Schizophrenia

2019年3月30日

定义

Article updated andreviewed by Christos Ballas, MD, Attenting Psychiatrist, Inpatient and Consult/Liaison Psychiatry, Hospital of the University of Pennsylvania. Editorial review provided by VeriMed Healthcare Network on May 11, 2005.

精神分裂症是一种严重的精神障碍，其特征是两种症状;积极的精神病症状 - 思想障碍，幻觉，妄想和偏执狂 - 以及消极症状 - 情绪范围，能源和活动享受的障碍。对于正式诊断，这些症状必须持续至少一个月，通常会导致工作和/或社会运作的严重损害。

描述

精神分裂症是一种特殊的精神病形式，该术语包括几种严重的精神障碍，导致与现实的接触丧失以及主要的人格紊乱。

The illness can be described as a collection of particular symptoms that usually fall into four basic categories: formal thought disorder, perception disorder, feeling/emotional disturbance, and behavior disorders.

正式的思想障碍。精神分裂症患者描述奇怪或不懈alistic thoughts. In many instances, their speech is hard to follow due to disordered thinking. Common forms of thought disorder include circumstantiality (talking in circles around the issue), looseness of associations (moving from one topic to the next without any logical connection between them), and tangentiality (moving from one topic to another where the logical connection is visible, but not relevant to the issue at hand).

Many schizophrenics feel they possess extraordinary powers, superhuman strength, or superior insights. They may believe that their thoughts are being controlled by others or are being broadcast over the public airways, or that outside thoughts are being implanted in their heads. When such ideas are persistent, organized, and maintained in spite of evidence to the contrary, they are called delusions.

感知障碍。那些有精神分裂症的人经常报告不寻常的感官经验，特别是当疾病处于急性阶段时。最常见的经验是听力声音的形式，或听觉幻觉。

人员可以听到一两个（有时更多）声音对其行为进行评论。他们可能不知道声音，或者他们可能相信这是上帝的声音，魔鬼或朋友或亲戚。重要的是，这些声音被认为是真实的或来自个人外部的，而不是自己的声音或良心。遇到这些幻觉的人往往是为了安静或消除声音来表现行为或习惯。典型的例子正在打开收音机或电视以静态，以淹没声音。

Feeling/Emotional Disturbance.有精神分裂症的人可能表现出平坦或受限制的影响。这意味着它们不会在情绪上对通常引起某种感觉的事件进行响应。例如，它们并不展示悲伤，幸福或幽默的感觉，尽管他们可能能够理解这些事情应该是悲伤，快乐或有趣。他们的面部表情和声乐语调仍然是相同的，无论它们周围发生了什么。情绪骚乱经常导致社会退出。有精神分裂症的人经常避免与朋友联系，对日常生活和活动失去兴趣。这次撤销往往导致该人的生活质量的重大损害，并且可以导致从学校开除或从工作中解雇的人。

Behavior disorders.Certain forms of schizophrenia are associated with particular movements or behaviors. Lack of blinking and repetitive movements can be seen. Catatonic behavior, where the person appears frozen and motionless, can also be observed. Though catatonia is a symptom of schizophrenia, it often requires a different class of medications—benzodiazepines—which are not routinely used in schizophrenia.

Causes

研究人员怀疑精神分裂症的生物学（遗传或环境）基础，可能在调节思想和情绪的脑化学品中可能存在不平衡。兄弟姐妹或精神分裂症的父母增加了一个人将具有疾病的可能性。

精神分裂症通常在晚期的青春期到20多岁的女性中的20多岁的起点。

Symptoms

There are an array of symptoms associated with schizophrenia. The first signs are usually disruption in one's social and family relationships - withdrawing into oneself and developing illogical thought processes. This is followed by slow deterioration in other areas, such as the ability to perform in school or at work, and finally, to care for oneself. Additionally, the person may experience delusions, hallucinations, and disorganized or altered speech.

诊断

诊断基于患者的临床历史和呈现。它还基于统治精神疾病的有机原因，例如药物或有毒物质的影响，或脑肿瘤，梅毒或感染等神经系统问题。

Treatment

精神分裂症的患者通常不会响应治疗或仅部分改善并保持功能损害。虽然已经发现药物治疗疾病的“阳性”症状有效，但治疗抑郁症的“消极症状”（包括缺乏能量，动机和情绪范围）历史上没有非常成功。在近25％的那些患者中，这种情况对于他们需要保管护理的神经抑制药物治疗是如此难治。

精神分裂症患者的精神病复发预防是一种主要的长期临床目标。精神病剧集的持续时间预测复发的风险。一年多一年以上的精神病的患者比不到一年的人更频繁地再次复发。神经抑制药物治疗大大缩短了精神病发作。

抗精神病药物，也称为神经抑制因素，对精神分裂症的管理至关重要。除氯氮平（Clozaril）外，所有抗精神病药体总体上都有同样有效。已知称为“典型”抗精神病药的较旧的药物通常具有比新的“非典型的”抗精神病学更严重的副作用，特别是震颤，躁动和肌肉痉挛等蛋白质症状。

Atypical antipsychotic medications include risperidone (Risperdal), olanzapine (Zyprexa), ziprasidone (Geodon), quetiapine (Seroquel), and aripiprazole (Abilify). Typical antipsychotic mediations include haloperidol, chlorpromazine, thioridazine (Mellaril), trifluoperazine (Stelazine), and thiothixene (Navane).

Clozapine (Clozaril) has been shown to be more effective than any other treatment for schizophrenia, especially in refractory cases. It is effective for both positive and negative symptoms of the disease and has a low incidence of extrapyramidal side effects. However because of the risk of agranulocytosis, a disorder of suppressed white blood cells, it is rarely used as a first line agent.

As compliance with daily medication is an obstacle to care in schizophrenia, there are several long acting forms of antipsychotic medication that only have to be administered every week or every few weeks. Some of these long term medications include haloperidol deconate (Haldol Decanoate), fluphenazine deconate (Prolixin Decanoate), and Risperdal Consta.

其他药物包括锂和苯二氮卓类药物。单独的锂迫使诱导精神病缓解后的神经抑制剂。