schizoaffective disorder
Introduction
Introduction to split emotional disorders Splitting affective disorder, also known as schizo-affective psychosis (schizo-affectivepsychosis), refers to a group of schizophrenic and affective symptoms that are simultaneously present and equally prominent. The symptoms of division are positive psychotic symptoms such as hallucinations, delusions and thinking disorders. The emotional symptoms are symptoms of manic episodes or depressive episodes. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: schizophrenia
Cause
Cause of schizoaffective disorder
(1) Causes of the disease
1. Controlled data on first-degree relatives of genetic factors (Maier and Krause, 1989) showed that the disease is genetically between schizophrenia and bipolar affective psychosis, while single-phase severe depression is not obvious. Genetic specificity, speculation that schizoaffective psychosis is a combination of two genetic diseases, schizophrenia and bipolar affective psychosis, but this hypothesis is not consistent with clinical features, such as patients with schizophrenia gene In addition, there are genes for bipolar affective psychosis, and the prognosis of schizoaffective psychosis will be worse than the above two psychiatric diseases, because the second pathogenic gene has a negative effect on the prognosis, and the other hypothesis is the continuity model (continuity) Model), the hypothesis is that: single-phase, biphasic, schizoaffective psychosis and schizophrenia are a continuous from yellow to green blue green blue, biphasic to yellow disease, schizophrenia to blue disease, Splitting affective psychosis is a green disease. This hypothesis itself has many unresolved doubts. To demonstrate that genotype is a continuation model, a large number of epidemiological population adjustments are needed. Investigation or investigation of first-degree relatives (Samuel G. Siris, Michael R. Lavin, 1995).
A family survey of split-emotional probands reported that the prevalence of affective disorder was higher than that of the general population and supported the relationship with affective disorder. However, some studies found that relatives had a higher risk of schizophrenia. This disease may be a variation of schizophrenia. Some authors found that the incidence of affective disorder and schizophrenia was high according to the family data of the probands of the disease, but no seizure affection occurred in the family. The rate has increased and is believed to support the genetic heterogeneity of the disease (Tsuang MT, 1991).
2. The cause of the disease Kasanin first proposed that the disease has stress or huge life events before the onset of the disease, Brickington (1980) reported that 10/32 of the split manic psychosis before the onset of stress: childbirth, surgery, head trauma or important Interpersonal relationship issues, Tsuang (1986) reported that there were more triggering factors before the onset of schizoaffective psychosis, which was 60%, 11% for schizophrenia, 27% for mania, 39% for depression, Marners et al. 1990) It was found that schizoaffective psychosis and affective disorder accounted for 51% of life events before the onset, while schizophrenia was 24%. In addition, alcohol was reported to increase the risk of psychotic emotional syndrome.
3. Neuroendocrine research affects the research work of this disease due to differences in diagnostic criteria and classification.
There are differences in neuroendocrine studies of schizoaffective disorders. For example, the de-suppressive rate of dexamethasone suppression test (DST) is lower in schizoaffective depression, close to schizophrenia and normal photography, unlike severe depression. High de-inhibition rate, the same response to thyroxine (TSH) and prolactin in response to injection of thyroxine-releasing hormone (TRH), the response of schizophrenic patients is similar to schizophrenia and normal controls, and Not slow, different from patients with severe depression.
However, some of the schizophrenic patients have similar endocrine reactions to patients with endogenous depression. These patients recover more completely than other schizophrenic patients.
There are few studies on schizophrenic patients, but at least one study was found. The results of the DST and TRH trials were similar to those of affective disorder, and another study was performed in the urine 3-methoxy-4- The rate of hydroxyphenyl glycol (MHPG) is close to bipolar disorder rather than schizophrenia.
(two) pathogenesis
Regarding the pathogenesis of this disease, some authors (Samuel Siris, Michael Lavin, 1995) proposed that the quality model of schizophrenia can be referred to. The genetic load of a small number of patients and the biological basis are extremely significant, and can occur in any environment. Cognitive and perceptual disorders of schizophrenia, whose genetic quality is in an intermediate state, only under the impact of biological and psycho-social factors in a series of environments, the genetic quality load is extremely small, and it is not easy to have schizophrenia under the influence of stress. Symptoms of the disease.
Research data show that the disease is genetically between schizophrenia and bipolar disorder. Some scholars speculate that schizoaffective psychosis is two kinds of hereditary diseases, namely schizophrenia and bipolar affective psychosis. The combination of genes.
The study found that pre-infection stress or a huge life event contributed 60% of the disease, which was higher than schizophrenia, mania and depression (11%, 27% and 39%). In addition, there were reports. Alcohol can increase the risk of psychotic emotional syndrome.
The results of neuroendocrine studies on schizoaffective disorders are inconsistent.
Prevention
Split emotional disorder prevention
So far, the prevention of mental illness has been carried out in the areas of synergy, society, education, and the existing level of medicine. As for the prevention of mental illness, it is awaiting psychiatry and related sciences. The development of the disease, as well as the full clarification of the etiology and pathogenesis of various mental illnesses, is an arduous and noble mission given to human medical science by human history.
At present, it is almost universally recognized that many of the problems discussed in the etiology and epidemiology of mental illness have multiple sources, that is, the development and prognosis of some mental diseases, the genetic factors of patients, and the susceptibility , pre-existing personality characteristics, the state of the body at the time of onset, trauma, the triggering factors in the environment, and even the social and cultural background, have a wide range of links, the pre-infection stress or the huge life events on the disease At 60%, it is important to have preventive interventions for incidents that have occurred.
First, we should accurately understand the types of life events faced by the parties, understand the nature of the social support that may be obtained, and what kind of response the environment will have, and then consider whether or not to intervene, such as separation after marriage. Things like children's entry into middle school, although they are life events, do not necessarily pose a threat to mental health. For example, if a mourner has no help from a close relative, they will no longer need to mobilize to participate in the Mutual Help Group.
On the contrary, in some specific cases, preventive interventions are urgently needed. For example, in the case of a life-threatening serious illness and urgent need for major surgery, such as breast cancer undergoing total mammectomy, the patient lacks the deep sympathy and support of the spouse. Consultation is required for preventive intervention (Maguire et al., 1980) by discussing the patient's post-operative wound repair before and after surgery, and then following up every 2 months to check upper limb movements and encourage Exercise, while learning from the spouse and mobilizing the patient to resume active work, the above project was conducted in 152 women, randomly divided into two groups of experimental and control, and then 3 months after surgery, 12 Months and 18 months analyzed the assessment of anxiety, depression and sexual problems. The results showed that both groups had anxiety, depression and sexual life problems, but the experimental group lasted for 6 months, while the control group was the 10th. The month has not been eliminated. In addition, the experimental group has fully resumed work, the social function is excellent, and the breast can be adapted to the lack of breasts. Very satisfied.
Complication
Complications of schizoaffective disorders Complications schizophrenia
(1) schizoaffective disorder complicated with tuberculosis: because patients with schizoaffective disorder have symptoms such as lazyness, withdrawal, diet, and loneliness, often leading to decreased nutritional status and poor body resistance, so it is easy to develop tuberculosis. Such as tuberculosis and intestinal tuberculosis. The treatment of concurrent tuberculosis is: First, ask a psychiatrist and a tuberculosis doctor to see how serious the two diseases are. If the condition of schizoaffective disorder has stabilized, and tuberculosis is active, it should be hospitalized in the tuberculosis hospital, and the psychiatrist should provide a specific plan for psychiatric treatment; if it is the opposite, it should be treated in a psychiatric hospital; if two diseases If they are very heavy, they should be consulted by the doctors of the two departments. When both diseases are serious, it is tricky in treatment and there is a big contradiction. For example, tuberculosis needs to rest adequately, and patients with schizoaffective disorder often have excitement or illusion, delusion and arbitrage, and cause tuberculosis to worsen. Severe tuberculosis patients have physical weakness, which limits the treatment of psychosis. Therefore, such patients must be sent to the hospital in time and treated by experienced physicians. At present, China's larger psychiatric hospitals have TB areas, which can be treated for this type of patients. Before the 1950s, the prevalence of tuberculosis in patients with schizoaffective disorder was high. In the past 20 years, with the improvement of psychiatric medical care and the development of psychiatry, the prevalence of schizoaffective disorder complicated with tuberculosis has been decreasing year by year. .
(2) schizoaffective disorder combined with liver disease: more comprehensive psychiatric hospitals have infectious disease areas for tuberculosis and hepatitis. When schizoaffective disorders with infectious hepatitis, they can be hospitalized in psychiatric hospitals. It should be pointed out that there is a great contradiction in the treatment of schizoaffective disorders and infectious hepatitis. Because all drugs that treat schizoaffective disorders are detoxified by the liver: on the basis of hepatitis causing liver function decline or failure, the drug will further increase the liver burden and worsen liver function; without treating schizoaffective disorder The patient's excitement and harassment will also promote liver failure, so the pros and cons must be weighed when treating.
(3) schizoaffective disorders with heart disease: some antipsychotic drugs can aggravate heart failure; conversely, heart disease can greatly limit the treatment of schizoaffective disorders. Therefore, the use of antipsychotic drugs depends on the condition of the heart function, and the treatment plan after the patient is hospitalized should be made by an experienced physician.
(4) treatment of schizoaffective disorders combined with other diseases: patients with schizoaffective disorders such as appendicitis and other surgical diseases, need to go to surgery for surgery, if necessary, send psychiatric nurses to care; suffering from oral, otolaryngology and other diseases, Specialized consultation is required and treated by the relevant department. In short, patients with schizoaffective disorders, like healthy people, can suffer from various diseases. The general principle is to see which kind of disease the patient is based on. If it is a schizoaffective disorder, the combined disease is very light, and you live in a psychiatric ward. On the contrary, if you live in a ward with a disease, you can ask a psychiatrist to consult and propose the necessary psychiatric treatment plan and spirit. The nursing staff went to the nursing. At present, psychiatric hospitals with good equipment conditions in large cities in China are equipped with internal and external clinics for internal and external diseases.
Symptom
Symptoms of schizoaffective disorder Common symptoms Schizophrenic personality disorder victim delusion Insomnia Depression Illusion mood High spirit disorder Illusion no emotional response
1. Clinical features
(1) There is a typical depression or manic disease, and there are symptoms of schizophrenia. These two symptoms exist at the same time, or appear in the pathogenesis. The symptoms of splitting are positive psychotic symptoms such as delusion, hallucinations and thinking disorders.
(2) The course of the disease often has recurrent episodes, leaving no obvious defects after intermittent or symptom relief.
(3) The onset is more urgent, and there may be induced stress factors before the onset.
(4) There is no obvious defect in the personality before the disease. Some patients may have schizophrenia and a family history of bipolar disorder.
(5) The age of onset is more common in young adults, and more women than men.
2. Clinical classification
According to the affective disorder, the symptoms of the affective disorder are single-phase or biphasic (mania, depression or both), which can be divided into three types: manic, depressive, and mixed.
Mainly according to the characteristics of clinical manifestations, must have schizophrenic symptoms and affective symptoms, exist simultaneously or successively throughout the course of the disease, and appear to be close to the disappearance time, in the diagnosis should pay attention to the evolution of the symptoms of the entire disease, not only for a moment The symptoms seen are the basis of diagnosis. Otherwise, it is easy to be misdiagnosed as schizophrenia or bipolar disorder. The time when the schizophrenic symptoms are the main clinical phase must last for more than 2 weeks, which is one of the main conditions for the diagnosis of this disease. Disease diagnosis points:
1. Symptoms of schizophrenia and affective disorder are clinically prominent and difficult to distinguish between primary and secondary.
2. The patient's social function is seriously impaired, and the self-knowledge is incomplete or lacking.
3. The schizophrenic symptoms and affective symptoms exist for at least 2 weeks in the whole course of the disease, and appear to be close to the time of disappearance.
China's mental illness classification system (CCMD-2-R, 1995) lists schizoaffective psychosis under the schizophrenia and other psychotic disorders, meaning that "split symptoms and emotional symptoms exist simultaneously and are equally prominent, often with recurrent episodes. a disease in which the schizophrenic symptoms are positive psychotic symptoms such as delusions, hallucinations and thinking disorders, and the emotional symptoms are mania or depression,"
4. Meet the symptom criteria for schizophrenia and affective disorder.
5. Severity criteria, which meet the following 2 items:
(1) Social function has declined significantly.
(2) Insufficiency or lack of self-knowledge.
6. The schizophrenic symptoms and affective symptoms exist simultaneously in the whole course of disease, and the time of appearance and disappearance is relatively close, but the time when the schizophrenic symptoms are the main clinical phase must last for more than 2 weeks.
7. Explain that if a patient presents with schizophrenic or affective symptoms as the main clinical phase in different episodes, the diagnosis is still based on the main clinical phase of each episode.
Examine
Examination of schizoaffective disorders
There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.
There is currently no specific laboratory support for this disease.
Diagnosis
Diagnosis and differentiation of schizoaffective disorders
Diagnostic points:
There must be a significant increase in mood, or a less obvious mood with irritability or excitement. In the same episode, there should be at least one, preferably two, typical symptoms of schizophrenia. This category applies. In a single manic schizophrenic episode and most of the hair as a manic type of repetitive schizophrenia, including: split emotional psychosis, manic.
Splitting affective disorder, depression is a mental disorder in which the schizophrenic symptoms and depressive symptoms are prominent in the same episode of the disease. Depressive mood is usually accompanied by several characteristic depressive symptoms or behavioral abnormalities such as hysteresis, insomnia, No energy, loss of appetite or weight, decreased normal interest, impaired concentration, guilt, hopelessness and suicidal ideation, or in the same episode, there are other more typical symptoms of schizophrenia: for example, patients insist on themselves The mind is being broadcast or being disturbed, or the power of aliens is trying to control themselves. They may be convinced that they are being tracked or caught in a conspiracy, but their own actions cannot explain that these convictions are reasonable and audible. Not only to degrade or blame the sound of the content, but also to hear about killing patients or auditory hallucinations in their behavior, depressive schizophrenic emotional seizures are often not as sharp and astonishing as madness, but generally last longer Long, and the prognosis is poor, although most patients are completely relieved, individual patients gradually evolve into schizophrenia Defect.
Diagnostic criteria
There must be significant depression, at least with 2 typical depressive symptoms or behavioral abnormalities associated with depressive episodes. There is at least one, and preferably 2, typical schizophrenia symptoms during the same episode. This category applies to Simple depressive schizophrenic seizures and most recurrent episodes of depression, including: schizoaffective psychosis, depression; schizophrenic psychosis, depression.
Splitting affective disorder, mixed type: Symptoms of schizophrenia and mixed bipolar affective disorder, including: circulatory schizophrenia.
Differential diagnosis
First of all, it is necessary to rule out mental disorders caused by organic mental disorders, psychoactive substances and non-addictive substances. It is not difficult to distinguish from schizophrenia or affective disorders. The key is to identify clinical symptoms and to confirm the symptoms and emotions of schizophrenia. The primary and secondary status of sexual symptoms, if a patient presents with schizophrenic or affective symptoms as the main clinical phase in different episodes, the diagnosis is still made according to the main clinical phase of each episode.
1. Schizophrenia schizoaffective disorder and schizophrenia are more difficult to distinguish, because schizophrenia is often accompanied by emotional symptoms, especially depressive symptoms.
(1) Psychiatric symptoms can be sustained from the beginning to the recovery, but the proportion of the disease in the episodes of the two is different. The schizoaffective disorder is active in the period of psychotic symptoms and lasts for a long time, accounting for most of the total disease period. At the time, the mood episodes of schizophrenia are common with depressive episodes, and the residual phase of the prodromal period lasts for a short period of time.
(2) The severity of emotional episodes is different. The emotional episodes of schizoaffective disorders are heavier. The mood episodes of schizophrenia are mostly depressive episodes.
2. The identification point of mood disorder is mainly the duration of emotional symptoms. Both psychotic symptoms can continue from the disease to the time before the disease is recovered, but the duration of emotional symptoms is significantly different.
3. History of psychotic disorders caused by physical illness, physical examination or laboratory examination results show.
4. History of medication for psychotic disorders caused by substances, physical examination, especially laboratory tests to detect drugs in the body fluids of patients, to help identify these two diseases.
5. Psychic Disorders Psychiatric symptoms of paranoid disorders are limited to delusions, and delusions are not weird.
