schizophrenia
Introduction
Introduction to Schizophrenia Schizophrenia is a type of most common psychiatric disorder characterized by a change in basic personality, division of thought, emotion, and behavior, and disharmony between mental activity and the environment. Schizophrenia is the most common group of mental illnesses in mental illness. According to survey data from six districts in the United States, the annual incidence rate is 0.43~0.69, and the age of 15 years old is 0.30-1.20 (Babigian, 1975). The area is 0.09, according to the International Schizophrenia Pilot Survey (IPSS) data, 20 centers in 18 countries, surveyed over 3,000 people over 20 years, the annual incidence of schizophrenia in the general population is 0.2~0.6 Between , the average is 0.3 (Shinfuku, 1992). The etiology of schizophrenia is complex and has been fully elucidated. Many illnesses occur in young and middle-aged people, manifesting in many obstacles such as perception, thinking, emotion, and willing behavior. Mental activities are inconsistent with the surrounding environment and inner experience, and are out of reality. General unconsciousness barriers and obvious intellectual disabilities can be cognitive impairments in terms of attention, working memory, abstract thinking, and information integration. The course of the disease was prolonged and repeated, and some patients experienced mental activity decline and different degrees of social function defects. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: anxiety
Cause
Cause of schizophrenia
1 Neurobiological factors 1 Neurochemical studies have shown that patients have a variety of neurotransmitter dysfunction, mainly involving dopamine, serotonin, glutamate. Central dopamine levels increase, hyperfunction, traditional antipsychotic drugs are central nervous system dopamine receptor blockers. The central serotonin level is abnormal. In addition to its antagonistic effect on dopamine receptors, the new antipsychotic drugs also have an antagonistic effect on serotonin receptors. The central glutamate level is low and the function is insufficient. 2 Neuroanatomy and neuroimaging studies showed that the temporal lobe, frontal lobe and limbic system had brain tissue atrophy, ventricular enlargement and sulcus widening. 3 maternal viral infection, perinatal complications, juvenile adverse stress and physical disease, associated with neurological developmental defects, have a certain impact in the pathogenesis of schizophrenia.
2 Genetic factors Large-scale population genetic epidemiological survey shows that the prevalence of relatives in patients is several times higher than the general population, the closer the blood relationship, the higher the prevalence. Molecular genetic studies have suggested susceptibility loci associated with schizophrenia. It is generally believed that schizophrenia may be polygenic, and the onset is caused by the superposition of several genes.
3 Social psychology factors such as life events, economic status, and pre-existing personality factors with poor social psychology may play a role in inducing and promoting the pathogenesis of schizophrenia.
The etiology of schizophrenia has yet to be fully elucidated. Some of the influencing factors that can be identified at present have no clear causal relationship to the disease. The current accepted view is that susceptibility and external adverse factors lead to disease through the combination of intrinsic biological factors.
Prevention
Schizophrenia prevention
Mental health work puts forward the concept of three-level prevention. First-level prevention refers to taking measures to prevent the occurrence of diseases from the pathogenesis of the cause, secondary prevention refers to early detection, early diagnosis and early treatment, and tertiary prevention refers to prevention of recurrence. And prevent disability.
The causes and pathogenesis of schizophrenia have not been fully elucidated so far, so primary prevention is difficult to implement. In the secondary prevention, domestic and foreign scholars have done a lot of work, such as the unification of diagnostic criteria, the use of standard rating scales, The early psychological and social interventions in the disease made the secondary prevention work progress faster.
Secondary prevention:
Before the primary prevention of schizophrenia can not be implemented, the focus of prevention should be on early detection, early treatment and prevention of recurrence. Therefore, it is necessary to establish a mental health prevention and treatment institution in the community, popularize the knowledge of mental illness prevention among the masses, and eliminate the spirit. Patients' discrimination and incorrect views enable patients to find early and receive early treatment. After returning to society, they must mobilize family and social forces to create conditions for patient rehabilitation, and support and support under the guidance and training of community rehabilitation institutions. To improve the patient's social adaptability, reduce psychological stress, adhere to medication, avoid recurrence, and reduce disability, domestic and foreign experience all indicate its importance and feasibility.
Genetic counseling: Genetic quality is one of the factors in the occurrence of schizophrenia. It is recommended that patients at the reproductive age should not have children when their mental symptoms are obvious. If both sides have schizophrenia, it is recommended to avoid childbirth. The survey data indicates that parents Both of them were schizophrenia patients, and their children had a 39.2% chance of developing the disease, which was about 1 times higher than the chance of the child of the patient (16.4%).
Schizophrenia is caused by the combination of genetic quality and biological and psychosocial factors in the environment. Existing research data indicate that viral infection during maternal pregnancy, perinatal comorbidities, trauma, and social psychology in which young children are forced to separate from each other. Stress can have a certain impact on the occurrence of schizophrenia. Therefore, the family of high-risk groups should consult in time, pay attention to the health care during the pregnancy and childbirth, and the mental health development environment during the growth and development of their children to reduce fetal development. Biological and psychological stress factors in a growing environment are important.
Tertiary prevention:
Tertiary prevention mainly refers to rehabilitation. It refers to the use of the conditions and timing to obtain the comprehensive means to achieve maximum functional recovery. Patients with schizophrenia have high recurrence rate and take effective measures in time to try to prevent patients from recurring or less. Recurrence is an important prevention and treatment measure. It can be started from the following aspects:
1. Psychotherapy before discharge: After the majority of psychiatric symptoms disappeared after schizophrenia patients were hospitalized, the self-knowledge was partially restored. Through psychological treatment, patients were helped to understand their own changes in mental symptoms, and patients were encouraged to establish a victory over disease. Confidence, teach patients some ways to prevent disease recurrence.
2. Carry out health education for the patient's family members, so that the patient can receive medical support and psychological support.
3. Establish a regular outpatient follow-up system to guide patients to take appropriate amount of maintenance treatment drugs and prevent recurrence through drug treatment. Studies have shown that maintenance of medication can effectively reduce the recurrence rate.
4. Improve the level of mental health knowledge in the whole society. You can start the mission of mental health knowledge from the community, establish daytime treatment stations in qualified communities, and create a good social environment for schizophrenia patients to help them return. society.
Complication
Schizophrenia complications Complications
Due to the characteristics of the disease itself, schizophrenia is a recurrent chronic prolonged disease, and the condition is easy to repeat. Each recurrence may cause permanent damage to the brain, further impair cognitive function, and further decline in social function; For the patient's family, recurrence means the deterioration of the family's condition and multiple mandatory hospitalizations, which must bear greater economic burden and emotional stress; for medical workers, recurrence will increase the difficulty of treatment, and the final prognosis is not ideal, Therefore, effectively preventing the recurrence of schizophrenia has become an urgent problem to be solved.
In addition, the patient has no special immunity to any other disease. On the contrary, due to mental symptoms, poor self-care ability and increased chances of suffering from other physical diseases, it should be pointed out that schizophrenia and other physical diseases exist in treatment. There are several situations in the contradiction:
(1) schizophrenia complicated with tuberculosis: because schizophrenia patients have life lazy, retreat, diet is not active, loneliness and less symptoms, often lead to decreased nutritional status and poor body resistance, so easy to concurrent tuberculosis, such as tuberculosis and intestines Tuberculosis, etc., the treatment of tuberculosis is: first, ask psychiatrists and tuberculosis doctors to see how serious the two diseases are, such as schizophrenia, the disease has stabilized, and tuberculosis is active, should go to tuberculosis Hospital hospitalization, psychiatrists provide specific treatment for psychiatric treatment; if the opposite, they should be treated in psychiatric hospitals; if both diseases are heavy, they should be consulted by doctors from two departments, when two When the disease is very serious, it is very difficult to treat, and there are great contradictions, such as tuberculosis needs to rest adequately, and schizophrenia patients are often excited or illusory, arbitrarily arbitrarily running around, causing tuberculosis to worsen; Severe tuberculosis patients have physical weakness, which limits the treatment of psychosis. Therefore, such diseases Must be sent to the hospital in time, treated by experienced physicians. At present, China's larger psychiatric hospitals have tuberculosis areas, which can treat this type of patients. Before the 1950s, the prevalence of tuberculosis in patients with schizophrenia was high. In the past 20 years, with the improvement of psychiatric medical level and the development of psychiatry, the prevalence of schizophrenia complicated with tuberculosis has been decreasing year by year.
(2) Schizophrenia with liver disease: More comprehensive psychiatric hospitals have infectious tracts for tuberculosis and hepatitis. When schizophrenia is associated with infectious hepatitis, it can be hospitalized in a psychiatric hospital. It should be noted that the spirit There is a great contradiction in the treatment of schizophrenia and infectious hepatitis, because all drugs for treating schizophrenia are detoxified by the liver: on the basis of hepatitis causing liver function decline or failure, the drug will further increase the burden on the liver. Deteriorating liver function; not treating schizophrenia, patient excitement, and harassment can also promote liver failure, so the pros and cons must be weighed when treating.
(3) Schizophrenia with heart disease: Some antipsychotic drugs can aggravate heart failure; conversely, heart disease can greatly limit the treatment of schizophrenia. Therefore, the use of antipsychotic drugs depends on the heart function. The treatment plan for the patient after hospitalization should be made by an experienced physician.
(4) Treatment of schizophrenia with other diseases: patients with schizophrenia, 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, need specialist consultation In general, schizophrenia patients, like healthy people, can suffer from various diseases. The general principle is to see which diseases the patients are mainly. If they are mainly schizophrenia, the combined diseases are very light. In the ward of the psychiatric ward; on the contrary, the ward where the disease is ill can ask the psychiatrist to consult, propose the necessary psychiatric treatment plan and send the psychiatric nursing staff to go to the nursing. At present, the equipment in the big cities in China is better. The psychiatric hospitals are equipped with internal, external, and women's physical diseases clinics.
Symptom
Symptoms of Schizophrenia Common Symptoms Paroxysmal laughter imitates verbal illusion Introverted thinking is difficult to hear about the slow-reflecting content of light... The sinister delusion has no purpose to chew the lip violent disorder mechanically repeating around...
The performance of schizophrenia involves multiple aspects, and there are many different manifestations, but each patient's performance is only a few of them, not all symptoms. How to diagnose according to performance, see the diagnosis of disease.
Early symptoms of the disease
Most patients are chronic onset, work enthusiasm and work ability decline, students' academic performance declines, people are cold, alienated from people, not interested in outside things, careless about family care, life lazy, sensitive and suspicious, personality change, etc. . Some patients may have insomnia, headache, dizziness, weakness, emotional instability and other symptoms of neurosis. Some cases can be severely onset, and clinical manifestations include sudden excitement, impulsiveness, disordered speech, behavioral disorders, episodes of illusions and delusions.
Thinking association disorder
The lack of coherence and logic in the process of thinking association is the most characteristic symptom of schizophrenia.
The whole conversation or writing content of the patient lacks logic, the narrative is not very relevant, and the meaning cannot be clearly expressed around the central idea of the conversation. It is very difficult to talk with the conversation, which makes people feel confused (thinking relaxation). There is a lack of connection between the sentences, and the language is messy (broken thinking).
When the patient spoke, the association suddenly broke down, and the brain was blank, and then it was converted into a new topic (interruption of thinking). At the same time, I feel that my mind has been taken away (thinking is taken). A series of associations (thinking or compulsory thinking) suddenly emerge in the brain. Sometimes I feel that the thoughts in my mind are not my own, they are imposed by the outside world, and others use their own brains to think about problems (thinking insertion). Under the above circumstances, the patient is accompanied by obvious involuntary feeling and is not controlled by himself.
When thinking, the patient feels that his thoughts become voices at the same time, and he and others can hear them (thinking). Your own thoughts are spread out and everyone knows (thinking diffusion).
The patient's logical reasoning process is bizarre, ridiculous and bizarre (logically inverted). Some ordinary words, movements, and symbols are given special meanings, which are incomprehensible to others (pathological symbolic thinking). Create words, words or symbols and give special meanings (new words).
Chronic patients and patients with negative symptoms, with less language, simple language, lack of verbal content, lack of active speech (lack of thinking). Lack of thinking, apathy, and lack of will constitute a negative group of symptoms of schizophrenia.
Thinking content disorder
The main performance is delusion. Delusion is a pathological distortion of belief. This belief is inconsistent with objective facts, educational level, cultural background, etc., and even ridiculous, but patients do not believe, can not be persuaded, can not be personally experienced correct.
Delusion is one of the most common symptoms of schizophrenia, and various delusions can occur. Some patients have a high degree of delusion. In the early stages of the disease, the patient may be suspicious of certain apparently unreasonable thoughts. As the disease progresses, it merges with the pathological beliefs and cannot identify itself.
Relationship delusions and murders are the most common paranoia. Patients feel threatened and unfounded believe that some people want to frame, destroy, or murder themselves, follow up, monitor, etc. The patient feels that what is happening around him is related to himself. He is directed at himself and thinks that everyone around him is talking about him and talking about him (relationship). The patient feels that his or her own thoughts, emotions, behaviors, and body movements are controlled by outsiders or outside forces, and are not controlled by themselves (passive experience, controlled feeling, affecting delusions). I think that my thoughts and things I do are known to others (the inner feelings are insightful). I think my parents are not biological parents (non-system delusions). I firmly believe that a certain opposite sex has a love for myself (love and thought). Believe that the lover is unfaithful to himself, and has an affair (thinking). Unreasonably exaggerate one's ability, status, and wealth (exaggerated delusions). Suddenly, pathological beliefs (primary delusions) that are unrelated to the patient's experience and the real environment. The patient suddenly has a delusion (destination perception) about the normal perceptual experience.
Illusion
Illusion means that in the absence of something in objective reality, the patient perceives his existence and is a common symptom of schizophrenia.
The most common hallucination is auditory hallucination. No one is talking around, but the patient hears a voice. It is more common in verbal and auditory hallucinations. The content is commentary, controversy, imperative or thinking (the patient thinks of something, there is a voice that tells what he wants) is a characteristic auditory hallucination, more sustained The existence of verbal auditory hallucinations also has diagnostic value.
Other types of hallucinations include visual hallucinations, touch illusions, taste illusions, olfactory hallucinations, visceral hallucinations, and the like.
Affective disorder
The patient's emotional response to the surrounding things is lacking, and the early stage is a meticulous emotional loss, such as caring for the loved ones (emotional dullness), serious indifference to major events involving their own interests, and troubles to the average person, the patient has no corresponding Emotional reaction (emotional apathy). It can also express emotions and the surrounding environment is not coordinated, no reason to laugh, it is difficult to communicate emotionally with patients. The above symptoms are characteristic symptoms of schizophrenia.
Will behavior disorder
Performance is isolated, passive retreat, lack of initiative and enthusiasm, doing nothing all day, life is lazy, no high-level intentions (will decline), no interest in work, study, communication, ability to decline significantly, social function is impaired. Stupid, naive, and weird behavior can also occur.
When the patient is light, the patient has less speech, less movement, slower behavior, and does not eat, drink, speak, or move when severe, with increased muscle tone (tension and stiffness). In the stupid state, there can be sudden excitement, impulsiveness, and behavioral disorder (tensionful excitement). Tensile stupor and tension excitement constitute tight tension symptoms.
Self-awareness
Self-awareness refers to the ability to recognize one's own disease and performance.
Patients are not aware of hallucinations, weird thoughts, and behavioral sensations. Patients cannot recognize that they have problems with their mental activities, are unable to recognize their morbid changes, and deny that they are ill and have no self-awareness.
Clinical type and performance
1. Paranoid type is the main clinical manifestation of delusion, often accompanied by hallucinations. It is more common to be sensitive, suspicious, imaginative, and murderous. Followed by influence, ambiguity, etc. The vast majority of patients have several delusions at the same time.
2. Youth type begins in adolescence, showing excitement, more words, more activities, disordered speech, strange behavior, confusion, stupidity, childishness, uncoordinated thinking, feelings and behavior.
3. Tension-type tension and tension and excitement, with tension syndrome as the main clinical manifestation.
4. Simple type is the main clinical phase with negative symptoms such as lack of thinking, apathy, lack of will, and social withdrawal. Insidious onset, slow development, at least two years of disease, and gradually tend to mental decline. Generally no positive symptoms such as hallucinations and delusions.
5. The final type does not conform to the above four types, and it is difficult to type or mix.
6. Others such as childhood or late onset schizophrenia, post-schizophrenia depression, or residual, chronic decline.
Examine
Examination of schizophrenia
There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.
Since the concept of schizophrenia has been proposed, brain morphological changes and some toxic metabolites have been studied from various aspects, and no positive results have been obtained. Until the past two or three decades, some positive results have been discovered due to advances in inspection techniques. As a result, brain imaging technology research has found that the disease has an organic basis. In the past 20 years, imaging technology has provided a convenient way for people to understand the function and structure of living brain, and the research on brain abnormalities in schizophrenia is mainly Involved in three aspects, first, through CT or MRI to find the site of brain damage that increases susceptibility to schizophrenia; second, using functional imaging techniques such as PET, SPECT, fMRI, to observe local neuronal activity To establish the interrelationship between neurological dysfunction and the clinical features of schizophrenia. Third, through the molecular structure of brain tissue, to clarify the nature of the pathological process of neuronal deficits, such as PET, SPECT observation of neurotransmitters Receptors, or MRS to detect changes in neurochemistry.
1. Structural image
The reduction of the whole brain volume of schizophrenia and the enlargement of the ventricle are relatively consistent, and the volume reduction of gray matter is more obvious. CT found that the ventricles of patients with schizophrenia are enlarged and the volume of brain tissue is reduced, and the parts of brain tissue shrinking are different. Some believe that in the temporal lobe, especially the left temporal lobe, some believe that there is a general size reduction, and the amount of sputum, sacral occipital lobe is obvious, ventricular enlargement can be detected early in the disease, and pre-operative functional impairment , negative symptoms, poor treatment and cognitive impairment, no significant correlation with the course of the disease, although CT abnormalities have clinical significance, but no diagnostic specificity, because the same abnormalities can also be seen in patients with AD and alcoholism, Some patients with schizophrenia have enlarged ventricles, while others with active symptoms use dopamine blockers with good efficacy. These phenomena make Crow (1980) propose the hypothesis of two types of pathological processes of schizophrenia, which are type I and type II. Schizophrenia, Crow believes that negative symptoms are associated with brain tissue loss and ventricular enlargement, but CT does not provide evidence in this regard, most studies Studies have shown that ventricular enlargement is associated with clinical cognitive function and neuropsychological deficits. Other scholars have sought to find specific cognitive impairments and brain tissue loss. For example, Raine et al. (1992) found that frontal volume was reduced. In the neuropsychological test, the scores of frontal lobe function tests were correlated, and plasma high vanillic acid levels were used as indicators of dopaminergic activity. Breier et al. (1993) found that patients with schizophrenia had abnormally increased dopaminergic activity under drug-induced stress. It is also believed that the magnitude of the dopaminergic response is inversely related to the frontal lobe volume.
The advantage of MRI is that it can distinguish gray matter and white matter, can measure the size of special brain regions, and make the study of brain structural abnormalities in schizophrenia from general structural abnormalities to study specific regions. However, despite schizophrenia There are more possible brain regions, but there are fewer positive regions. The earliest MRI study found that patients with schizophrenia have selective frontal lobe, total brain volume and intracranial volume, suggesting that the above abnormalities are related to imperfect neurodevelopment. Instead of future degenerative changes.
The change of frontal lobe is one of the focuses of many studies. Because the prefrontal lobe performs more cortical function, these functions are obviously damaged in schizophrenia patients, including executive function, abstract thinking and working memory ability. There have been many studies in this area. In recent years, studies have found that there are atrophy of frontal lobe in chronic and first-episode patients, as well as thalamic, amygdala, hippocampus, basal ganglia and temporal lobe atrophy, in which the volume of the upper iliac crest is reduced and auditory hallucinations Related, Andreasen is the first to use MRI to study and report the reduction of frontal lobe. Many studies have confirmed this. For example, the results of the prefrontal cortex suggest that the area of the dorsolateral cortex of the prefrontal cortex is negative. Related, domestic researchers in the study of 38 cases of schizophrenia and 34 cases of control group MRI found that Hastelloy value of schizophrenia, lateral ventricle body index, third ventricle, left frontal sulcus, corpus callosum The anteroposterior diameter and area were significantly different from the control group, suggesting that there is lateral ventricle in schizophrenia, especially the lateral anterior horn and third ventricle, left frontal lobe The expansion of the sulcus and the reduction of the corpus callosum once again indicate the significance of changes in the structure of the frontal lobe in schizophrenia. The study also found that the anterior horn of the lateral ventricle, the third ventricle and the left frontal lobe in patients with type II schizophrenia In patients with sulcus larger than type I, the anteroposterior diameter and area of the corpus callosum are smaller than type I, indicating that the negative symptoms are related to brain atrophy. There is no difference in brain structure abnormalities between patients <30 years old and those >30 years old, suggesting early years Neurodevelopmental disorders may be responsible for abnormal brains and subsequent schizophrenia.
The temporal lobe-edge system has an unusual significance for mental activity. A large number of studies have confirmed that this part of schizophrenia patients also has atrophy, and the volume is reduced by about 8%, which is more obvious on the left side. In addition, the change of the upper back It is closely related to positive symptoms such as auditory hallucinations and thinking disorders, and it is worthy of further study.
2. Functional imagery
The SPECT study found that cerebral blood flow in patients with schizophrenia changes stepwise from front to back. The most serious damage occurs in the frontal lobe, the left side is heavier than the right side, and the blood of almost every region of interest and any other region of interest. There is a significant correlation between flow perfusion, and there is only a correlation between specific regions in normal people. This result suggests that the interaction between various regions of the brain varies between schizophrenia and normal people. As a signal for cerebral neurological changes and disorders in schizophrenia.
Compared with cerebral blood perfusion in patients with schizophrenia at rest and activation, it was found that at rest, the blood flow in the dorsal prefrontal cortex was significantly reduced. In the activated state, the blood flow perfusion in the normal person increased. The patient did not increase, and the schizophrenic patients who had not been treated with the drug had a higher prefrontal perfusion than the normal person at rest; in the activated state, the perfusion of the part would not increase, while the normal person would increase significantly, suggesting the spirit. Patients with schizophrenia have prefrontal dysfunction at the time of onset, consistent with findings from structural imaging.
Domestic researchers have suggested that the abnormality of cerebral blood perfusion in schizophrenia is mainly in the frontal lobe, and coincides with the abnormality of the visual evoked potential P300 amplitude. Therefore, it can be considered that schizophrenia has abnormality in frontal lobe integration, which is closely related to its negative symptoms. The SPECT examination before and after cognitive activation was performed on the first-episode schizophrenia patients, and the changes of SPECT images before and after activation were compared. The result was that the patients in the resting state had perfusion changes of temporal and frontal lobe compared with normal people; The amount of patients with negative symptoms was not significantly increased, but the blood flow perfusion of the patients with positive symptoms was significantly higher than that of negative symptoms. The lighter the symptoms, the more obvious the increase.
The characteristics of late-onset and early-onset schizophrenia are different. The former manifests as a decrease in bilateral frontal and temporal lobes, a decrease in the perfusion ratio between the left hemisphere and the right hemisphere, and a decrease in perfusion of the left temporal lobe. The most sensitive of the control group, the latter also showed low perfusion of the frontal lobe, the left amount was more obvious, but the blood flow perfusion of the temporal lobe was not obvious.
The study of cerebral blood perfusion characteristics of various symptom groups of schizophrenia showed that the thinking form disorder and exaggerated delusion were positively correlated with bilateral frontal and temporal sacral perfusion; delusional concept, hallucinatory behavior and suspicion and bilateral frontal lobe, cingulate gyrus, There was a negative correlation between left temporal lobe and left thalamic perfusion; negative thinking was negatively correlated with left frontal lobe, left temporal lobe and left parietal perfusion. After drug treatment and clinical symptoms improved, residual positive symptoms and brain local blood There was no correlation between flow perfusion, and negative symptoms were inversely correlated with bilateral frontal lobe, temporal lobe, cingulate gyrus, basal ganglia and hindbrain perfusion.
SPECT technology is used as a means to study the mechanism of action of drugs. The research in this area mainly includes the effects of antipsychotics on regional cerebral blood perfusion and its relationship with clinical efficacy, as well as changes in receptor binding rate at specific sites before and after drug treatment. The results of studies on perfusion are not consistent, suggesting that antipsychotic effects act on specific receptors and neurotransmitters to some extent, rather than by altering the effects of regional cerebral perfusion, neurotransmitter studies have found that The D2 receptor density index of patients with schizophrenia is higher than that of normal people, and the variation is larger. The ligand binding rate of patients taking drugs decreases, indicating that the D2 receptor occupancy rate is increased. The striatum D2 is taken by typical antipsychotics. The body occupation rate is higher than that of those who do not take drugs or take atypical antipsychotics. The incidence of extrapyramidal adverse reactions is also high. There is no difference in D2 receptor utilization between patients and healthy people in the basic state. D2 of patients after amphetamine is used. Receptor utilization is significantly reduced, and excessive dopamine release is associated with aggravation of certain symptoms in patients, schizophrenic patients who have never used medication, medication 3 After the day, the change of the ratio of ligand binding rate between the basal ganglia and the frontal lobe was significantly correlated with the efficacy and extrapyramidal adverse reactions: the curative effect was good, the ratio of patients with small adverse reactions decreased, and the ratio of patients with poor efficacy and large adverse reactions increased. It is suggested that antipsychotics can cause up-regulation of D2 receptors in the basal ganglia of the latter type of patients.
PET can more clearly observe the activation status of the brain under different stimuli, the activation of the brain by certain drugs, the receptor occupancy rate of the specific central part, the dynamic changes of various related parts, and the blood concentration and clinical efficacy of the drug. Relationships, etc., PET receptor studies have shown that 5HT2 receptors in schizophrenia patients are not reduced, patients with extrapyramidal adverse reactions are associated with D2 receptor occupancy, the latter is dose-dependent, and with patients Age related.
The fMRI study of schizophrenia is often associated with cognitive deficit symptom studies. Cognitive function studies have found that cognitive deficit symptoms in patients with schizophrenia involve multiple areas, such as memory, attention, executive function, and integration. Scholars have used different fMRI cognitive research models for these different cognitive deficits. Among them, memory (especially working memory) has the most fMRI studies, and fMRI findings of working memory in patients with schizophrenia are inconsistent. More studies support schizophrenia. Patients (including high-risk offspring) have low activation of the dorsolateral dorsolateral (DLFC) and posterior lobes, but there are some opposite conclusions that lead to increased frontal lobe activation. In addition, Fletcher et al. found that with verbal working memory capacity Increased, DLFC activation increased in the control group, while activation of the above-mentioned parts of schizophrenia patients decreased with increasing capacity; Stevens et al and Barch found that speech working memory is more obvious than non-verbal working memory activation, possibly The defects that reflect the verbal working memory of patients with schizophrenia are more obvious. As for the treatment before treatment There are very few fMRI studies. Wexler et al. used a series of word position memory tests to study the effects of cognitive training on cognitive function. Eight patients with stable disease received a 10-week memory training and found that patients with schizophrenia after cognitive training left. The activation of the lateral forearm was significantly stronger than that before training; Wykes et al. used the reciprocal n test (n=2) to study the changes before and after cognitive therapy in patients with schizophrenia, and found that patients with schizophrenia after cognitive therapy were related to working memory. The activation of brain regions (especially frontal lobe) was significantly increased. Domestic Liu Dengtang and Jiang Kaida also used fMRI to study patients with first-episode schizophrenia. The digital homework test was used as the stimulation mode, and the digital homework test was mainly used to measure the subjects. The maintenance of linguistic material information, with selective attention and executive control of cognitive component participation, the study found that the left DLFC (mainly the left frontal gyrus) of the first schizophrenia patient before treatment, the left frontal lobe The activation of the lateral (VLFC) and the posterior lower part of the left parietal lobe (the upper left lobule and the left rim of the left side) is low, which is basically consistent with the above known findings. It shows that patients with schizophrenia have defects in working memory (mainly verbal working memory) at the early stage of the disease. After treatment with risperidone or chlorpromazine for 2 months, fMRI was reviewed and risperidone treatment was found. The activation of the left upper frontal and left lower frontal gyrus was significantly improved. After chlorpromazine treatment, the left upper frontal and left lower frontal gyrus of schizophrenia patients also improved, and risperidone There were no significant differences in the changes of brain regions between the group and the chlorpromazine group before and after treatment. Further analysis of the causes may be related to the first schizophrenia with positive symptoms in the study. The positive symptoms of the patients were significantly improved, and the symptoms of cognitive impairment associated with positive symptoms were also improved. If further follow-up, there may be differences between the two groups.
(1) Research on resting state of the brain: The study of brain function in resting state of patients with certain diseases is often the beginning of imaging studies of such diseases, and the results of the research are mostly used as baseline data. Used to compare results with other non-resting states.
There was no difference in the regional cerebral blood flow between the schizophrenia patients and the healthy control group at rest. The difference was that the frontal lobe did not increase in activity relative to the posterior brain region, but this characteristic was more obvious in the healthy control group. Especially in the prefrontal cortex area, although some studies do not support this conclusion, the proposed "low frontal function" of schizophrenia has become the classic theory of schizophrenia so far. Since then, the same results have been found using SPECT and PET techniques, particularly in the prefrontal and left frontal cortex, and another important finding for resting studies in patients with schizophrenia is an increase in basal ganglia activity, which appears to be The follow-up findings after antipsychotic treatment were consistent with the increase in the activity of the putamen after a single dose of antipsychotic drugs in the healthy control group.
The biggest problem encountered in the interpretation of the above results is that it is difficult to determine the cognitive activity of the subject under the so-called "resting state", because in the "resting state", the patient still has emotional and cognitive activity Different from person to person, this difference causes different functional states in the corresponding brain regions. The researchers have even confirmed different "resting states" (closed eyes, thunder, closed eyes and ears), healthy people will show Different brain functional states, they therefore think that "resting state" is an inappropriate name, however, the study of "resting state" provides a basis for partial mental disorders of mental disorders, which is to further study these The nature of the disease provides a baseline for comparison, and how to make the resting state a true rest is already a new direction of exploration in the field.
(2) Research on brain function under cognitive activation: Using cognitive activation tasks to measure the brain function status of subjects when completing tasks is one of the most used imaging methods in mental disease research, which is online. Assessment of brain function provides a pathway for studying cognitive function in schizophrenia using cognitive tasks that activate the prefrontal cortex. These cognitive tasks include continuous work tests, Wisconsin card classification tests, and Raven's progressive model tests. And working memory tests, etc., the level of prefrontal activation is lower in patients with schizophrenia than in the control group. Because of the low level of behavioral responses and response levels in patients with schizophrenia, problems with such studies Yes, it is not certain whether the subject is being "online" or "immediately imaged" while performing cognitive tasks, and it is not possible to determine that low levels of prefrontal activation are the cause of schizophrenia response and low response levels. Still the result, in order to answer the latter question, the researchers designed such a scheme, that is, Patients with schizophrenia who have similar low-response and response patterns to Huntington's disease (HD) undergo a Wisconsin card classification test, but HD patients do not exhibit low frontal activation levels, which at least to some extent indicate that low frontal lobe cannot be The level of activation is simply attributed to a low response level.
The H215O PET technique was used to examine the blood flow of the prefrontal cortex when completing a multi-level memory task. When the task was to recall a few words, the patient completed the task and the activation of the prefrontal cortex were similar to the control group. When the number of words requiring recall increases, the patient's completion of the task becomes worse, and the clinical manifestation and the patient's prefrontal blood flow cannot be increased correspondingly with the increase of the cognitive task load, suggesting that the patient's prefrontal lobe is cognizant. The decline in responsiveness of a task may only appear when the patient is unable to complete the cognitive task.
In addition, the abnormality of prefrontal activation in patients with schizophrenia presents different conditions due to the different characteristics of cognitive activation tasks used. For example, patients exhibit low pre-frontal activation levels when completing fluency tasks, and complete semantic tasks. This phenomenon does not occur at the time, although both tasks are subject to word processing tasks and are related to prefrontal activation, the former requires vocabulary based on prompts, while the latter requires classification of external stimuli, so it is speculated The low activation level of the prefrontal lobe in patients with schizophrenia is associated with a defect in its endogenous synthetic ability.
(3) Research on mental symptoms:
1 Study on the relationship between symptom group and local brain function: There are 3 groups of characteristic clinical symptoms in patients with schizophrenia, namely negative symptoms, thinking disorders and positive symptoms (ie hallucinations and delusions), with PET A method for examining regional cerebral blood flow was found to have a negative correlation with negative prefrontal blood flow; thought disorder was associated with cingulate gyrus function; and hallucinations and delusions were associated with blood flow in the central cortex of the temporal lobe.
If the symptoms of depression were divided into 3 groups, the same method was used to study depression, and the anxiety symptoms were positively correlated with the blood flow in the posterior and parietal cortex of the cingulate gyrus; psychomotor retardation and Depression was negatively correlated with blood flow in the left frontal prefrontal and parietal cortex; cognitive function was positively correlated with cortical blood flow in the left prefrontal cortex. In addition, it was found that both single-phase and bipolar depression, patient's abdomen The lateral cortical area has a functional abnormal decline with respect to the corpus callosum; while in the biphasic mania, the function of this part is increased. This phenomenon suggests that the functional status of the area may be emotionally state-dependent, that is, with the emotional state. Change and change.
2 Immediate brain function study at the onset of symptoms: Some researchers believe that patients with a diagnosis of the same disease with a certain symptom at the time and without symptoms of the brain function is a more direct way to reveal the symptoms, they compared The brain function of patients with schizophrenia with auditory hallucinations and those without auditory hallucinations found that patients with auditory hallucinations had relatively lower levels of metabolism in the lateral part of the temporal lobe, while those in the lower right frontal lobe were relatively more metabolically Gao, another study compared the brain function of the same group of patients in the presence of rich auditory hallucinations and the relief of auditory hallucinations. For patients with auditory hallucinations, they were required to move their fingers while hearing auditory hallucinations, and the testers saw them. At the time of finger movement, brain function imaging was performed. It was found that the local blood flow in the left lower frontal area of the patient with auditory hallucinations was higher than that in the patients without auditory hallucinations. The blood flow in the left anterior cingulate gyrus and temporal lobe cortex was also relative. Higher, when other researchers repeated the above test, the requirement to move the finger was changed to the button, and the results suggest the function of auditory hallucinations and striatum, the central cortex of the thalamus and temporal lobe. turn off.
These trials all aim to "capture" brain function changes at the time of the onset of symptoms, but there is a deficiency that mental symptoms are often a subjective experience, and the quality of the test data will ultimately depend on the credibility of the patient's reported symptoms. Faithfulness, and the process of marking symptoms, such as moving a finger or a button, may also affect the functional state of the brain.
A cross-sectional study of psychiatric symptoms refers to the study of the same type of symptoms that occur in different diseases. This method is especially applicable to psychiatric subjects because, for example, delusions, depression and hallucinations often occur in different mental illnesses, a series of studies The association between depression and neuroimaging function secondary to HD and Parkinson's disease (PD) was compared. Some results suggest that bilateral ankle, prefrontal and anterior temporal cortex are low-metabolism in both groups; There are also some studies supporting PD patients with depressive symptoms showing low metabolic levels in the bilateral frontal lobes and anterior cingulate cortex. Although the results are different, they all suggest that the depressive symptoms themselves may be independent of the disease they are associated with. The frontal lobe, temporal cortex, and striatum neural pathways are functionally related, and functional deficits in this neural pathway may lead to primary depression, or other diseases associated with the basal ganglia, and, in addition, poor mental activity A comparative study of schizophrenia and depression with psychomotor retardation revealed a decrease in the function of these symptoms and the left frontal prefrontal cortex (DLPFC). Related to, regardless of the disease associated with it, from the above studies, there are certain specific structural regions or neural pathways in the brain. Some mental symptoms may be related to the function of these parts, and what kind of symptoms occur. Mental illness has nothing to do.
3. Neuroreceptor imaging technology on the theory of neurotransmitter in schizophrenia
Schizophrenia is one of the most complete neurotransmitter theories in many mental disorders. It mainly involves two major transmitter systems, dopamine and 5-HT. The focus of molecular imaging studies on this aspect is also concentrated in this study. The main design patterns can be divided into two categories: one is called clinical research, which aims to understand the neurochemical abnormalities of mental diseases such as neurotransmitters and receptors, and to further understand the pathophysiological mechanisms of diseases; the other is Receptor occupancy studies are used to better understand the mechanisms and pathways of action of drugs.
The central dopamine receptors are mainly located in the cortex and striatum. Due to the late development and development of radioligands suitable for cortisol dopamine receptors, there are many studies on striatum dopamine receptors. Clinical studies have confirmed that the spirit The striatum has a higher density of dopamine D2 receptors in the striatum than in the normal control group. Amphetamine is used to stimulate the release of dopamine. The peak of release is clearly related to the transient psychiatric symptoms caused by amphetamine. The phenomenon has nothing to do with whether the patient has used antipsychotics in the past; moreover, the above phenomenon occurs only when the patient's disease is aggravated, and disappears after the symptoms are relieved. The most common explanation for this phenomenon is that the patient's dopamine release is caused by amphetamine stimulation. In addition, another explanation is the increased affinity of the patient's D2 receptor for dopamine.
The defect in the amphetamine stimulation test is that the change in dopamine in the synaptic cleft is due to non-physiological stimuli, and the trial fails to provide data on the baseline concentration of dopamine in the synaptic cleft, using A-methyl-terptyrosine (AMPT). To inhibit dopamine synthesis and to assess the baseline level of dopamine inhibition in the presynaptic gap and its binding to the postsynaptic D2 receptor by an increase in the binding rate of the ligand to the postsynaptic D2 receptor due to the above ligands The increased rate of binding to the postsynaptic D2 receptor occurs only in in vivo assays and does not occur in in vitro assays, suggesting that this phenomenon is not related to receptor upregulation, but rather due to endogenous dopamine depletion and originally bound by dopamine. The D2 receptor is re-dissociated. It is confirmed by the above test that the rate of D2 receptor binding to dopamine is higher in patients with schizophrenia than in healthy controls, which is related to the high dopamine level in patients with synaptic cleft. Consistent.
In addition, studies of dopa decarboxylase and dopamine transporters using specific radiolabeled ligands have also confirmed increased dopamine levels in patients with schizophrenia.
The current "receptor occupancy study" is mainly used for the study of the mechanism of action of drugs on drugs and the comparison of classic and non-classical antipsychotic drugs. The D2 receptor occupancy rate of classical antipsychotic drugs is 70% to 89%. The clozapine occupancy rate is 28% to 63%, even if the former dose is added to the upper limit of the clinical use dose, the latter uses the lower limit of the clinical use dose, and their respective receptor occupancy rates remain in the original range. Internally, it suggests that the D2 receptor occupancy rate is not related to the drug dose, but an indicator of drug properties, which can be used to distinguish between classic and non-classical antipsychotics. However, for two types of non-classical antipsychotics, risperidone and olanzapine. The findings do not support this claim because both D2 receptor occupancy rates increase with increasing dose.
There is no major breakthrough in the clinical study of 5-HT because of its high non-specific binding rate, low labeling/interference rate, difficulty in measuring free radicals in plasma, low clearance rate in the brain, and receptor occupancy. The results indicate that the antagonism of 5-HT2A receptor is a feature of non-classical antipsychotic drugs that is different from classical antipsychotic drugs. However, the improvement of clinical symptoms caused by 5-HT2A receptor blockade is still the direction of future research.
4. Changes in brain evoked potentials in schizophrenia
(1) P300: Foreign studies on schizophrenia P300 have the following findings:
1 volatility decline, schizophrenia P300 amplitude is significantly reduced, may be the obstacles to the active processing of information and the results of passive attention to the defect, recent research found that the high-risk children with schizophrenia P300 amplitude reduction, that P300 can be used as a pre-onset Forecast indicator
2 The incubation period is prolonged, and the P300 latency of patients with schizophrenia is prolonged by more than 2 standard deviations in 20% to 30% of schizophrenia; and the P300 latency of children at high risk of schizophrenia is significantly shortened;
3P300 is distributed in different brain regions, and P300 in patients with schizophrenia is deficient in the left middle and posterior temporal region of the scalp.
Olichney (1998) reported the relationship between P300 amplitude and senile schizophrenia with a late onset of age, and found that the amplitude of auditory P300 was lower in schizophrenia patients with earlier onset age, but not in older schizophrenia with a later onset age. With similar changes, the study found that there was no difference in the amplitude of N100 and N200 in auditory P300 between schizophrenia patients with early onset age and late onset age; P300 amplitudes in patients with early onset of schizophrenia were higher than normal. The violent decline in the schizophrenia patients with late onset of age was mostly within the normal range, indicating that patients with earlier onset schizophrenia had more serious information processing defects.
Weir (1998) described the P300 latency and topographic map distribution of schizophrenia and depression. According to the DSM-III-R diagnostic criteria, 19 patients with right-handed positive schizophrenia and 14 patients with right-handed depression were tested. P300 topographic map of the patient and 31 normal people found that the left central region of patients with schizophrenia was significantly deficient, while the depression of the right side of the P300 topographic map was defective. The latency of schizophrenia patients was 22 ms longer than that of normal people. There was a significant difference in the analysis of the study; the latency of depression was 10 ms longer than that of the normal person, and there was no significant difference in statistical analysis.
Buchsbaum et al. believe that the increase or decrease of N100 amplitude reflects the degree of opening and closing of the "valve structure" that regulates the sensory afferent pathway of the cerebral cortex. The amplitude of N100 increases with the increase of light stimulation intensity, and the N100 amplitude is not only stimulated. In addition to the influence of personality factors, they also found that the spirometry patients with P300 N100 ~ P200 amplitude decreased; chronic schizophrenia N100 amplitude changes and acute schizophrenia, the former increased, while the latter decreased, N100 was It is considered to be related to selective attention.
The decline in P3 amplitude of schizophrenia P300 is consistent with the findings of domestic and international research reports. The decrease of target P3 amplitude in P300 may be one of the attributes of schizophrenia, because this variation can be seen in patients in remission and some high-risk groups.
(2) CNV: Ruiloba found that CNV in patients with schizophrenia has the following changes:
1 The basic waveform has large variation and no regularity;
2 The highest peak potential decreased, the average amplitude decreased, and patients with mental symptoms such as auditory hallucinations, depression, delusions, etc., the CNV amplitude was lower;
3CNV extended time;
4 The error of the operation reaction test is increased; E. The time course (PINV) of the negative change after the stimulation is extended.
Jiang Kaida et al (1982) reported that 76 cases of schizophrenia CNV findings found:
1 Waveform characteristics: After the command signal, the negative phase expects the wave to be irregular in shape and poor in stability;
The total time course of 2CNV was prolonged, and the PINV was more obvious. The total time course of CNV in patients with chronic schizophrenia was extended to 1612.9ms, while the normal group was only 1154.6ms. The difference was very significant. The PINV incubation period of chronic schizophrenia was 677.2ms. The normal group was 220.2ms, the difference is very significant, at the same time, the proposed PINV more than 400ms can be used as one of the electrophysiological reference indicators for clinical diagnosis of schizophrenia;
The peak potential of 3CNV decreased: the mean value of CNV peak potential in patients with acute and chronic schizophrenia was 11.9±4.3V, 14.3±4.7V, and the normal person group was 16.7±4.9V, the difference was very significant;
4 The negative change area of the command signal is reduced, and the negative change area of the command signal is increased;
5 The time after the command signal is significantly prolonged, and the patients with chronic schizophrenia are more obvious;
The 6CNV time course and amplitude changes were parallel with the degree of clinical symptom relief in patients with schizophrenia. In acute patients, the psychotic symptoms were relieved after treatment. When the condition became stable, the CNV waveform became stable, the amplitude increased, and the PINV latency was shortened (treatment The first 535.4±380.2ms, 149.5±40.6ms after treatment, the CNV spike and PINV time course can be considered as an objective reference for assessing the short-term efficacy of patients.
(3) N400: Wu Liangtang et al (1995) found that the N400 waveform of patients with schizophrenia was not irregular, the amplitude decreased, or even disappeared, the incubation period was prolonged, and the amplitude of N400 decreased, indicating that it had defects in semantic expectations, N400 The incubation period is extended, prompting the delay of the information process.
Ren Yan et al (1997) reported that patients with schizophrenia can induce significant N400 components. When not taking drugs, the amplitude of N400 is significantly lower than that of normal people, and the waveform is different. It may be the thinking disorder of patients with schizophrenia. The brain's ability to process information, so the unpredictability of semantics is poor, the ability to recognize semantic differences is low, and the ability to process language information is not as good as normal, causing N400 anomalies.
Hou Yu (1993) conducted a controlled study of event-related potential N400 in 19 patients with schizophrenia. The N400 latency of patients with schizophrenia was significantly longer than that of the normal control group, and the amplitude was reduced. The frontal area was more obvious, suggesting that patients with schizophrenia Language generation mechanisms and information processing may have some degree of obstacles.
(4) MMN: Patients with schizophrenia found a decrease in amplitude in the MMN experiment. Javitt (1993) reported a decrease in the amplitude of 14 patients with chronic schizophrenia. The amplitude of MMN was not significantly correlated with age and IQ. The amplitude change was a mental disease MMN study. Quite a consistent result.
(5) SEP: Shagass and Schwartz reported that before 100ms, the SEP amplitude of patients with schizophrenia was greater than that of normal people. Chronic patients were larger than patients with acute schizophrenia. Shagass divided schizophrenia patients into two groups: one was chronic group. (including undifferentiated, delusional, simple type of chronic disease); second is the "other" group (including stress, emotional, acute schizophrenia), SEP findings recorded from C3, C4, chronic The group has a particularly high amplitude at N60, which may be a feature of patients with chronic schizophrenia. Shagass also reported schizophrenia with a low score on the Depression Symptom Scale and a high score on the Concise Psychiatric Symptom Scale in patients with schizophrenia. In patients, the SEP amplitude within 100ms was higher than that of the schizophrenic patients with a low score on the Depression Symptom Scale and a low score on the Concise Psychiatric Symptom Scale, and the variation was small. In addition, N130, P180, P280 waves after 100 ms of somatosensory stimulation, It was found that patients with schizophrenia had lower volatility and irregularity than normal people.
Jiang Kaida et al (1996) reported that the P2 amplitude of the SEF main wave in patients with schizophrenia was 1.26±0.9V, and the normal person was 3.5±1.2V. There was a significant difference between the two. The SEP waveform variation of schizophrenia was also found in some patients. Or the P3 wave is larger than the P2 main wave. In addition, it is found that the incidence of P3 and P3 waves in both normal and schizophrenia patients is higher than that of VEP and AEP, which may be related to the VEP and AEP conduction pathways. The number of elements is related to the sensitivity of various neurons.
(6) AEP, VEP: Shagass reviewed relevant literature and found that the main changes in schizophrenia AEP and VEP are summarized as:
1 The main wave group (N1-P2-N2) variation was significantly larger than the normal control group;
2 amplitude reduction;
3 latency is shortened;
4 After the rhythm (after 300ms), the activity of the components is low, and the occurrence rate of P3 waves is low and the amplitude is low;
5 Recovery function changes, the amplitude recovery is lower than normal.
Zhang Mingdao reported changes in AEP and VBP in 82 patients with schizophrenia in 1983. The main findings are as follows:
1 Waveform characteristics: AEP, VEP waveform variation of patients with acute and chronic schizophrenia is larger than that of normal people, and patients with acute schizophrenia are more obvious. The main wave group (N1-P2-N2) is irregular and unstable, the same patient There is no consistency in the two rounds of experimental waveforms in the same time;
2 amplitude reduction: acute, chronic schizophrenia patients N1-P2 average amplitude decreased by 25% to 30% compared with the normal group, P2-N2 amplitude decreased by 30% to 40%, P2 amplitude decreased by 17.5% to 37.5%, compared with normal control There are very significant differences between groups;
3 Incubation period: The P2 wave latency of acute patients is shorter than that of the normal group, while the P2 latency of chronic patients is not significantly different from that of the normal group.
Roth, Schlor through the VEP N1 and P2 latency studies found that latent latency was associated with positive symptoms, and latent latency was associated with negative symptoms such as apathy. Schwartz, Kopf analyzed different stimulation intensities, VEP, compared with negative, positive symptoms. The difference in VEP latency showed that the average P2 latency of the positive symptom group was significantly lower than that of the negative symptom group under low-intensity stimulation. Crow suggested that negative symptoms represent a possible organic disease, which is due to a certain area of the brain. The damage causes loss of function.
(7) P50: Wang Jianjun et al (2001) showed that the schizophrenia group showed two changes: a decrease in C-P50 amplitude and a decrease in T-P50 inhibition (a significant increase in T-P50 amplitude and T/P ratio), ie, sensation Abnormalities in the door, they also found that P50 in patients with schizophrenia has nothing to do with the course of the disease. On the other hand, it reflects that the sensory door defect of the disease has its inherent material basis. Many researchers believe that the attention disorder of schizophrenia may belong to the attention. The choice and maintenance of the problem, which is related to central inhibition of dysfunction.
Venables (1964) suggested that patients with schizophrenia show symptoms of division because they cannot effectively filter the stimuli and are "submerged" by excessive stimulation. Epstein et al. (1970) argue that patients with schizophrenia have increased stimuli. Lack of integration of input information, and speculate that attention and sensory impairment in patients with schizophrenia are caused by sensory afferent filtration or control defects, because such defects can lead to excessive alertness and difficulty in identification, further research suggests that central dopamine Hyperfunction is associated with a decrease in P50 amplitude and latency, and norepinephrine hyperfunction is associated with sensory gating deficits.
5. Problems in imaging studies of schizophrenia Whether in structural or functional imaging studies, there is a problem that insufficient attention is paid to the heterogeneity of schizophrenia, positive and negative, with Cognitive and non-cognitive deficits are subtypes that are already known, but there must be subtypes that are unknown, so any study should first determine the subtype to be studied in order to purify the sample. A reliable conclusion is obtained. In addition, the functional and structural defects of the frontal lobe are the most noteworthy imaging findings of schizophrenia, but this seems to be more closely related to negative symptoms. As for the positive symptoms, is there any part corresponding to it? Is the frontal problem a characteristic or stateful indicator of schizophrenia? These questions can be understood after studying the brain condition of the patient before and after the disappearance of the symptoms, but at least the current answer is still unknown.
In short, the relationship between different subtypes or symptom groups of schizophrenia and rCBF in different regions of the brain is complicated. Because different researchers use different research methods, the results are different, and it is necessary to use uniform standards and methods for research. In order to clarify the relationship between subtypes of schizophrenia or changes in psychopathological symptoms and changes in imaging indicators.
Diagnosis
Diagnosis and differentiation of schizophrenia
diagnosis
Unlike many other diseases, the current cause of schizophrenia is not fully elucidated. To date, there is no exact laboratory test or laboratory test to support clinical diagnosis. Some scale assessments and laboratory tests can be used as a doctor-assisted diagnosis and a measure of severity, and can be used as a basis for differential diagnosis and cannot be used as a definitive basis for diagnosis. The diagnosis is still determined by the medical history, combined with the mental symptoms and the progression of the disease.
If there are no obvious reasons, the above-mentioned perceptual, thinking, emotional, and volitional behaviors are manifested. The mental activity itself is not in harmony with the external environment. For a certain period of time, there is no understanding of abnormal performance, and it is highly suspected of mental illness. Possible.
Diagnostic classification criteria currently used in clinical practice: Chinese Classification and Diagnostic Criteria for Mental Disorders - Third Edition (CCMD-3), International Classification System for Mental Disorders (ICD-10), and American Classification System (DSM-IV).
According to the Chinese Classification and Diagnostic Standard for Mental Disorders - Third Edition (CCMD-3), the diagnostic criteria for schizophrenia are as follows:
Symptom standard
At least the following two items are not secondary to disturbance of consciousness, mental retardation, high or low sentiment, and simple schizophrenia provides:
1. Repetitive verbal auditory hallucinations;
2. Obvious thinking relaxation, broken thinking, incoherent speech, or lack of thinking or lack of thinking content;
3. Thoughts are inserted, removed, disseminated, interrupted, or compulsory thinking;
4. Passive, controlled, or insightful;
5. Primary delusions (including delusional perception, delusional mood) or other absurd delusions;
6. Thinking logic inversion, pathological symbolic thinking, or new words;
7. Emotional inversion, or obvious emotional apathy;
8. Tension syndrome, weird behavior, or stupidity;
9. Significant will decline or lack.
Serious standard
Self-knowledge disorder, and severely impaired social function or inability to conduct effective conversations.
Disease standard
Symptoms and severity criteria have been met for at least 1 month (CCMD-3), and the simple type is otherwise specified.
Exclusion criteria
Exclusion of organic mental disorders, and mental disorders caused by psychoactive substances and non-addictive substances. Patients with schizophrenia who have not yet been relieved, if they suffer from the above two types of diseases in this item, should be diagnosed in parallel.
Differential diagnosis
In cases with typical schizophrenia, according to the operational diagnostic criteria, the diagnosis is generally not difficult. When the symptoms are not typical and are not clear, the following diseases need to be identified.
1. Patients with schizophrenia with neurasthenia, especially those with early symptoms of negative symptoms, may experience weakness, dullness, difficulty in completing work, inattention, and similar neurasthenia symptoms, but the self-knowledge of neurasthenia patients is Complete, the patient fully understands his condition and situation; sometimes he overestimates his condition, has a strong emotional reaction, and actively requests treatment. Early schizophrenia patients sometimes have self-knowledge, but are incomplete, not Corresponding emotional response and urgent treatment requirements, if you carefully trace the medical history and learn more about the condition, you can find that these patients are interested in reduction, emotional retardation, behavioral solitude or bizarre thinking.
2. Obsessive-compulsive disorder Part of the early stage of schizophrenia is mainly forced state. At this time, it needs to be differentiated from obsessive-compulsive disorder. The forced state of schizophrenia has the characteristics of bizarre, ridiculous and incomprehensible. Complete, the patient's desire to get rid of the forced state is not strong, and the painful experience of compulsive symptoms is not profound. These are different from obsessive-compulsive disorder. As the disease progresses, the emotional response becomes more and more dull, and on the background of compulsive symptoms. , the characteristic symptoms of schizophrenia gradually appear.
3. Depression, depressive episodes In the early symptoms of schizophrenia, according to Hafner's data, the cumulative prevalence of depression in chronic onset schizophrenia can be as high as 80%, requiring clinical attention, with an early discovery. Avoid missed diagnosis or diagnose neurasthenia.
4. Mania, manic episodes of acute onset and excitement and irritability in schizophrenia patients, the appearance can be similar to manic patients, the emotional response of the two and the contact with the surrounding are significantly different, the emotions of mania patients Active, vivid, infectious, emotional expression, regardless of emotions, is consistent with the content of thinking, coordination with the surrounding environment, retaining emotional interaction with people, although schizophrenia patients increase activity, but patients and the environment The contact is not good, the emotional change does not match the environment, and the action is more monotonous.
5. Reactive mental disorders, post-traumatic stress disorder in patients with schizophrenia directly affected by trauma, early thinking and affective disorders can have a strong reaction color, need to be differentiated from post-traumatic stress disorder However, with the development of schizophrenia, the content of delusion is farther and farther away from spiritual factors, and it is increasingly detached from reality. It is increasingly ridiculous in structural and logical reasoning. Patients do not actively expose inner experience and lack corresponding emotional reactions. The emotional response of patients with post-traumatic stress disorder is sharp and strong, and the mental symptoms gradually decrease and disappear with the release of mental stimulation.
6. Paranoid mental disorder Paranoid mental disorder is a general term for a group of diseases. The common feature is that systematic paranoia is the main clinical symptom. Behavioral and emotional reactions are consistent with delusional concepts. There is no mental decline, and intelligence remains good, including paranoia. Mad, paranoid mental illness or paranoid state.
Paranoid schizophrenia sometimes needs to be differentiated from paranoia and paranoid psychosis. The latter two occur in the interaction of impaired personality and psychological factors. These patients have special personality defects, subjective and stubborn. Sensitive, suspicious, self-respecting, self-centered and pretentious, especially in paranoia, the latter's delusions are developed on the basis of one-sided evaluation of facts, thinking is always organized and logical, emotional Consistent with behavior and delusions, no mental decline is different from schizophrenia and has important significance in identification.
7. Mental disorders caused by physical diseases Patients with schizophrenia who are caused by physical factors, have acute onset, early symptoms of consciousness, directional errors, visual hallucinations, etc., need to be differentiated from symptomatic psychosis, symptomatic Although mental illness can be similar to the symptoms of schizophrenia, these symptoms appear on the background of disturbance of consciousness. The hallucinations are regarded by the horror of horror, and there are volatility of light and night, when the disturbance of consciousness is reduced or disappeared. The patient has good contact with the environment, the emotional response is preserved, and there are no characteristic symptoms of schizophrenia.
8. Brain organic psychosis Brain organic psychosis has intelligent disorders and positive signs of the nervous system. It is not difficult to identify and diagnose in general. In recent years, sporadic viral encephalitis is more common, and mental symptoms are often the first symptom. Nearly half of the patients did not see signs of the nervous system in the early stage, which is easy to cause misdiagnosis. Common psychiatric symptoms include: stupor state, indifferent language, psychomotor excitement, hallucinations, visual distortions and delusions, etc. It is not uncommon for schizophrenia. Such patients, such as careful observation, can often find out in time that patients have directional, memory and attention disorders, as well as symptoms of brain damage such as incontinence, can be identified, if there is abnormal EEG and Cerebrospinal fluid changes can be used as an important basis for diagnosis.
In the state of epilepsy, symptoms of schizophrenia, such as inconsistency and sense of control, can be seen, according to the history and the unique thinking viscosity and narration of patients with epilepsy, and the emotional response is good, and the treatment cooperation, etc. Diagnosis is not difficult. In addition, patients with epilepsy have special EEG changes, which is also an important basis for identification.
9. Brain tumor patients with brain tumors due to obvious mental symptoms accounted for 0.13% of hospitalized patients (Shanghai), 19 cases were diagnosed by operation, ventriculography or autopsy (12 cases in Shanghai, 7 cases in Beijing Anding Hospital) The occurrence of the temporal lobe is the most common, followed by the deep temporal lobe and the posterior part of the third ventricle. Most of the tumors grow in the "quiet zone". In the early stage, the lack of positive signs of the nervous system causes misdiagnosis. The patient's psychiatric symptoms are: rich Hallucinations, delusions, stupor or depression accompanied by suicide attempts, when examined in detail, can be found in varying degrees of memory impairment and mental retardation, as well as chronic brain organic syndrome such as apathy, sluggishness, and visible sleepiness or subacute confusion Status, misdiagnosed cases are caused by behavioral disorders, suspicious, personality changes as the first symptom.
10. Sick personality Some patients with schizophrenia can express their early symptoms as pseudo-pathological personality, especially in the onset of adolescents, patients with slow progression, easily misdiagnosed as pathological personality, at this time the differential diagnosis must have a detailed understanding of the patient's life experience In the family, the performance of all aspects of the school, and the development of personality, morbid personality is the deviation of personality development, not a disease process, in the unsuccessful environment, personality defects can be more obvious, the amount of change.
