How Effective is Early Intervention in Psychosis?

Schizophrenia-like psychosis follows the diagnostic rules of schizophrenia. What differs from schizophrenia is duration. Schizophrenia-like psychosis lasts longer than one month and does not exceed six months. If not cured for more than six months, the diagnosis changes to schizophrenia. In terms of duration, schizophrenia-like psychosis lasts longer than short-term mental disorders (duration lasts more than one day and less than one month) and is shorter than schizophrenia. ^[1]

Schizophrenic psychosis

Schizophrenic psychosis compliance

If the patient has a short onset of time and is first diagnosed with schizophrenia, early treatment with a new type of antipsychotic with comprehensive effects and low side effects is the key to treating the disease and early recovery. Especially in patients with adolescents, only by quickly controlling symptoms and recovering their ability to study, work and live as quickly as possible can the disease not affect their future future. The acute exacerbation of the disease in a certain period of time is mainly due to improper maintenance of the patient or the use of drugs, too little dose, or intermittent use, or sudden withdrawal of the drug. Even acute relapses occur in the context of medication. Each relapse will aggravate the condition, treatment will be more difficult, and repeated episodes will cause the patient's social function to gradually decline. And insomnia can cause schizophrenia. Five classifications of schizophrenia:

(1) Genetic factors : Clinical genetic studies have proved that genetic factors play a certain role in the occurrence of this disease. Root investigation found that the prevalence of close relatives of patients with this disease is several times higher than that of ordinary residents. The closer the blood relationship with the patient, the higher the incidence of schizophrenia. Research on twins predicts that the same disease rate of monozygotic twins in this disease is generally 4-6 times higher than that of twins, and the same is true of fosters.

Regarding the genetic pathway, most of them are at the hypothetical stage. Many authors prefer polygene inheritance, that is, the disease is caused by the action of several pairs of pathogenic genes and environmental factors. In recent years, due to the advancement of molecular genetics, British scientists have conducted research in families with more prominent schizophrenic families, suggesting that the pathological gene of this disease is located on the fifth pair of chromosomes, which has attracted attention from the psychiatric community. At present, the genetic mapping of schizophrenia is inconclusive.

(2) Endocrine factors : Most of the disease occurs during sexual maturity around adolescence, and some patients have acute onset after delivery. In addition, the incidence of this disease is also higher in the menopause stage. The above clinical facts show that endocrine has a certain role in the pathogenesis. Thyroid, gonad, adrenal cortex and pituitary dysfunction have also been suspected by many scholars as the etiology of the disease. However, studies on these aspects have not reached a definitive conclusion.

(3) Pre-illness personality characteristics : Withdrawal, sensitivity, shyness, good fantasy, poor logical thinking and other special pre-illness personality characteristics lead to schizophrenia, 50% ~ 60% of schizophrenia patients. Analysis of domestic data found Before the illness, 40% had timidity, hesitation, poor initiative and strong dependence. 7 times higher than the control group.

(4) Environmental factors : Fetuses infected with virus during maternal pregnancy have a significantly higher chance of schizophrenia in adulthood than the control group. Complications during pregnancy and perinatal period also increase the incidence of this disease.

(5) Socio-psychological factors : The occurrence of this disease is mostly caused by difficult encounters in childhood and adult life, and contact with relatives of schizophrenia is the main cause of the disease. Some scholars believe that social and psychological factors play a decisive role in the occurrence of schizophrenia, and data from the epidemiological survey of mental illness in 12 regions in China show. The prevalence of people with high and low economic levels is different, and the difference is significant. The prevalence of working and non-employed people is also significantly different. This may be caused by the poor physical environment of the living and the mentality caused by economic poverty. Stress and social and psychological stress are more related.

Recurrence harm

The high recurrence rate of schizophrenia has become the focus of world health attention. Due to the characteristics of the disease itself, schizophrenia is a chronic, persistent disease that recurs, and the condition is prone to recurrence. Each relapse may lead to permanent damage to the patient's brain, further impairment of cognitive function, and further decline in social function; for the family members of the patient, relapse means the deterioration of the loved one's condition and multiple mandatory hospitalizations, which must bear greater Financial burden and emotional stress; for medical workers, relapses can make treatment difficult and ultimately unsatisfactory. Therefore, effectively preventing the recurrence of schizophrenia has become a problem that needs to be urgently addressed. At the national launch meeting of "ADHES China Discovery" held on June 17, Professor Zhou Dongfeng, chairman of the Chinese Medical Association Psychiatry Branch, announced a survey on risk factors for relapse and hospitalization of patients with schizophrenia. Professor Zhou also introduced: "The non-compliance or partial compliance of patients with schizophrenia is the most important factor leading to recurrence and rehospitalization. The survey launched today is an attempt to find the important factors of different non-compliance factors To actively explore for better treatment effects. "Improving the compliance of schizophrenia treatment and helping patients return to society. Long-term drug treatment can easily make patients with schizophrenia lose confidence in treatment. Frequent missed medications will inevitably lead to recurrence of the condition, or even worse, and have to be hospitalized again. When a patient relapses several times, it will take longer to recover from each cycle, and the efficacy of antipsychotic drugs will decrease accordingly. With time, the difficulty of treatment gradually increases. Drug compliance is one of the key factors for successful treatment of schizophrenia. Therefore, efforts to improve patient compliance through various efforts are very important for the treatment of schizophrenia. Experts agree: "The development and application of new drugs is the most effective way to improve compliance." With the advent of new atypical psychiatric drugs, while improving the efficacy, it has also improved the adverse reactions such as stiffness, slow movement, trembling, drooling that traditional drugs tend to produce, but patients' compliance has not been obvious. improve. According to research, the 18-month treatment interruption rate for oral atypical antipsychotics is as high as 75%. Long-acting injections of atypical psychiatric drugs in treatment methods have brought new solutions for doctors and patients. This new type of long-acting injection "Hengde" uses "Medisorb microsphere technology" to make the active pharmaceutical ingredient decompose stably and continuously in the body, continue to exert its effect for 2 weeks, and metabolize into water and carbon dioxide after complete decomposition, and it is safer.

Signs of relapse

Patients with schizophrenia generally have the following manifestations before relapse:

1. The patient's expression has changed:

During the remission or recovery period, the patient's facial expressions are more natural, and his eyes are more flexible. Others can see the normal expression changes of joy, anger, sorrow, and joy from their faces. And the change of expression can reflect the corresponding emotion in his heart. When they are about to commit an illness, patients often show sluggish eyes and straight eyes.

2. Changes in attitude towards people around you:

Generally speaking, schizophrenic patients get along well with family, colleagues, friends, and others who come into contact with them during the recovery and remission stages of the disease. They talk naturally, answer questions, and make people feel like they are with him. There is no gap in communication. If the patient suddenly becomes lonely, out-of-group, does not associate with others, is alone, thinks down, or is arrogant, irritable, and unwilling to communicate and communicate with others, he or she may fall ill.

Relapse prevention measures

The recurrence rate of schizophrenia is very high, and the more recurrences, the more severe the mental defect caused by the disease, which places a huge burden on patients, families and society. Therefore, once you have schizophrenia, you must do everything possible to take measures to prevent recurrence, that is, to take measures without recurrence.

1. Persistent maintenance medication is the most effective measure to prevent relapses. A large number of clinical statistics show that most schizophrenia relapses are related to voluntary withdrawal. The relapse rate was 40% in patients who maintained the dose. The rate of recurrence was up to 80% in those who did not maintain the dose. Therefore, patients and their families should attach great importance to maintenance treatment.

2. Find the precursor of recurrence in time and deal with it in time: The recurrence of schizophrenia has precursors. As long as you detect it in time and adjust the medicine and dosage in time, you can generally prevent recurrence. The common precursor of recurrence is: the patient has no cause of poor sleep. , Laziness, unwillingness to get up, dazedness, cyanosis, emotional instability, irritable temper, irritability, cranky thoughts, outrageous speech, or sick thoughts showing up. At this time, you should seek medical treatment in a timely manner, and adjust the treatment in a timely manner when the condition fluctuates to avoid recurrence of the disease.

3. Insist on regular outpatient review: Be sure to insist on regular outpatient review, so that doctors can continuously and dynamically understand the condition, so that patients are often under the medical supervision of psychiatrists, and adjust the dose in time according to the change of the condition. Through the review, the righteous person can get timely counselling and psychological treatment to relieve patients of various confusions in life, work and medication, which also plays an important role in preventing the recurrence of schizophrenia.

4. Reduce predisposing factors: family members and those around them should fully realize the weak state of mental state of schizophrenic patients, and help arrange daily life, work, and study. Talk to patients often, help patients to treat diseases properly, treat real life correctly, help patients to improve their psychological endurance, learn how to deal with stressful events, encourage patients to strengthen their confidence, guide patients to enrich their lives, so that patients have no psychological stress and mental distress Living in an environment.

5. To carry out community psychiatric prevention and control work, in order to detect patients early, treat them early, and prevent recurrence, it is necessary to establish prevention and treatment institutions for psychiatric diseases in the society, and to popularize knowledge on prevention and treatment of psychiatric diseases in primary health care organizations. Since the establishment of community psychiatric prevention and control institutions, the relapse rate of schizophrenia has decreased significantly.

Schizophrenia refers to the impairment of the basic functions of human thinking, perception and emotion. Patients with schizophrenia often suspect that they are being tracked, framed, etc. in the event of a seizure of the disease, which leads to uncontrolled behavior, which is a severe mental illness, mostly occurring in adolescence or early adulthood. It includes thinking disorders, emotional disorders, will and behavior disorders, and self-consciousness disorders. The average person does not have all the obstacles exemplified below at the same time. In January 2002, the Japanese Psychological and Neurological Society renamed "schizophrenia" to "syndrome," because they thought the name "schizophrenia" had a negative personality meaning.

The treatment of mental illness mainly adopts drug therapy, behavior therapy, work therapy, recreation therapy, psychological therapy and counseling in various aspects to eliminate or alleviate various obstacles of the sick. In addition, diet therapy is also a very good choice. According to a statistical study by the Psychiatric Clinic Center of Guangdong Min'an Hospital, the rate of early detection and treatment of schizophrenia is several times higher than the average cure rate. Therefore, schizophrenia should be treated early to prevent the disease from worsening.

Surgical treatment

The "Administrative Measures for the Clinical Application of Medical Technology" recently issued by the Ministry of Health clearly states that xenogeneic stem cell therapy technology, xenogeneic gene therapy technology, and human somatic cell cloning technology cannot be applied to the clinic for the time being. The "Measures" to be implemented on May 1 this year also stipulate that the central nervous system surgery will be detoxified, stereotactic surgery for psychiatric technology, allogeneic stem cell transplantation technology, tumor vaccine treatment technology, homologous organ transplantation technology, and degeneration surgery. Wait for the third type of medical technology to be audited; Any medical institution that has clinically applied before the release of this measure should submit an application for review to the technical audit institution within six months; if it has not been registered with the medical administrative department of medical technology, its clinical application will be stopped. The Ministry of Health explained that the third type of medical technology refers to major ethical issues, safety and effectiveness of which require standard clinical trial research, further validated medical technologies, and high-risk medical technologies whose safety and effectiveness need to be verified. technology.

medical treatement

Indications: Schizophrenia, depression, epilepsy. Western medicine prescriptions: ziprasidone, clozapine, perphenazine, chlorpromazine, risperidone, haloperidol, quetiapine fumarate, sulpiride, trimetazine, and olanzapine. With the continuous development of society and the increasing pressure of work and life, the number of mental patients in our country has increased year by year. At present, there are 100 million mental patients in our country. Most of the mental illnesses occur in young adults, some are intermittent, and some continue to progress. It is gradually becoming chronic, with a high recurrence rate and a high disability rate. Without active treatment, mental decline and personality changes may occur, it may not be able to adapt to social life, and it is difficult to fulfill the responsibilities to the family and society.

Psychotherapy

Traditional wisdom holds that mental illness is incurable. Once suffering from mental illness, only long-term medication can be taken to maintain a normal mental state. With the development of society, some mental illnesses can be completely treated through psychological therapy. In Beijing and other places, some psychological counseling institutions that have in-depth research on mental illness can already help patients to completely cure mental illness through psychological therapy.

TCM regulates balance activation therapy

To be used in the treatment of psychiatric and schizophrenia, clinical data show that patients can achieve better results as long as they persist in treatment. Results The clinical application was 58,000 cases, ranging from 1 to 2 weeks. The symptoms disappeared and gradually reduced. The curative effect was obvious and lasting. The clinical effective rate was 98%. For family members of patients, the following three points should be noted: First, they must believe in doctors and not in witches. The second is to choose treatment methods and medical units carefully. The third is to be patient with patients, and to find ways to create a relaxed environment for them, especially when patients are ill, they must not be impatient, they cannot judge the right and wrong with the thinking of normal people, and they cannot lose confidence in patients and give up treatment.

Treatment of negative symptoms

For patients with negative symptoms of schizophrenia, it is mainly disorders of personality, emotional response, will, behavior, and social function. Therefore, in addition to continuing to take appropriate antipsychotic treatment for these patients, special attention should be paid to psychological treatment. And fully cooperate with behavior therapy in work and entertainment, and family therapy. When performing behavioral therapy, they can be allowed to participate in recreational activities and self-care activities, adopt positive reinforcement method, and when patients perform good and normal behaviors that meet the treatment requirements, they will be awarded points to strengthen their normal behaviors and motivate them. At the same time, they should be patiently educated, inspired and induced, cultivate good living and labor habits, and encourage them to participate in collective labor and cultural and sports activities to enrich their spiritual life and activate their emotions. This has an important role in improving patients' brain function and preventing decline, and can also improve their self-care ability and social ability. Because the family is the living base of the patient and it has a great impact on it, it should also actively cooperate with family treatment at the same time, which can play an important role in preventing the recurrence of the disease and the deterioration of the disease. In the eyes of ordinary people, patients may have strange thoughts and behaviors, but they also need respect, love, and care. Family members of patients should understand the patient's condition, treatment principles and methods, and prognosis. It should be treated with sympathy, thoughtfulness, patience and sympathy, and adopt reasonable and practical methods to deal with the personal problems of patients and their families. The family can take the patient's medication and seek medical attention as soon as the symptoms appear. Studies show that family management can reduce relapses. In particular, patients should not be shy to go out. The more the patient participates in social work and work, the more stable the condition becomes.

Carry out genetic counseling. For patients with schizophrenia who are at the age of marriage and childbearing, it is recommended to avoid marriage and childbirth before the symptoms have disappeared, especially when both parties have suffered from schizophrenia.

Carry out community mental health advocacy, early detection and early treatment. The occurrence and recurrence of schizophrenia are mostly related to the adverse mental stimulation in the surrounding environment. Therefore, it is very important to create a friendly humanistic environment. For those who have experienced mental symptoms, they should pay special attention to care and love, and avoid giving bad mental stimulation.

Early Schizophrenia

1. Neurasthenia-like headache, insomnia, easy to wake up from dreams, loss of work, inattention, nocturnal emission, menstrual disorders, fatigue, and fatigue. Although there are many discomforts, there is no painful experience and no active medical treatment.

2. A person who has always been mild and quiet has suddenly become unreasonable. He loses his temper or is suspicious of a trivial matter. He thinks that people around him cannot pass him. When he sees someone speaking, he suspects that he is talking about himself. Even coughing was suspected of being directed at yourself.

3. Emotionally laughs for no reason, becomes indifferent to relatives and friends, and ignores them, that is, they don't care about others, they don't care about other people's concern for them, or they are nervous, anxious, and afraid for no reason.

4. Retarded against the original positive, enthusiastic, and eager to learn, becoming sloppy, irresponsible, and even absent from work, declining academic performance, not paying attention to lectures, unwilling to hand in homework, and even truancy; or life becomes lazy, Ritual is unreliable, not enterprising, pass and pass, and can not afford to be embarrassed.

5. Abnormal behavior and movement are contrary to the enthusiastic and optimistic expression in the past. They are silent, hesitant, expressionless, or standing, sitting, staring, alone, not loving, or screaming at the air, mumbling, or Doing something inexplicable is puzzling. If you find the above abnormal signs without reasonable and reasonable explanations, and you have a recent mental history, you should pay great attention to it and seek a psychiatrist for timely examination and early treatment. Do not neglect to avoid delaying treatment.

Factors affecting the recovery of schizophrenia

At present, the etiology of schizophrenia is unknown, and the course of schizophrenia continues to develop and gradually worsen. At this stage, the treatment effect is still unsatisfactory. Through clinical research and observation, it is generally believed that the following factors can affect its prognosis:

1. Pre-diseased personality Pre-diseased personality is lonely and unsuitable; or has a split personality, such as withdrawn, reticent, non-associative, lack of aggressiveness, sensitive, afraid, and strange personality; often daydreaming, poor adaptability After a person is ill, they can quickly go into decline and chronic disease, with a poor prognosis.

2, the age of onset before the age of 15 years, the prognosis is often poor, and the decline quickly and chronically.

3, the form of onset of insidious onset, long-term or acute onset of treatment and prolonged and unable to alleviate, often easily lead to mental decline.

4. When the predisposing factors have no obvious mental or physical factors as inducers, the prognosis is poor.

5. Symptoms and types have the typical symptoms of schizophrenia, such as fixed and persistent symptoms of persecution paranoia and paranoia, or behavioral withdrawal, poor prognosis. The prognosis of simple type and adolescent type is poor.

6. Social environment and genetic factors. Low family economic level, poor family relations, poor life care, and lack of a good social and family support system will directly affect the prognosis of patients with schizophrenia; have a family history of positive schizophrenia The prognosis is mostly poor.

7, the number of relapses, the more the number of relapses, the less likely to get a good response.

8. Timely, effective and systematic treatment and maintenance treatment can greatly reduce the relapse rate and delay mental decline.

In short, the current prognosis of schizophrenia is not optimistic, but we believe that through the joint efforts of the majority of psychiatric medical workers, the prognosis of schizophrenia will be improved in the near future.

Rehabilitation of schizophrenia

In addition to timely, regular and systematic hospitalization of schizophrenia, maintenance treatment after discharge is also important to prevent recurrence of the disease. The following briefly discusses several issues that need attention in family maintenance:

1. To understand the general knowledge of commonly used antipsychotics, antipsychotics are broadly divided into typical antipsychotics and second-generation antipsychotics (including risperidone and quinine). The second-generation antipsychotic drugs have relatively small side effects, are well tolerated and adherent to the medication, are effective against negative symptoms, and can improve cognitive function, but are more expensive than typical antipsychotic drugs.

2. Pay attention to observe the therapeutic effect of drugs. Different drugs have relative selectivity for different mental symptoms. Different drugs are used in different patients, and the effects are also very different.

3. Family members should keep medicines for patients to prevent accidents caused by patients swallowing a large amount of medicines at the same time. Each time the medicine is taken, the family members must urge and check the patient's medication situation to ensure that the patient takes the medicine to the belly.

4. Family treatment must be carried out under the guidance of a psychiatrist. When discharged from the hospital, it must be ordered by the doctor at the time of discharge. In addition, psychiatric drug treatment is very technical, and each addition or subtraction of a drug is determined based on changes in the patient's condition. Family members must not discontinue the drug on their own, considering that the patient is in a good condition or worried about side effects after taking the drug.

5. The following situations need to be reviewed immediately in the hospital: Fluctuations of the condition: family members should pay close attention to the signs of recurrence of the condition, the first insomnia, inattention, and drowsiness. If the above situation occurs, the treatment plan should be adjusted in time to prevent the condition relapse. When the patient has a heavy side effect of the drug, such as acute dystonia, the patient's eyes are turned up, the mouth and neck are skewed, and severe swallowing difficulties and accidents occur. A rash was found on the patient. Send to the hospital for review. If the patient has any problems that the family members do not understand, they should return to the hospital as soon as possible.

6. Observe the side effects of the drug at any time. Antipsychotic drugs have certain side effects. Drugs such as chlorpromazine and perphenazine can often cause hand and foot tremor and flexible reactions (extrapyramidal reactions). This situation is necessary to stop the medicine, just report it to the doctor, and the doctor can combine the drugs to check the situation.

Excretion of drug toxins:

The latest research in the medical field shows that taking drugs all year round can cause drug toxins to remain and accumulate in the patient's body. Over time, it can cause significant harm to the patient's health. In addition to causing recurrence of old diseases, it can also cause changes in body tissues and patients. Shortened life. To remove toxins remaining in the body, a basic method is to drink "photon water". The specific method is simple: (photon water = warm boiled water with a small amount of common salt + ice cubes + sun light exposure) Note: due to various reasons Photon water must be drunk in the morning after waking up in the morning and must not be drunk at night. An ancient Chinese saying: Drink salt water in the morning, such as ginseng soup, and drink salt water in the evening. The temperature of photon water should not be too cold, so as not to irritate the stomach and cause discomfort. [Clinical treatment research] From the perspective of clinical application, if it is mild schizophrenia, perphenazine can be taken for control, but if it is used for a long time, it will cause drug dependence. Can achieve more significant effects. In addition, patients should develop better lifestyle habits, such as taking a walk after dinner and exercising more often. The key is to find their own cause under the guidance of a doctor in the heart and rely on a firm will to overcome the disease.

Notes on schizophrenia during rehabilitation

1, avoid living room is not quiet, noisy, noisy living environment will only make patients sicker. Therefore, after the patient gets sick, the family should give sympathy and arrange a quiet and comfortable environment for them, or send the patient to a quiet rural area for treatment, in order to shorten the course of treatment.

2. Avoid going out alone. Patients with schizophrenia who go out alone have certain risks. They should be avoided, and their families must be accompanied and guarded.

3. Avoid drinking, smoking, tobacco and alcohol are irritating, which are contraindications in schizophrenia precautions.

4, avoid mental stimulation avoid watching thrilling, homicide, tragic novels, pictorials, comic strips, television, movies, etc., so as not to increase the patient's stimulus and increase the patient's condition.

Symptoms

1. Phlegm dampness internal resistance: loose thinking, dull emotions, sluggish behavior, fatigue, weakness, passive contact, delayed withdrawal. But there are delusions and poor appetite. Tongue marks, white fur, greasy or slow pulse.

2. The phlegm is disturbed and excited, the words are incoherent, the face is red, the eyes are red, and the mood is unstable. Do not sluggish at night, like cold food, red or thick tongue, yellow fur thick or greasy, strong pulse slippery.

3. Qi stagnation, blood stasis, irritability, disordered speech, easy excitement, stupid behavior, visible false sights; dull complexion, women may have amenorrhea; dark purple tongue, less moss, blood stasis under the tongue veins, pulse strings or astringent

4 Yin Huo-wang's illness is prolonged and prolonged, but he sees signs of tiredness and laziness. He is lonely and unwilling, but occasionally sees impulse; thin, red, and thirsty; red tongue, no moss, and pulse count.

5. Yang deficiency is poor in thinking, lazy and flinching, silent and silent, not thinking about diet. He is weak, looks pale, and has chills, cold limbs; pale tongue, thin white fur, and fine veins.

Common characteristics of disease symptoms

1. Thinking disorder: It is an indispensable symptom of schizophrenia throughout the course of the disease. It is often unobtrusive in the early stages and becomes prominent in the development stage. There are association obstacles and thinking content obstacles in thinking obstacles. Association obstacles begin with association slackness, conversations are not compact, and responses are often irrelevant. As a result, there are loose associations, and then there are broken thoughts and interrupted associations. Or symbolic thinking, new words or words. Obstacles to thinking content are various delusions. Their logical reasoning is ridiculous, unsystematic, disconnected from reality, and often generalized, involving everyone. The contents of delusions are common in victimization, jealousy, etc. There may also be delusions of exaggeration and sin. There can also be a sense of control, dissemination of thought, thought insertion or thought deprivation.

2. Perceptual impairment: auditory hallucinations are most common, and subjective hallucinations are often absent, such as critical, controversial, or imperative hallucinations, or thoughtful voices. Other hallucinations follow.

3. Affective disorder: It is the most noticeable symptom of schizophrenia. Emotional expression is not coordinated with thinking activities and will behaviors, and it is not coordinated with the surrounding environment, which is the characteristic of this disease. Emotional disorders are more common in their insensitivity and indifference. They are less concerned about people and things. With the development of the disease, the emotional disorder is getting worse and worse. Other irritations, irritability, emotional outbursts, and emotional conflicts with no obvious incentives. The change of emotion makes people feel as if they are different.