Psychiatric disorder is one of the most complex psychiatric diseases, and its complexity is not only reflected in the unknown biological mechanism, but also in its varied clinical manifestations. Although we have made many gratifying advances in the field of psychiatric research in recent years, none of the thousands of biomarkers found in research so far can be applied in clinical practice. At present, the diagnosis of mental illness still depends on the clinical observation of doctors.
This article will focus on explaining the common mental disordersPositive and negative symptomsI hope to help everyone better understand the performance of "yin" and "yang", help patients and their families identify relevant symptoms earlier, and avoid unnecessary misdiagnosis and delay.
Highlights:Due to the complexity of mental illness, this article will involve more professional terms, in order to better digest the knowledge points of this article, please read the relevant reading at the end of the article as appropriate. ）
** process
Psychosis is a group of severe mental disorders that are abnormal in perception, thinking, emotion, behavior, and cognition, and are mainly characterized by impairment of reality checking ability and corresponding behavioral changes.
Reality check capabilities, refers to the ability to distinguish subjective experience from objective reality, the ability to test one's own perception and perception with objective reality;When a person's perceptions and perceptions contradict the external reality, the person is able to respect the reality instead of clinging to his own ability to distort cognition. Put simply, it is the ability to distinguish between what is real and what is not, and the ability to accurately interpret and respond to external stimuli. This is an important criterion for distinguishing normal people from people with severe mental disorders.
About 20% of patients with mental illness have only one acute episode in their lifetime after timely standardization**;Less than 20% of patients have refractory psychosis at the first onset.
Most patientsIt presents a chronic, recurrent course, and typically a prodromal period of several months to years from adolescence, followed by an exacerbation of psychotic symptoms and an acute attack. After **, the psychotic symptoms gradually resolve, and most patients may have symptoms for various reasons until the chronic phase or residual symptom phase (Figure 1).
Patients may have different dimensions of symptom clusters in the acute phase, including negative symptoms, positive symptoms, cognitive symptoms, affective symptoms, and psychomotor symptoms.
Fig. 1 Disease process of psychiatric disorders.
Common negative symptoms
Negative symptoms, referred toReduction or absence of normal behaviors related to motivation, interest, or expression, usually already present in the prodromal phase of psychosis. Although patients do not usually present for negative symptoms, butStudies have found that negative symptoms are one of the most common presenting symptoms of psychosis
The following five are common negative symptoms.
Hypovolition (most common).
Due to a lack of motivation, the patient's ability to initiate or maintain goal-directed activities decreases. It is manifested by a decrease in subjective desires, interests, and goals, as well as a decrease in autonomous and intentional behavior. Patients may be content with the status quo, have nothing to do, have no plans for the future, no pursuits, lack of concern, and neglect to take care of personal hygiene.
Anhedonia (most common).
Patients lack a pleasurable experience with a range of activities or events. This includes a lack of pleasure during an activity or event, such as playing a game you once loved, such as playing a sport you once loved, skiing, or practicing a musical instrumentand a lack of pleasure in participating in future activities or events, such as the idea of a long-awaited destination that is boring and indifferent.
Emotional bland and sluggish
The patient's emotional expression and reaction to events are reduced, which is reflected in facial expressions, language and posture, which appear wooden and dull.
Lack of socialization
Due to the lack of motivation or interest in forming and maintaining interpersonal relationships, patients do not socialize with family members and friends, and do not actively participate in social activities. Appears indifferent to family members, who sometimes feel that the patient has become selfish and self-conscious.
Poverty of speech
Patients present with a marked decrease in the volume of speech and spontaneous expression.
Common misunderstanding] My child is introverted and timid, and does not like to socialize, does he have mental illness?
Not necessarily. Evaluation of negative symptoms is clinically challenging, as they are more difficult to distinguish than positive symptoms. Therefore, long-term observation is required to make a longitudinal comparison with the patient's previous conditionIt is also necessary to make a horizontal comparison with people of the same age and living environment in order to draw a conclusion about negative symptoms.
Common positive symptoms
Positive symptoms refer to the presence of some symptomsDidn't have it before the illnessAbnormal perceptions, feelings, and behaviors。Positive symptoms are more likely to be detected by those around them than negative symptoms. Patients may present with illogical and inverted speech.
Fourth, the content is ridiculous, or laughing at oneself and acting strangely.
The following three categories are the most commonly observed positive symptoms.
01丨Hallucination
The most common type of psychosis is auditory hallucinations, also known as auditory hallucinations. Normal people may also have occasional auditory hallucinations, which can be non-verbal, such as insects chirping, bird chirping, machine rumbling, etc.;It can also be verbal, such as hearing someone shouting their name. This kind of monotonous auditory hallucinations has little clinical significance.
Patients with mental illness often have persistent symptoms in a state of clear consciousnessCritical, argumentative, or imperative auditory hallucinations。Verbal auditory hallucinations with a certain frequency and intensity are diagnostic. It is important to note that the risk of suicide and impulsivity must be assessed when the patient has command auditory hallucinations, as the patient may act in accordance with the auditory hallucinations and even hurt others and themselves. Sometimes auditory hallucinations are heard in the patient's subjective space, such as in the brain or stomach, and not through the ears, which is called "pseudoauditory hallucination" and is also a common symptom of psychosis.
Common misconceptions: I hear someone talking to me, but I can't see them, am I mentally ill?
Not necessarily. Clinically diagnostic auditory hallucinations include commentary (auditory hallucinations evaluate the patient's behavior), argumentative (auditory hallucinations arguing with each other and arguing around the patient), or commanding (auditory hallucinations commanding the patient to do something). Doctors also need to assess the frequency of auditory hallucinations, which must last almost every day for more than 1 month to be more diagnostic. In addition, the patient's level of knowledge and belief in auditory hallucinations also influences the diagnosis, and the patient is very confident in the content of the auditory hallucinations and will act according to the auditory hallucinations, which often points to more severe symptoms.
丨Delusional
Delusion is one of the most frequent symptoms of mental illness, and its manifestations are diverse, with the content of victimization, relationship, special significance, exaggeration, love, and non-ancestry. The delusional content may be related to the patient's life experience, education level, and cultural background. Persistent bizarre or unbelievable delusions (culturally inappropriate and impossible) on the basis of clarity of consciousness, such as superpowers to control the weather and being able to be read directly by others, often suggest a diagnosis of psychosis.
Common Myth] I feel that someone is targeting me, is this delusional?
Not necessarily. The three characteristics of delusions are:
Self-involvement: The content of delusions is all self-centered. For example, this organization is trying to kill me, and there are electronic devices controlling me.
Personal: Delusions are distorted, irrational beliefs that are unique to an individual and are often not accepted by other members of the culture group or subculture in which they are located. For example, I firmly believe that everyone who walks to the ** is watched, and the people around me don't think so.
Convinced: The patient does not accept factual and rational correction, and has a firm belief or certainty. Even if there is enough evidence to point to the irrationality of the belief, the patient is still unshakable. For example, after searching the whole house and not finding a single camera, I still believe that I am being watched at all times.
Therefore, the evaluation of delusions needs to be evaluated in the context of the individual's cultural background and the logical reasoning process, if the belief does not involve the self, or if there are two or more individuals in the same context who have similar beliefs, or if the individual does not believe in it, it is not enough to judge the belief as delusional.
03丨Thinking disorder
It mainly refers to the obvious disturbance of the thinking form or thinking logic of the verbal expression, which can be observed through the patient's speech and written content. Thought form disorder can be manifested as loose thinking, broken thinking, mixed words, etc.;Thinking logic disorders can be manifested as new words, logical inverted thinking, pathological symbolic thinking, etc. The occurrence of the above-mentioned typical thinking forms and logic disorders is of great significance for the diagnosis of psychosis.
Examples of disordered thinking].
Loose thinking: The patient's thinking activities appear to be loose and scattered, and it is very difficult to talk to them, and the speech is obscure. It seems to be answering your question, and it is as if "answering the wrong question". There is a lack of connection between what is spoken or written, between one paragraph and the next.
Broken thinking: Individual sentences are grammatically correct in structure, but lack the coherence and logic they deserve, and there is a lack of connection between one sentence and the next, and others cannot understand their meaning. Word clutter is a serious breakdown in thinking, which refers to the lack of coherence and logic between individual sentences, and the speech is more fragmented.
A new work of words: The patient creates some strange words, symbols, graphics or language and gives them a special meaning that others cannot understand. For example, "%" stands for "divorce".
The "** of psychosis is reflected in the separation of the world perceived by the patient's brain from the real world, and also in the fact that the patient has significantly different negative and positive symptoms at the same time. However, a special reminder is neededEven if there are positive symptoms and negative symptoms, it does not necessarily point to mental illnessIt may be a mental or physical illness, or even just an anomaly in a specific situation
The diagnosis of psychiatry is not based on ** and pathogenesis, but a descriptive and phenomenological diagnosis, which is made based on the patient's performance, the observation of an insider, the development of the disease, and the impairment of function. Doctors give a diagnosis of mental illness after close observation, with reference to complex diagnostic criteria, and careful consideration.
In the past few decades, people with mental illness and their families have endured tremendous discrimination and prejudice from all walks of life. Although the pathogenesis is unknown, psychiatric disorders are inherently chronic, as are other psychiatric disorders (eg, anxiety, depression) and certain medical conditions (eg, hypertension, diabetes).
If all walks of life look at mental illness scientifically and objectively with the attitude of ordinary chronic diseases, encourage patients and their families to go to professional hospitals for evaluation in a timely manner, and patients and their families no longer talk about disease discoloration, shame on illness, and avoid medical treatment, then they will be able to bridge the broken spiritual world and pick up the warm and quiet daily life through early detection, timely intervention, and systematic means.