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Transferred from the contents of Dr. Xiaohe App's notes
"Science and technology are developing, new drugs, new treatment methods are also emerging, let us work together, find a suitable program for patients, never give up, never abandon, so that patients' conditions are improved, the quality of life is improved."
First, the first acquaintance with the patient
It was 8 years ago, when 18-year-old Xiaoying was brought to my clinic by her father, when she had been suffering from schizophrenia for four years, and she looked sluggish and had no spirit. Through a detailed medical history, I learned that Xiaoying's main clinical manifestations in the past 4 years of illness were verbal auditory hallucinations (hearing someone talking to her out of thin air), relationship delusions (suspecting that people around her were saying bad things about her behind her back), and suspicion of being monitored.
The family did not care at first, the symptoms appeared for half a year only the first time to see a doctor, had taken risperidone, quetiapine, zilasidone and other drugs in the past, at first the symptoms were well controlled, and then Xiaoying was admitted to a college, but then stopped the drug on its own, the condition became unstable, the symptoms fluctuated, could not insist on going to school, had to withdraw from school. After a psychiatric examination and psychological assessment, I found that she also had some manifestations of anxiety, depression, and compulsion.
Second, the patient's treatment process
Considering that Xiaoying's symptoms were more severe and predominantly positive, accompanied by some symptoms of anxiety, depression and compulsion, I adjusted her medication regimen (risperidone plus zilasidone), and the dose of zilasidone was slowly reduced to stop, and olanzapine system treatment was added. In addition, although the treatment effect of risperidone is good, it will cause hyperprolactinemia in young women (Xiaoying's prolactin value exceeds the standard by 5 times), causing side effects such as menopause. Considering that Xiaoying was a young girl, I slowly stopped risperidone and replaced her with aripiprazole. Aripiprazole does not have the side effect of hyperprolactinemia, and the combination of olanzapine in the treatment of auditory hallucinations is good. At the same time, I also asked her to take escitalopram to treat the symptoms of anxiety and depression. After the adjustment of the drug, Xiaoying's condition has improved significantly, the delusions have disappeared, a little auditory hallucination remains, and the anxiety and depression have slowly improved, but the obsessive-compulsive symptoms have not improved significantly. So I replaced escitalopram with fluvoxamine ( the drug of choice for the treatment of obsessive-compulsive symptoms ) .
I told Xiaoying:
To learn to coexist with auditory hallucinations, when you have auditory hallucinations, you tell yourself, "This sound is fake, just like I dreamed of hearing a voice, this sound is what I heard in my dream, don't care."
In this way, Xiaoying re-read the third year of high school with residual verbal auditory hallucinations, and her state became better and better, and she was admitted to the university undergraduate in the second year. In the four years of college, residual auditory hallucinations have always accompanied Xiaoying's study and life, but she insisted on taking medication on time, ignored the auditory hallucinations, reviewed them regularly, and finally successfully completed her studies and participated in the work. After Xiaoying worked, because the adverse reactions of taking olanzapine (easy to be sleepy) were more prominent, affecting the work, I helped her adjust the drug treatment plan again, reduced the amount of olanzapine, stopped aripiprazole, and added the new drug bunamserin, and the current program is olanzapine combined with bunamserine. Bunanserin has a good effect, there is no side effect of drowsiness, and Xiaoying's condition has been stable so far, and the auditory hallucinations have completely disappeared.
Third, the patient's precautions in treatment
1. Patients with schizophrenia must pay attention to taking medication on time and regular physical examination to do relevant laboratory examinations.
2. Family members should closely observe the changes in the condition, pay attention to the nutritional balance of the diet, and carry out aerobic exercise appropriately. Most importantly, when symptoms fluctuate, you must contact the doctor for follow-up consultation in time so that the drug treatment plan can be adjusted in time.
3. Spring is the season when schizophrenia is most prone to recurrence. If it is found that there is a seasonal pattern of the patient's onset, increasing the dose of the drug in advance can better control the disease. In addition, it is also necessary to pay close attention to whether the patient has insomnia, emotional instability, abnormal behavior and other precursors of recurrence.
4. Patients with schizophrenia often need long-term systematic and standardized drug treatment, and the principles of drug treatment are as follows: single medication is necessary to combine drugs, small doses begin to increase slowly, sufficient sufficient course of treatment, drug reduction should be slow and not fast, it is strictly forbidden to stop the drug by yourself, and it is necessary to follow up regularly. To improve the patient's medication compliance, the family should pay a lot, and usually pay attention to observe the change of the condition.
Fourth, the patient's treatment effect
Xiaoying is a patient with more prominent positive symptoms such as hallucinations and delusions, according to the characteristics of her condition, I have helped her adjust the drug many times, and selected olanzapine combined aripiprazole, which has better treatment of positive symptoms; for anxiety and depression and obsessive-compulsive symptoms, escitalopram and fluvoxamine have been selected successively. Escitalopram has a good effect on anxiety and depression, and fluvoxamine has a good effect on obsessive-compulsive symptoms, and these two drugs have the advantages of good efficacy and small adverse reactions. The patient recovered better, was admitted to university, successfully graduated and joined the work force.
After joining the work, Xiaoying was not confident enough in interpersonal communication, and the work was not a major she was good at, so the work pressure was very high. In order to prevent the recurrence of Xiaoying's illness, I gave her systematic psychotherapy, starting from the perspective of personality growth, helping her to cultivate correct cognitive patterns and sound personality, and teaching her to look at problems positively and optimistically. After a period of treatment, she felt better and better! I plan to continue to implement drug combination psychotherapy in the next step to help her successfully pass the two key levels of life: marriage and fertility.
V. Precautions for patients in their daily lives
1. Family members should usually try to provide necessary support to patients, communicate with patients more, improve patients' ability to cope with adverse events, and avoid the stimulation of adverse events. Pay attention to careful observation, and when patients are found to have adverse reactions, they should contact the doctor for follow-up consultation in time for drug adjustment. The change of seasons is especially like the late winter and early spring when the patient's condition is prone to fluctuations, and it is necessary to follow up in time.
2. Patients with schizophrenia often have various adverse drug reactions because they take antipsychotic drugs for many years. Take obesity, for example. Therefore, patients need to properly control their diet and strengthen physical exercise. You can choose some physical activities suitable for schizophrenics, such as baduanjin, tai chi, swimming, walking and other aerobic exercises.
3. The magic weapon for the rehabilitation of mental illness: drug treatment, psychological treatment, family care, self-growth, animal companionship, and more self-adjustment and growth.
Sixth, the doctor's understanding
1. The treatment of schizophrenia should follow the principles of early detection, early diagnosis and early treatment
Xiaoying only went to the doctor for half a year after the onset of illness, which can be said to be some delay in the condition. Early detection, early diagnosis, early treatment, the prognosis of patients will be much better. As a family member, how do you identify the early manifestations of schizophrenia? In general, patients with schizophrenia have the following changes in the early stages of the disease:
(1) Mood changes: depression, anxiety, mood swings, irritability, etc.;
(2) Cognitive changes: suspicious and sensitive, some strange and abnormal ideas and concepts, learning or work ability to decline, etc.;
(3) Personality change: Compared with before, if the two people are judged, lonely, treat others coldly, and have indifferent family affection;
(4) Behavioral changes: such as withdrawal or loss of interest in social activities, poor personal hygiene, and a decrease in the level of social functioning;
(5) Physical changes: changes in sleep and appetite, fatigue, decreased activity and motivation, etc.
In my clinical work, I often encounter patients who have been ill for several years, and who have been treated repeatedly in general hospitals and have not been cured, and finally come to the psychiatric department for treatment. In this long process of medical treatment, it not only delays the treatment of patients, but also causes the waste of time, money and energy of the family, which is really not worth the loss. The reason is mostly because the family does not know that the patient has a mental illness and needs to see a psychiatrist; some family members have a misunderstanding of the psychiatric department and feel that it will be laughed at by people to see the psychiatric department. These lack of knowledge and backward views need to be corrected gradually. It is believed that with the improvement of social civilization, people will be more and more able to look at schizophrenia patients more and more rationally, and family members will eliminate the sense of shame.
In general, the earlier the diagnosis and the earlier the drug is used, the better the recovery effect and the higher the recovery rate; conversely, the longer the onset time and the later the doctor, the worse the recovery and the lower the cure rate. Therefore, learning more about mental health and coming to the doctor in time is the best choice for patients and their families. I hope that our doctors and patients will work together to educate and popularize the knowledge related to psychiatric diseases more early and earlier.
2. Systematic drug therapy is the key to rehabilitation
When a patient is diagnosed, medication is generally essential. However, when the disease was controlled, many patients and their families stopped the drug privately, and the results could be imagined, and the patient quickly relapsed. Why? Because mental illness such as schizophrenia requires long-term drug maintenance treatment, discontinuation or reduction of drugs requires professional doctors to make adjustments through judgment of the patient's condition, and patients and their families generally do not have this ability.
When I was in the outpatient clinic, I often encountered patients with schizophrenia who had been ill for decades, did not need to be accompanied by family members, came to prescribe medicine by myself, my mental state was very good at a glance, I could do housework, and I did a good job at work. Through communicating with them, I came to the conclusion that adhering to long-term medication as prescribed by the doctor is a key factor in ensuring the physical and mental health of patients! Almost all patients who recover well are patients with good medication compliance, and those with poor medication adherence tend to have a poor mental state and often relapse.
Systematic drug treatment includes: take the drug for a long time and dose enough. Efficacy is assessed periodically by the doctor and, if necessary, the treatment regimen is adjusted: in addition, dressing change, or combination of medications. After recovery, it is still necessary to continue to take drugs for a period of time to prevent recurrence, and the specific time should be based on the diagnosis of the patient, and the previous incidence of the disease should be recommended by the attending doctor.
In general, schizophrenia and bipolar disorder should be taken for a long time. It is not advisable to reduce or discontinue the drug at will, and it is also not advisable to change the drug at will. In addition, there are some family members who pursue the thoroughness of the curative effect and hope to completely eliminate the symptoms, so they take multi-drug super-large dose combination therapy, resulting in serious drug side effects in patients, which is really not worth the loss. Science and technology are developing, new drugs, new treatment methods are also emerging, let us work together, find a suitable program for patients, never give up, never abandon, so that patients' conditions are improved, quality of life is improved.
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