relieved, partially relapsed, or recurred many times. The prognosis is related to the type, stage and treatment of the disease. Among the types of diseases, neurological type is better, followed by paranoid type and adolescent type, while simple type is not good. The shorter the course of disease, the higher the remission rate. The remission rate is 60-70% within half a year, and the remission rate decreases after more than one year. Antipsychotics can improve the condition of 3/4 patients, and the recurrence rate of those who insist on maintenance treatment is significantly lower than that of the control group. In addition, those with family history of psychosis, unknown pathogenic factors and schizophrenic personality before illness have poor prognosis.
[Diagnosis and Differentiation]
The diagnosis of schizophrenia is mainly based on the detailed medical history and mental symptoms, and then comprehensively consider the onset age, disease stage and course of disease. The diagnosis of this disease is quite strict and cannot be taken lightly. The diagnosis basis is:
First, mental symptoms are mainly thinking disorders, abnormal emotions, perception, will and behavior, and uncoordinated mental activities. Association and thinking content obstacles, emotional indifference, divorced from reality. Normal consciousness and intelligence, but lack of self-knowledge;
The second is the onset of youth and middle age;
The course of disease is long, more than three months;
4. If there were similar diseases in the past, some mental defects or personality changes were left during the intermission;
Fifth, similar family history of mental illness can be used for reference;
Six, physical and nervous system examination found no evidence of organic diseases.
Attached are the diagnostic criteria of schizophrenia in Chinese Classification and Diagnostic Criteria for Mental Disorders (CCMD-III):
1. Symptom criteria: At least the following two symptoms can be determined. If symptoms are suspicious or irregular, you need at least three:
(1) Association obstacle: destructive thinking or relaxed thinking, or logic inversion thinking, or film thinking, or poor thinking content.
(2) Delusions: delusions that first occurred, or delusions with contradictory contents, or two kinds of delusions that are unrelated to each other, or delusions with changeable contents, or delusions with absurd and bizarre contents.
(3) Emotional disorder: emotional indifference, or emotional abnormality, or self-mockery.
(4) Auditory hallucinations: critical auditory hallucinations or controversial auditory hallucinations, or imperative auditory hallucinations, or thinking aloud, or verbal auditory hallucinations for more than a few weeks.
(5) Behavior disorder: stress syndrome, or childish and stupid behavior.
(6) Passive experience or controlled experience.
(7) The exposed inner experience (epiphany) or the spread of thinking.
(8) the insertion of ideas, or the withdrawal of ideas, or the interruption of ideas.
Second, the severity standard: mental disorder causes at least one of the following situations:
Loss of work (including housework) and learning ability;
(two) life can not take care of themselves;
(three) unable to effectively talk with patients;
(4) losing self-knowledge;
Third, the course of disease standard: mental disorder lasts for at least three months.
Exclusion criteria: Mental disorders caused by brain organic and somatic diseases, mental disorders caused by psychoactive substances and emotional insincerity should be excluded. Diagnosis should be differentiated from the following diseases:
(1) Neurasthenia: Schizophrenia patients with slow onset (such as simple type) often have symptoms similar to neurasthenia, such as headache, insomnia and memory loss. In the initial stage, but they are short and inactive, have no direct emotional response, and have no urgent requirements for treatment. If you ask about the medical history carefully, you can find that they have symptoms such as decreased interest in the environment, emotional retardation, withdrawn behavior, or weird thinking, and when neurasthenia patients know that they are sick, when they tell their illness,
(2) Obsessive-compulsive disorder: obsessive-compulsive symptoms may appear in the early stage of schizophrenia, such as obsessive-compulsive concepts and actions, which are easily misdiagnosed as obsessive-compulsive disorder. After detailed medical history and follow-up observation, it can be found that the obsessive-compulsive symptoms of this disease gradually become absurd, the characteristic symptoms of schizophrenia gradually appear, the anxiety due to obsessive-compulsive disorder is lacking, and the treatment requirements are not urgent. These are different from obsessive-compulsive disorder. Obsessive-compulsive disorder has a single symptom, a focus on the disease, a remarkable personality, and needs urgent treatment.
(3) Bipolar disorder: During the course of schizophrenia, manic state or depressive state may occasionally appear, which is difficult to distinguish. Sometimes it is necessary to distinguish treatment from follow-up observation and prognosis. If accompanied by symptoms of schizophrenia, it is helpful for diagnosis, but the possibility of schizophrenia-affective psychosis should be ruled out.
(4) Reactive psychosis: Sometimes schizophrenia is diagnosed as reactive psychosis after being stimulated by some kind of mental stimulation, but the latter is a sudden attack after a strong mental trauma. The symptoms reflect the emotional experience of mental trauma and the emotional response is strong. There is no similar attack in the past, short course of disease, good prognosis and no recurrence, which can be used for differentiation.
(5) Organic psychosis: Schizophrenia-like symptoms may appear in the course of brain organic psychosis and symptomatic psychosis. Mental retardation often occurs in patients with brain organic psychosis, and consciousness disorder often occurs in symptomatic psychosis, accompanied by positive findings of nervous system signs or physical diseases, while schizophrenia is generally unconscious and mentally retarded, which can be distinguished by auxiliary examination.
(6) Mental retardation: Patients with mild mental retardation, although able to engage in general simple manual labor, have poor social skills, low work efficiency, inactive emotions, childish behaviors, and even stupid criminal acts, and are sometimes misdiagnosed as schizophrenia. If we can collect detailed medical history, it is not helpful to identify mental retardation from infancy.
[therapy]
Because the etiology and pathogenesis of schizophrenia are unknown, there is no etiological treatment at present. The main goal is to relieve acute mental symptoms and improve the situation of chronic stubble cutting. Generally, comprehensive treatment measures such as anti-schizophrenia drugs and psychotherapy are taken. Physical therapy is the main method to control mental symptoms as soon as possible at the stage of obvious symptoms. When the symptoms begin to ease, while insisting on treatment, psychological treatment should be increased in time to reduce the mental burden of patients, encourage them to participate in group activities and industrial and recreational treatment, and promote social rehabilitation of mental activities. We should still adopt a positive treatment attitude towards patients with chronic stage, strengthen the contact between patients and society in the morning, activate patients' lives and prevent recession.
The treatment of schizophrenia is mainly psychotropic drugs.
First, antipsychotics can effectively control acute and chronic mental symptoms and improve the clinical remission rate of schizophrenia; Most patients who insist on maintenance treatment in remission can avoid recurrence; It often plays an active role in the treatment of preventing mental decline. At present, more than 40 kinds of antipsychotics have been used in the data. Commonly used drugs are chlorpromazine, clozapine, sulpiride, perphenazine and haloperidol. Chlorpromazine is the first choice, and chlorpromazine and clozapine are more effective than locusts. Haloperidol has no obvious anti-hallucination and delusional effect, and can alleviate or eliminate loneliness and withdrawal symptoms, which is suitable for acute and chronic schizophrenia. Triflurazine, fluphenazine and reserpine, which were commonly used in the past, are rarely used now.
The advent of long-acting antipsychotics is not only limited to the treatment of patients who refuse to take drugs, but also promotes the understanding of maintenance treatment for patients in remission, thus reducing the recurrence rate. Penfluridol is the main oral long-acting preparation, and the therapeutic effect of 30-60mg of oral gas can last for one week. At present, fluphenazine decanoate and Amdo (haloperidol decyl ester) are widely used in China, and the duration of one injection is 3 weeks and 4 weeks respectively.
Second, electroshock therapy has a significant effect on those who are nervous and stiff, excited and uneasy, hurt others and have serious negative emotions. Psychotropic drugs should be used after symptom control.
Third, insulin coma treatment is effective for paranoid and adolescent schizophrenia. Due to the complexity of treatment methods, the need for special facilities and the supervision of trained personnel, and the long treatment period, these restrictions have almost been replaced by convenient and safer antipsychotic drugs.
Fourthly, psychotherapy refers to psychotherapy in a broad sense. Pure psychoanalytic therapy is not suitable for this disease. As an adjuvant therapy, it is helpful to improve the curative effect of He Gong's walk-on, and is suitable for patients with paranoia and obvious mental factors in recovery period. Behavioral therapy is beneficial to the management and rehabilitation of chronic patients.
5. Psychosurgical treatment is a destructive treatment measure, and the indications should be strictly controlled. It should only be used as the last treatment for chronic maintenance patients who are ineffective in long-term treatment by other methods and endanger the safety of society and people around them.