Name: 精神分裂症 - 原因、症狀、診斷、治療和病理。 (Schizophrenia - causes, symptoms, diagnosis, treatment & pathology)
Uploaded: 2021-01-14T07:28:12.000Z
Duration: 8 min 15 s
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Schizo means split, and phrenia, in this case
refers to the mind.

程度副詞

Even though schizophrenia can be interpreted
to mean “splitting of the mind”, it does

情態助動詞 B1

not refer to a split personality, like some
media sources might portray, but rather schizophrenia

describes a scattered or fragmented pattern
of thinking.

Schizophrenia's actually a syndrome, meaning
there're all sorts of symptoms that might

be associated with it and different patients
might experience different symptoms, although

the symptoms can be broadly categorized into
three major areas: positive symptoms, negative

Alright taking a step back, most human symptoms
from any illness are extreme versions of a

normal physiologic process (for example everyone
has a heartbeat and tachycardia is a fast

heartbeat, everyone has a normal body temperature,
but during a fever that temperature is higher).

In schizophrenia, patients have positive symptoms
which aren't positive in the sense that

they're helpful, but positive in the sense
that they're some new feature that doesn't

have some “normal” or physiologic counterpart.

These are the psychotic symptoms, so delusions,
hallucinations, disorganized speech, and disorganized

or catatonic behavior; none of which occur
physiologically.

Delusions are false beliefs that the patient
might feel very strongly about, so much so

that they won't change their mind, even
if you give them evidence against it.

There are all sorts of different delusions,
like, for example, a delusion of control,

where somebody thinks that some outside force
or person or thing is controlling their actions.

They could also be delusions of reference,
where someone might think that insignificant

remarks are directed at them, like a newscaster
is speaking directly to them through the TV.

Hallucinations are a second type of positive
symptom, and can be any kind of sensation

that's not actually there, including visual
but also including auditory sensations, like

A third type is disorganized speech An example
being something like a “word salad”, which

seems like just a random jumbling of words
or phrases, like “pencil dog hat coffee

Disorganized behavior on the other hand could
be like if they exhibit bizarre or silly behavior

that's out of context and doesn't seem
to have much of a purpose, like for example

wearing multiple layers of jackets on a hot
summer day.

Also sometimes the behavior is described as
“catatonic”, which has to do with their

So like they might be super resistant to moving,
or be in an unresponsive stupor.

Negative symptoms, are like when there's
this reduction or removal of normal processes,

and this is like a decrease in emotions they
can express, or a loss of interest in things

One type of a negative symptom is called flat
affect, where they don't respond with an

emotion or reaction that would seem appropriate,
like if they saw something very unexpected

like a small monkey playing in their living
room, they might simply sit and watch idly

Another type is alogia, or poverty of speech,
which is a lack of content in speech, so like

if somebody asked them “do you have any
children?”, they might respond with “yes”,

instead of “yes, one boy and two girls”.

A third type of negative symptom is avolition,
which is this decrease in motivation to complete

certain goals, so someone might stay at home
for long periods of time, without trying to

Cognitive symptoms include things like not
being able to remember things, learn new things,

These symptoms are more subtle though, and
more difficult to notice and might only be

detected if they have really specific tests
performed.

An example might be somebody not being able
to keep track of several things at once, like

People with schizophrenia seem to cycle through
three phases, typically in order.

During the prodromal phase, patients might
become withdrawn and spend most of their time

alone, and often this seems similar to other
mental disorders like depression or anxiety

During the active phase, patients experience
more severe symptoms like delusions, hallucinations,

disorganized speech, disorganized behavior,
or catatonic behavior.

Following an active phase, patients often
enter into a residual phase, where they might

exhibit cognitive symptoms like not being
able to concentrate or becoming withdrawn

For an official diagnosis of schizophrenia,
patients need to be diagnosed with two of

the following symptoms—Delusions, hallucinations,
disorganized speech, disorganized behavior

or catatonic behavior, or negative symptoms,
and at least one of them has to be either

delusions, hallucinations, or disorganized
speech, So basically they couldn't have

just disorganized behavior and negative symptoms.

Even though some patients have cognitive symptoms
as well, they aren't specifically needed

Also though, for a diagnosis, signs of these
disturbances must be ongoing for at least

6 months, meaning they're likely in one
phase or another for 6 months, but there must

be at least one month of active-phase symptoms.

And finally, those symptoms can't be attributable
to another condition, like substance abuse.

Now that we've diagnosed it...why does it
even happen in the first place?

Well we don't really know, since it seems
like the signs and symptoms of schizophrenia

are pretty unique to humans, or at least they're
hard to imagine or notice in animal models

One clue is that the majority of antipsychotic
medications that improve schizophrenia symptoms

block the dopamine receptor D2, which reduces
dopamine levels in neurons.

This suggests that maybe schizophrenia has
something to do with increased levels of dopamine.

These medications, though, are neither universally
nor completely effective, and don't work

for everyone with schizophrenia, which adds
to the confusion and means there's probably

Interestingly, one of the most effective antipsychotic
drugs, clozapine, is a weak D2 antagonist,

suggesting that other neurotransmitter systems
like norepinephrine, serotonin, and GABA are

Twin studies have shown support for a genetic
basis as well, even though there haven't

been any specific genes conclusively linked
to schizophrenia yet.

Also, environmental factors, like early or
prenatal exposure to infection, and certain

autoimmune disorders like celiac disease have
been linked with schizophrenia.

Finally, another important set of clues involves
the epidemiology, schizophrenia seems to happen

slightly more in men than women, with onset
in the mid-twenties for men but late-twenties

for women; and the clinical signs of schizophrenia
are often less severe.

Some studies suggest this difference might
be due to an estrogen regulation of dopamine

There doesn't, however, seem to be any differences
among race.

Now treating schizophrenia can be really tricky,
and antipsychotic medications are often used,

but it's super important to combine the
efforts of several clinicians and health professionals,

including professionals in therapy or counseling,
medicine, and psychopharmacology.