Paranoid
Introduction
Profile of paranoia The cause of paranoid mental disorder may be heterogeneous, and the relative roles of heredity, personality characteristics and living environment in onset are still uncertain. The clinical features are clear consciousness, the structure of the delusion is more systematic, the content of the delusion is very variable, with little or no hallucinations, the personality remains relatively intact, the condition is prolonged, and even lasts for a lifetime, but there is less mental decline. There are different opinions on the taxonomy of this group of diseases. Some people think that paranoid mental disorder is a variant form of schizophrenia, and some people support it as an independent diagnosis. basic knowledge The proportion of illness: 0.050 Susceptible people: no special people Mode of infection: non-infectious Complications: insomnia
Cause
Paranoia
(1) Causes of the disease
The cause of paranoia is unclear and is an endogenous mental disorder that may be related to the following factors:
1. Personality characteristics: When studying the development process of personality characteristics of some patients, it shows that their personality has unhealthy performance. The patient's pre-disease personality is often subjective, stubborn, sensitive and suspicious, and is wary and insecure to others. Controversy, can't accept criticism from others, self-centered, pretentious, nitpicking, arrogant, arrogant, self-evaluating, ambitious, imaginative, arbitrarily, emotionally excited, unable to calmly face reality Such quality characteristics, these personality defects, are not necessarily the necessary conditions for the onset, may encounter some kind of psychosocial factors or internal conflicts, they will not properly cope, and the facts are misinterpreted or long-term care, it is possible Gradually formed a paranoid concept, leading to disease.
2. Genetic factors: Krafft-Ebing and Kolle both believe that paranoia has a genetic predisposition. Miller surveyed 400 relatives of patients with obvious paranoia, about 2% had paranoid psychosis, but also had the opposite opinion, visible genetics Factors need to be further explored.
3. Cultural background: Some people believe that paranoid mental disorder is not uncommon among some ethnic minorities. Margaret Mead observed that the paranoid personality in the Dobu minority in New Guinea seems to be an integral part of local culture. There is a relationship that cannot be ignored between cultural background and paranoid mental disorder (Xia Zhenyi, 1984).
(two) pathogenesis
The pathogenesis of paranoia, according to the Pavlovian school, believes that this disease is more common than strong and irreducible. The nervous system of this type has the characteristics of insufficient inhibition process and dominant process of excitement. At the time of setbacks, the nervous system's process of excitement is over-stressed, forming a pathologically inert excitatory foci in the cerebral cortex. This "isolated lesion" is associated with an abnormally strong emotional experience and intention, and because of its excitability is very strong, through negative induction The mechanism is widely suppressed around it, blocking the influence of other parts of the cerebral cortex, so the patient lacks criticism of his mental state, which is the origin of the system's delusion.
Prevention
Paranoia prevention
Human beings have taken an arduous course of 10 years in the prevention of mental illness. Many mental disorders can achieve the goal of cure through treatment and rehabilitation measures. Historically, schizophrenia, which is considered to have a poor prognosis, is in 20 In the mid-1980s, it was considered by social psychiatrists to be treatable (Syuzo Naka, 1985), but this is only a welcome but only a primitive beginning to explore at the level of social and clinical practice, due to psychiatry. The development of the whole medicine is relatively late, and because of the complexity of the basic theory of the profession, there are quite a few common mental diseases and the pathogenesis of the disease has not yet been elucidated. Coupled with the influence of the old concept, the cause of mental illness has been long-term It is considered to be mysterious and neglected, thus hindering the development of psychiatric prevention.
In fact, the mental illness of a person often affects the family and the collective, which inevitably affects labor production. Some patients will also add long-term burden to the society and even cause harm. Therefore, prevention of mental illness is not just medical science. An important topic in the work, but also an important task in the development of social culture and the management of social welfare. So far, the prevention of mental illness is basically in the exploratory stage, as far as the prevention based on modern natural science is perfect. The measures are still far from being recognized and mastered by people. However, it is worth emphasizing that it is precisely the ultimate goal of scientific prevention work to explore the causes and expose the inherent pathogenesis.
Complication
Paranoid complication Complications insomnia
Dizziness, palpitations, insomnia, fatigue, shortness of breath, laziness, numbness or numbness, pale or sallow, pale lips, fatigue, pale complexion, less bloating, loose stools, dizziness, women's menstrual flow Less, pale tongue, thin white fur, weak pulse. At the same time, due to the onset of mental illness, cognitive decline may occur, and accidental injury may occur.
Symptom
Paranoia symptoms, common symptoms, murder, delusion, illusion, exaggeration
The clinical features of paranoia are slow onset and systemic delusion as the main symptom. They begin to focus on victimization and then exaggerate delusions. These two delusions are mutually influential, mutual causal, accompanied by corresponding emotions and intentions. Activity, personality remains relatively complete, if the patient conceals the content, there is no difference with the normal person, the so-called system delusion, refers to the illusion based on some wrong judgments or pathological thinking related to the patient's personality defects, the structure of the paradox is hierarchical The reasoning process is clear, the reasoning process has certain logic, the content is not ridiculous, and some are closely related to the patient experience and situation, and give a new explanation according to the actual situation. The delusion is not generalized, and the disease is always illusory. The patient is convinced that it is difficult to follow the analysis and advice of others. Although it has been a long-lasting recession, Esquirol (1838) has proposed the term "monomania", which is clinically divided into the following types:
1. Litigious Paranoia: This is a more common type of paranoia. Patients think that they are persecuted, their reputations are defiled, their powers are violated, etc., and they cannot be resolved fairly. The madness is often intrinsically linked to the persecution idea. The patient's complaint is logical. The narration is detailed and hierarchical. There is no flaw in the words. If there is resistance during the proceedings, the patient does not retreat, but enhances it. Will win the determination, once the complaint is rejected by the court, take a roundabout response, do everything possible to publicize the world, request social solidarity, can be described as unyielding, fight for justice, lawsuit mad patients pre-disease personality is more conceited, sensitive, tough characteristics .
Case: Male, 57 years old, unmarried, middle school teacher, university education level, patient self-study, excellent grade in primary school, 13 years old into middle school, moved to the mainland with the school during the War of Resistance Against Japan, moved many times, life is more difficult, and at the same time The family lost contact. After graduating from high school, they were admitted to the Department of Economics of the XX University. They were reluctant, but they were calm, and they liked to study. They spent more time studying in the library, and had bad habits such as smoke-free wine. In the second year of college, they believed in communism. The doctrine of doctrine was arrested by the Kuomintang government and soon released. After liberation, he was transferred to the law department of a university in Beijing. At this time, he began to feel nervous, suspected that there was spy surveillance around him, and reflected to the school party committee. The leadership investigation was not a fact and was explained. Persuasion is ineffective, the patient firmly believes that there are special agents, and first of all think that a professor in the school is behind the scenes (the professor is a member of the Kuomintang).
Since he filed a complaint with the court, he was not accepted. From then on, he printed a leaflet and sent it to various places. Because he repeatedly complained about it and disturbed the social order, he was admitted to the hospital for treatment. After admission, the general performance was the same as that of a normal person, and his intelligence was good. There is no abnormality in memory and emotions. The patient actively contacts with the doctor and talks eloquently. It is easy to reveal systematic and solid victimization, sometimes involving related people. If the court does not accept it, the court believes that there are bad people in the court, denying the disease and resolutely Refusing treatment, his unfounded persecution and convictions, he was forced to be hospitalized, and he believed that the Public Security Bureau, the court and other units violated his personal freedom, and said that these units may be exploited by hidden enemies and bad people, and patients are discharged. After that, he continued to complain all over the place and demanded to openly hear it to the people of the whole country. He claimed to fight resolutely until his hair was white and his teeth were lost. He would never give up without victory. If he talked about something unrelated to this, it is normal. After more than 10 years of follow-up observation, The systematic victimization remains the same, the personality remains intact, and the body and laboratory tests are not abnormal.
2. Erotomania: The patient seems to be more common in women. The patient firmly believes that a certain man has a feeling of admiration for himself, but because of the objective situation, if both parties are married, or the age difference is large, the other partys social status is higher. I dare not publicly show the state of love, but use the eye-catching or flirting way to express my heart. When the patient is boldly tested and rejected by the other party, she is considered to be testing her loyalty, no regrets, and more convinced that her inference is correct. of.
3. Grandiose Paranoia: The patient is pretentious and talented. He claims to have amazing inventions or creations. He soon became the richest man in the country, or he was energetic, intelligent, and has a keen insight to foresee the future. Contemporary Zhuge Kongming.
4. Jealous Paranoia: The patient does not trust his spouse and thinks that he has a new love. The delusion is often accompanied by strong emotions and corresponding behaviors. When questioning the other party that they do not get a satisfactory answer, they often follow the trailing trail. Secretly check the spouse's bags and letters, and even limit their activities in daily life, and do not allow them to go out alone, especially on weekends or evenings. In severe cases, violence can occur.
Examine
Paranoid check
There is no specific inspection index in this disease laboratory.
Diagnosis
Paranoia diagnosis
Diagnostic criteria
Paranoia has unique clinical features. The paranoia diagnosis is based on systemic delusions as a prominent symptom. Its delusions are highly systematic, the content is relatively fixed, not absurd, no obvious illogical, clear themes, and have a certain relationship with the patient's situation. It is realistic. Without deep understanding, it is difficult to distinguish its authenticity. It is unshakable for at least 6 months. There is no hallucination in the content. The condition is prolonged, the social function is good, there is no mental decline, and the disease standard: at least lasts. 6 months (CCMD-2-R).
Differential diagnosis
The disease should be distinguished from the paranoid type of schizophrenia.
1. Paranoid schizophrenia: Schizophrenia is mainly based on primary delusion. The content is neither systematic nor absurd, and it is often implicated in a wide range of generalizations. There are often hallucinations, hunger concepts and other schizophrenia. The characteristics of the disease, the social function is seriously impaired, and the late stage of the disease often leads to mental decline.
2. Psychogenic paranoia: The disease is caused by the long-term existence of stressors or long-term difficulties, and the content of delusions is often related to the stressors, with realistic and easy to expose characteristics. In terms of prognosis, psychogenic delusions are clearly good.
3. Paranoid state: The delusion is not as systematic as the paranoia, the degree is lighter, and the prognosis is better.
4. Paranoid morbid personality: Although there are sensitive and suspicious personality characteristics, but do not form delusions, can be identified with paranoia.
