| disease | Schizophrenia |
Schizophrenia is a group of mental disorders with unknown causes, often emerging in young adulthood. It typically involves disturbances in perception, thinking, emotions, behavior, and incoordination of mental activities. Generally, there is no impairment of consciousness or intellectual abilities, and the course of the illness tends to be prolonged.
bubble_chart Diagnosis
1. Early symptoms are varied:
Most cases have a slow onset, with the most common manifestations being fluctuating and inconsistent personality changes and neurosis-like symptoms. They may also present as obsessive states or depersonalization. Subacute onset often manifests as depression, obsessive states, or hypochondriacal ideas, followed by delusional experiences. Acute onset cases frequently exhibit sudden excitement, agitation, impulsive destructive behavior, abnormal actions, fear, confusion, or accompanied by impaired consciousness.
2. Characteristic symptoms:
These are marked by a disconnection from reality, incoordination with the surrounding environment, and a lack of harmony among thought, emotion, and volitional activities.
① A lack of coherence and logic in the thought association process is a hallmark feature. While conscious, the patient's sentences, concepts, or contextual connections lack intrinsic meaningful links, known as loosening of associations or derailment, with severe cases displaying fragmented thinking. Logical reasoning may be bizarre and absurd (paralogical thinking), or ordinary words, nouns, or actions may be used to express peculiar meanings incomprehensible to others (pathological symbolic thinking). Alternatively, special significance may be attributed to symbols, self-invented, or cobbled-together "words" (neologisms). The patient's thought processes may suddenly halt without external influence (thought blocking) or be flooded with intrusive thoughts (thought crowding).
② Alien experiences of thought: The patient believes their thoughts are being taken away by an external force (thought withdrawal) or that certain thoughts are inserted into their mind by an outside influence (thought insertion). They may feel their inner experiences are known (thought broadcasting) or publicly disseminated (thought diffusion).③ Emotional blunting and indifference, where emotional responses fail to resonate with thought content or external stimuli. The patient lacks inner experiences regarding external events or matters related to their personal interests (emotional flattening). They may react with pain to joyful occasions or laugh at misfortunes (parathymia), experience two opposing emotions simultaneously (ambivalence), or burst into laughter, weeping, or rage without cause.
④ Social withdrawal, reduced activity, and passive behavior often accompany emotional indifference. The patient may develop opposing intentions toward certain things (ambitendency), consume inedible objects or harm themselves (inverted volition), refuse all requests (negativism), or mechanically comply with any demand (passive obedience).
3. Common symptoms
include: ① Hallucinations: Auditory verbal hallucinations are most frequent, where the patient hears two or more voices discussing them or commenting on them in the third person (argumentative or commentary hallucinations), issuing commands (command hallucinations), or vocalizing the patient's current thoughts (thought echo).
② Delusions: Persecutory, referential, and influence delusions are the most common. Secondary delusions arise against the backdrop of existing mental disturbances, while delusional perceptions, moods, or memories are primary delusions—sudden, inexplicable by psychological causes, and firmly believed once they emerge.
bubble_chart Treatment Measures
1. Principles of Drug Therapy:
Start with a small dose and gradually increase to the therapeutic dose with satisfactory efficacy. After maintaining this dose for about one month, gradually reduce it to the maintenance dose (equivalent to 1/4 to 1/3 of the therapeutic dose). Typically, maintenance therapy should continue for more than six months.
2. Common Oral Antipsychotic Drugs and Their Dosage Ranges:
Chlorpromazine 300–400 mg/d, Perphenazine 30–60 mg/d, Sulpiride 300–800 mg/d, Clozapine 300–400 mg/d, Thioridazine 400–600 mg/d, Haloperidol 20–30 mg/d, Risperidone 4–6 mg/d, Flupentixol (Fluanxol) 10–20 mg/d, Pimozide 2–12 mg/d.
3. Long-Acting Preparations:
These can effectively maintain efficacy in chronic-phase patients, such as: - Oral Penfluridol 30–60 mg weekly, - Intramuscular Fluphenazine Decanoate or Fluphenazine Enanthate 12.5–50 mg every 2–3 weeks, - High-potency Clopenthixol (Clopixol) 200 mg, - Flupentixol Decanoate 20–40 mg, - Monthly intramuscular injections of Haloperidol Decanoate or Pipotiazine Palmitate 50–100 mg.
4. Side Effects of Drug Therapy:
Extrapyramidal reactions are the most common side effects, which may manifest as pseudoparkinsonism, akathisia, oculogyric crisis, difficulty swallowing or speaking, etc. These can be managed with oral Trihexyphenidyl 4–8 mg/d or intramuscular Scopolamine Hydrobromide 0.3–0.5 mg. Other side effects include liver function impairment, leukopenia, orthostatic hypotension, drowsiness, constipation, lactation, pigmentation, amenorrhea, or sexual dysfunction.
