Adolescent schizophrenia

Introduction to youthful schizophrenia Adolescent schizophrenia occurs mostly in adolescence, and the onset can be urgent. The onset of the disease is relatively early, and the onset is generally slow. The rapid onset of the disease, the development of the disease is faster, in a short period of time can reach a serious degree. After the onset, the patient gradually shows solitude and emotional instability. As the disease progresses, many psychological or mental disorders may occur. basic knowledge The proportion of illness: 0.005%-0.008% Susceptible people: no specific population Mode of infection: non-infectious complication:

Causes of youthful schizophrenia

1. Genetic factors

According to the survey, the prevalence among relatives of schizophrenia patients is much higher than that of the general population. Moreover, the closer the blood relationship to the patient, the higher the prevalence. If both parents are schizophrenia, the incidence of their children will reach 35% to 68%; while one parent is schizophrenia, the incidence of children is also 15% to 26%; even children of schizophrenia Family members who have been fostered in mental health since childhood have a much higher incidence than those who have no family history. However, the inheritance of schizophrenia is quite complicated. At present, it is relatively unanimous that schizophrenia is a polygenic inheritance caused by the accumulation of many genes.

2, personality factors

A large number of survey reports show that about 50% to 60% of schizophrenia patients have some special personality characteristics before or during their illness, such as loneliness, introversion, shyness, sensitivity, suspiciousness, fear of strangers, and lack of relatives. Family, unwilling to play with children of the same age, but often close to the old man, sometimes there are some strange movements and strange postures, lack of logic in thinking, good fantasy, poor initiative, strong dependence, timid, hesitating . Sometimes inexplicably go out and wait. Some experts call this personality: a split personality.

3. Endocrine factors

Since most of the schizophrenia begins in the stage of sexual maturity before and after puberty, some scholars believe that the disease has a certain relationship with endocrine.

4, the virus

Some experts believe that schizophrenia is caused by viral infection. It has been reported that virus-like substances have been found in cerebrospinal fluid cell cultures in some patients with schizophrenia.

5. Social factors

The survey found that the prevalence of schizophrenia is higher in people with lower social levels, and its ratio to high-level population is about 9:1. It is speculated that this may be closely related to the poor physical environment of life, the psychological burden caused by economic difficulties, and the social stress.

Youth schizophrenia prevention

1, elderly patients or poor digestion should be given easy to digest food.

2. Patients who are religiously motivated and have a dietary preference should try to meet their needs, and those who are overly picky may not make it.

3, for overeating patients, the temperature of the food should be appropriate, remove the bone spurs when eating fish and appropriately limit the patient's food intake.

4, for patients who are guilty of sin, you can stir the food together, which is mistaken for leftovers to achieve the purpose of eating.

5, severe reactions to food, dysphagia can be given a liquid or semi-liquid diet, eating slowly, to urge, to prevent foraging.

6. Patients who insist on not eating and eating disorders should ensure adequate nutrition and water intake, and try to understand the causes of eating disorders, persuade, and assist in eating. Nasal feeding is given when it is not effective, and the nasal feeding solution can be made into a mixture rich in various nutrients. Such as milk plus broth, vegetable juice, juice and so on. If necessary, follow the doctor's advice to give fluid replacement.

7, patients with stupor schizophrenia sometimes quietly get up in the dead of night to eat automatically, so the food should be placed next to the patient's bed, convenient to eat automatically, the nursing staff should avoid the line of sight.

Adolescent schizophrenia complications Complication

There may be symptoms such as affective disorder, speech and thinking disorder, perceptual disorder, abnormal movement and behavior, and activity disorder.

Symptoms of youthful schizophrenia Common symptoms Victims of paranoia, paranoia, persecution, suspicion of being stolen or suspected

1, Lenovo barriers

Lenovo is loose and fragmented, making people feel unintelligible. Normal thinking suddenly stops or a lot of mandatory thinking emerges. The thinking association is poor and empty. Talking with people reduces speech, repeats some monotonous sentences, or full text only repeats a meaningless question.

2, affective disorder

Affective disorder is the basic symptom of this disease. In the acute phase of the disease, the patient's emotions can be dramatically changed without cause, which is a strong reaction caused by hallucinations and delusions. Excitement, excitement, nervousness, fear, anxiety, depression. Suddenly crying, suddenly laughing, suddenly furious and so on.

3. Will behavior disorder

It is manifested as not interested in outside things, often meditation, life lazy, not trimming margins; or creating contradictory intentions, doing anything is hesitant.

4, rich in illusion

Patients can often experience auditory hallucinations, visual hallucinations, touch illusions, taste hallucinations, olfactory hallucinations, etc., while the consciousness is completely awake. The illusion content is bizarre and varied.

5. Self-consciousness disorder

This is also a common symptom of this disease. For example, Xu Qiang in the above example sent himself a fax and asked himself to return from another place. It is a manifestation of the obstacle of self-consciousness. He believes that some part of his body or the whole body does not exist or does not belong to himself, and he is in another place. Self-consciousness can also be expressed as a second-person tone to describe one's own experience, or that you have split into two, and the two parts talk to each other in your mind.

6, attention to distraction

In the early stage of the onset, the patient is indifferent to daily life, and his work, study, and life are rude, and he is absent-minded.

7, logical process obstacles

In the process of thinking, patients can't analyze problems according to the normal logic of thinking, showing conceptual confusion and some strange logical reasoning.

8, delusion

It is a manifestation of a serious mental disorder. There is a pathological concept out of thin air.

Examination of youthful schizophrenia

There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.

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.

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.

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.

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.

(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. 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 and diagnosis 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).

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