思觉失调
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| 此{{#if:|{{#ifeq:none|left|章节|条目或其章节}}}}{{#if:|具有{{{reason}}}的问题，}}需要精通或熟悉{{#if:医学|医学{{#if:|、[[]]{{#if:|、[[]]}}}}|相关主题}}的编者参与及协助编辑。 (2022年4月11日) |
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| main = | other | #default = 使用医学模板含有多种参数的页面 }}}} 思觉失调（英语：Early Psychosis）<ref>Smart Patient Website - Early Psychosis. www21.ha.org.hk. [2022-10-12]. （原始内容存档于2022-10-14）.</ref><ref>Schizophrenia中文译名由“精神分裂症”更名为“精神分裂症”的历史轨迹。. pinsoul. [2022-10-13]. （原始内容存档于2022-10-15） （en-US）.</ref>是医学术语<ref>思觉失调 | 常见精神疾病 | 思健医务中心. 思健医务中心 HealthyMind. [2022-10-12]. （原始内容存档于2022-10-13） （中文）.</ref><ref>105年7月68期 - 国军高雄总医院-院刊内容.{{#switch:¬
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}}{{#if:|}}</ref>，是心智的异常状态，为精神病（英语：Psychosis）<ref>psychosis - 精神病. terms.naer.edu.tw. [2022-10-16]. （原始内容存档于2022-10-16）.</ref>的早期。描述一个人与现实失去联系<ref name="NIH2018QA">RAISE Questions and Answers. NIMH. [2020-04-24]. （原始内容存档于2019-10-08）.</ref>，属于精神分裂症（英语：Schizophrenia）的症状之一。但是一个人出现了思觉失调的症状，不一定是精神分裂症。换句话说，一个人也可能在不是精神分裂症的情况下经历思觉失调的症状<ref>Psychosis vs. Schizophrenia: Understanding the Difference. Healthline. 2022-01-26 [2022-10-12]. （原始内容存档于2022-10-16） （English）.</ref>。此外，如一个人经历思觉失调的症状，但持续时间少于一个月，会被诊断为“短暂性／急性思觉失调”(Acute schizophrenia-like psychotic disorder)。<ref>ICD-10 Version:2019. icd.who.int. [2023-09-23]. （原始内容存档于2020-03-31）.</ref><ref>Limited, Digital Candy Hong Kong. 什么是思觉失调？. Mind HK. [2023-09-23]. （原始内容存档于2023-10-03） （中文（繁体））.</ref><ref>Henderson, Dr Roger. Everything you need to know about schizophrenia. Netdoctor. 2020-04-28 [2023-09-23] （British English）.</ref>
思觉失调主要症状：
- 幻听、幻觉<ref name="HVM001">【 请使用“听声”取代“幻听”，避免污名化 】. [2022-10-13]. （原始内容存档于2022-07-07） （中文（台湾））.</ref> – 听声者听到、看到或感觉到身旁者没有听到、看到或感觉到的事情。
- 妄想 – 在现实环境中无充分的依据，且不被他人认同的强烈信念。
- 其他病征还有语无伦次及不合时宜的行为举止。
思觉失调有许多可能的成因，包含：
- 精神疾患。
- 药物滥用。
- 睡眠剥夺。
- 某些身体疾病等情况<ref name="NIH2018QA" /><ref name="NHS2020-C">Psychosis - Causes. NHS. [2020-04-24]. （原始内容存档于2021-01-26）.</ref>。
治疗包含：
- 抗精神病药。
- 心理咨商。
- 社会支持等<ref name="NIH2018QA" /><ref name="NHS2020-P">Psychosis. NHS. [2020-04-24]. （原始内容存档于2018-10-15）.</ref>。
要诊断精神疾患，应排除其他潜在的成因<ref name="NIH2018QA" /><ref>Cardinal, Rudolf N.; Bullmore, Edward T. The Diagnosis of Psychosis. Cambridge University Press. 2011-03-31: 279. ISBN 978-1-139-49790-9 （English）.</ref>，尤其如果出现不典型的症状<ref name="NHS2020-P" /><ref name="Sadock2015">Sadock, Benjamin J. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Wolters Kluwer. 2015: 317 [2020-04-26]. ISBN 9781469883755. （原始内容存档于2021-01-22）.</ref>。神经传导物质多巴胺据信扮演重要角色<ref name="NHS2020-C" />。
定义[编辑 | 编辑源代码]
在精神疾病诊断与统计手册的早期版本中，定义精神病为“现实感丧失”或“自我界限消失”<ref name="Arciniegas2015">Arciniegas, David B. Psychosis. Continuum (Minneap Minn). 2015, 21: 716.</ref>，导致日常生活功能下降。在国际疾病与相关健康问题统计分类第九版中，则使用当时传统的二分法，区分精神病与神经症，并且刻意没有给予详细定义。而在这两本手册的现今版本中，则使用狭义的定义，指须有妄想、幻觉或两者兼具的症状，并视思考障碍为可能出现的相关症状。当精神病的原因是精神疾患时，称为原发性精神症，当原因是其他医学情况时，称为次发性精神症<ref name="Griswold2015">Griswold, Kim S.; Regno, Paula a. Del; Berger, Roseanne C. Recognition and Differential Diagnosis of Psychosis in Primary Care. American Family Physician. 2015-06-15, 91 (12) [2022-11-13]. （原始内容存档于2023-03-03） （en-US）.</ref>。
流行病学[编辑 | 编辑源代码]
任何年龄、性别、种族、生活水准或学历的人士都有机会患病。在美国，精神病的终生盛行率约为3%<ref name=Griswold2015/>，其中约0.21%是由一般医学情况所引起的<ref>Perälä, Jonna; Suvisaari, Jaana; Saarni, Samuli I.; Kuoppasalmi, Kimmo; Isometsä, Erkki; Pirkola, Sami; Partonen, Timo; Tuulio-Henriksson, Annamari; Hintikka, Jukka; Kieseppä, Tuula; Härkänen, Tommi. Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population. Archives of General Psychiatry. 2007-01-01, 64 (1) [2022-11-13]. ISSN 0003-990X. PMID 17199051. doi:10.1001/archpsyc.64.1.19. （原始内容存档于2021-10-01） （English）.</ref>。精神分裂症及第一型躁郁症的终生盛行率则各约1%<ref>Merikangas, Kathleen R.; Pato, Michael. Recent developments in the epidemiology of bipolar disorder in adults and children: Magnitude, correlates, and future directions.. Clinical Psychology: Science and Practice. 2009-06, 16 (2). ISSN 1468-2850. doi:10.1111/j.1468-2850.2009.01152.x （English）.</ref>。
病征[编辑 | 编辑源代码]
妄想[编辑 | 编辑源代码]
自古以来，疯狂的核心特征就是妄想。{{#if:|{{#if:|}}
——{{#if:|，出自}}}}
妄想是坚信不疑的错误信念，纵使有强烈相反证据也无法动摇，并且不在所属文化中流行<ref name="Sadock2015" />。要将无法合理确认的信念视为妄想时，应特别谨慎，例如文化与宗教的领域。一群人所共同持有的信念不是妄想，例如相信幽浮的存在<ref name="Hopkins2020">Barta, Patrick. Delusions. Johns Hopkins Psychiatry Guide. [2020-04-24]. （原始内容存档于2021-01-22）.</ref>。妄想在精神分裂症中的盛行率至少90%，在躁郁症中则有50%。在第五版的精神疾病诊断与统计手册（DSM-5）中，定义怪异妄想为全然不可能的信念，不被所处文化的同侪所理解，也不是日常生活经验所导出的体悟<ref name="DSM5">Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association. 2013.</ref>，例如相信自己的器官已被换成别人的，还没有留下任何疤痕。
妄想可依内容主题分为被害妄想、爱恋妄想、夸大妄想、嫉妒妄想、身体妄想等。其中最常见的被害妄想，牵涉到个人相信本身被人谋害、欺骗、监视、跟踪、下毒、恶意毁谤、骚扰或是阻碍其追随长远目标的情况<ref name="DSM5" />。嫉妒妄想主题是伴侣不贞。[[:{{#if:妄想性错认综合征|妄想性错认综合征|Delusional misidentification syndrome}}|{{#if:妄想性错认综合征|妄想性错认综合征|Delusional misidentification syndrome}}]]患者的妄想主题都与人事物的身份被改变有关，例如卡普格拉综合征则是患者相信亲友被人冒名顶替，外表一模一样但是内在却不同；[[:{{#if:佛列哥利综合征|佛列哥利综合征|Fregoli syndrome}}|{{#if:佛列哥利综合征|佛列哥利综合征|Fregoli syndrome}}]]的患者认为不同的人皆是同一人所装扮而成的<ref name="Arciniegas2015" />。
与妄想相对比，[[:{{#if:超价观念|超价观念|Overvalued idea}}|{{#if:超价观念|超价观念|Overvalued idea}}]]则是不合理的执著信念，可被理解且未达坚信的程度<ref name="Arciniegas2015" />，例如在身体臆形症患者所认为自身外观缺陷的念头<ref>Matorin, Anu A; Shah, Asim A; Ruiz, Pedro. 8 Clinical Manifestations of Psychiatric Disorders. Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (编). Kaplan & Sadock's Comprehensive Textbook of Psychiatry 10th. Wolters Kluwer. 2017. THINKING DISTURBANCES, Thought Content, Disturbances in Thought Contents. ISBN 978-1-4511-0047-1.</ref>，或者当怀疑伴侣不贞的念头可以被相反证据所说服时，不应视为妄想<ref>Kinirons, Mark (编). French's Index of Differential Diagnosis, 1 An A-Z. CRC Press. 2011 [2020-04-26]. ISBN 9781444128703. （原始内容存档于2021-01-22）.</ref>。当错误信念牵涉到价值判断时，只有当该判断极端到不可置信时才可以被视为妄想。虚谈症也不是妄想，那是指无意欺瞒的编造记忆，通常为自传性质，讲述时非常相信，但却时常随即忘记<ref name="Arciniegas2015" />。
幻觉[编辑 | 编辑源代码]
根据法国精神科组织之父[[:{{#if:吉恩·埃斯基罗尔|吉恩·埃斯基罗尔|Jean-Étienne Esquirol}}|{{#if:吉恩·埃斯基罗尔|吉恩·埃斯基罗尔|Jean-Étienne Esquirol}}]]医师的定义，幻觉为“没有刺激来源的知觉”<ref>Freudenreich, Oliver. Psychotic Disorders: A Practical Guide. Lippincott Williams & Wilkins. 2007. ISBN 9780781785433.</ref>。没有病识感的幻觉才是精神症的症状<ref name="Arciniegas2015" />，相对于偏头痛预兆时所出现的视幻觉，偏头痛病人通常知道该幻觉并非真实。幻觉可能牵涉五官中任何一个感官，以不同形式出现，可以是简单的感受（例如光线、颜色、声音、味道、气味）或是复杂仔细的经验（看见形体、听见语音），通常具有生动且无法控制的特性<ref name="DSM5" />。其中，幻听是最常见且显著的一种形式，所听到的声音可能谈及某些人，甚至是好几个假想的角色中的对话。[[:{{#if:小人国幻觉|小人国幻觉|Lilliputian hallucinations}}|{{#if:小人国幻觉|小人国幻觉|Lilliputian hallucinations}}]]使人感到东西看起来比实际的或大或小忽远忽近，则较常出现在脑病变患者身上<ref name="Sadock Psychosis">Lewis S, Escalona R, Keith S. Phenomenology of Schizophrenia. Sadock V, Sadock B, Ruiz P (编). Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Wolters Kluwer.</ref>。
错觉与幻觉并不同，那是对真实刺激的错误解读。既视感也非幻觉<ref name="Arciniegas2015" />。
思想及言语紊乱[编辑 | 编辑源代码]
谈话内容无意义的、急迫、缺乏主题、杂乱无章、语无伦次，不切实际以致别人难以理解。
治疗[编辑 | 编辑源代码]
思觉失调可用药物治疗及心理治疗，药物治疗主要用作减退症状、由症状带来的紧张、不安及困扰。家人应持续监察患者情况，小心其滥用药物等的行为<ref name=":2">思觉失调的症状治疗与康复. [2012-05-09]. （原始内容存档于2021-01-06）.</ref>。
有些新的药物及疗法让患者不一定需要入院接受治疗，只需定期到门诊接受评估。即使需要住院治疗，其留医时间因为新的药物以及疗法亦可以尽量缩短 。每个患者的康复过程和速度都会有名有分别；有些人可在很短的时间便可康复；而有些人需要较长的时间。在症状未完全受到控制前，有些患者会感到困扰和沮丧，担心自己不能完全康复，以及不知如何去面对未来的日子。在这关键的时候，家人和朋友应该给予支持和鼓励，协助他们面对难关，使他们相信疾病是可以治疗的。
病发过程[编辑 | 编辑源代码]
- 先兆期
这阶段难以被察觉和并不明显。症状包括焦虑、失眠、思想难以集中、多疑和社交退缩。
- 急性期
这阶段会有较明显的症状，例如思想及言语紊乱、幻觉和妄想。
- 第三阶段 康复期
患者可能因接受治疗而使状况改善，但无法恢复至原先状态。 正性症状通常于此一阶段减轻许多，但负性症状却大多持续存在着。
病因[编辑 | 编辑源代码]
正常状态[编辑 | 编辑源代码]
在正常人身上偶尔也会有短暂的幻觉出现<ref name="Cardinal_2011_diagnosis_psychosis">Bullmore, Edward T. The diagnosis of psychosis. Cambridge, UK: Cambridge University Press. 2011. ISBN 978-0-521-16484-9. OCLC 671710663.</ref>，原因如下：
- [[:{{#if:刚睡醒|刚睡醒|hypnopompic}}|{{#if:刚睡醒|刚睡醒|hypnopompic}}]]或[[:{{#if:即将睡着|即将睡着|Hypnagogic}}|{{#if:即将睡着|即将睡着|Hypnagogic}}]]时，出现的听幻觉或视幻觉完全正常<ref name="Ohayon_et_al_1996">Ohayon MM, Priest RG, Caulet M, Guilleminault C. Hypnagogic and hypnopompic hallucinations: pathological phenomena?. The British Journal of Psychiatry. 1996-10, 169 (4): 459–67. PMID 8894197. doi:10.1192/bjp.169.4.459.</ref>
- 丧恸时，出现离世亲人的幻觉<ref name="Cardinal_2011_diagnosis_psychosis" />
- 严重的睡眠剥夺<ref name="sleep_dep1">Sharma V, Mazmanian D. Sleep loss and postpartum psychosis. Bipolar Disorders. 2003-04, 5 (2): 98–105. PMID 12680898. doi:10.1034/j.1399-5618.2003.00015.x.</ref><ref name="sleep_dep2">Chan-Ob T, Boonyanaruthee V. Meditation in association with psychosis. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet. 1999-09, 82 (9): 925–30. PMID 10561951.</ref><ref name="sleep_dep3">Devillières, P.; Opitz, M.; Clervoy, P.; Stephany, J. Delusion and sleep deprivation. L'Encephale. 1996-05, 22 (3) [2022-11-13]. ISSN 0013-7006. PMID 8767052. （原始内容存档于2022-11-13）.</ref>
- 压力<ref>Gispen-de Wied, Christine C. Stress in schizophrenia: an integrative view. European Journal of Pharmacology. Festschrift David de Wied. 2000-09-29, 405 (1): 375–384. ISSN 0014-2999. PMID 11033342. doi:10.1016/S0014-2999(00)00567-7.</ref>
精神性[编辑 | 编辑源代码]
原发性精神疾病包括<ref name="DSM5" /><ref name="ICD-10">World Health Organization, The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines (CDDG) {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}, 1992.</ref>：
- 精神分裂症与[[:{{#if:类精神分裂症|类精神分裂症|schizophreniform disorder}}|{{#if:类精神分裂症|类精神分裂症|schizophreniform disorder}}]]
- 情绪性精神疾患中，例如郁症、躁郁症中，郁症阶段时出现被害或自责妄想与幻觉，或是在躁症发作时经历夸大妄想
- 情感精神分裂症，同时出现情绪障碍症发作和精神分裂症的症状
- [[:{{#if:短暂精神病症|短暂精神病症|brief psychotic disorder}}|{{#if:短暂精神病症|短暂精神病症|brief psychotic disorder}}]]
- 妄想症
- [[:{{#if:慢性幻觉性精神症|慢性幻觉性精神症|chronic hallucinatory psychosis}}|{{#if:慢性幻觉性精神症|慢性幻觉性精神症|chronic hallucinatory psychosis}}]]
也可以出现在下列疾患中<ref name="Cardinal_2011_diagnosis_psychosis" />：
- 分裂性人格障碍
- 某些人格障碍遭遇压力时（包括妄想型人格障碍症、孤僻型人格障碍症、边缘型人格障碍症）
- 创伤后压力综合征
- 二联性精神病
- 有些强迫症患者
- 解离性障碍<ref>Shibayama, Masatoshi. [Differential diagnosis between dissociative disorders and schizophrenia]. Seishin Shinkeigaku Zasshi = Psychiatria Et Neurologia Japonica. 2011, 113 (9) [2022-11-13]. ISSN 0033-2658. PMID 22117396. （原始内容存档于2023-03-31）.</ref>
生理性[编辑 | 编辑源代码]
- 神经紊乱
- 脑癌<ref name="Brain_tumor">Lisanby, null; Kohler, null; Swanson, null; Gur, null. Psychosis Secondary to Brain Tumor. Seminars in Clinical Neuropsychiatry. 1998-01, 3 (1) [2022-11-13]. ISSN 1084-3612. PMID 10085187. （原始内容存档于2022-11-19）.</ref>
- 退化性痴呆症<ref name="DLB">McKeith, Ian G. Dementia with Lewy bodies. British Journal of Psychiatry. 2002-02, 180 (2). ISSN 0007-1250. PMID 11823325. doi:10.1192/bjp.180.2.144 （English）.</ref>
- 多发性硬化症<ref name="multiple_sclerosis">Rodríguez-Gómez, D.; Gónzalez-Vázquez, E.; Pérez-Carral, O. Acute psychosis as the presenting symptom of multiple sclerosis. Revista De Neurologia. 2005-08, 41 (4) [2022-11-13]. ISSN 0210-0010. PMID 16075405. （原始内容存档于2022-11-19）.</ref>
- 结节病<ref name="Sarcoidosis">Bona, Joseph R.; Fackler, Sondralyn M.; Fendley, Morris J.; Nemeroff, Charles B. Neurosarcoidosis as a Cause of Refractory Psychosis: A Complicated Case Report. American Journal of Psychiatry. 1998-08, 155 (8). ISSN 0002-953X. PMID 9699702. doi:10.1176/ajp.155.8.1106 （English）.</ref>
- 老人痴呆症<ref>Lesser, Jary M.; Hughes, Susan. Psychosis-related disturbances. Psychosis, agitation, and disinhibition in Alzheimer's disease: definitions and treatment options. Geriatrics. 2006-12, 61 (12) [2022-11-13]. ISSN 1936-5764. PMID 17184138. （原始内容存档于2022-11-19）.</ref>
- 帕金森病<ref name=":3">Goldman, Jennifer G.; Holden, Samantha. Treatment of Psychosis and Dementia in Parkinson’s Disease. Current Treatment Options in Neurology. 2014-03, 16 (3). ISSN 1092-8480. PMC 3994190 可免费查阅. PMID 24464490. doi:10.1007/s11940-013-0281-2 （English）.</ref>
- 多巴胺分泌异常
- 电解物质紊乱
- 低钙血症<ref name="Rossman_1956">Rossman, P. L.; Vock, R. M. Postpartum tetany and psychosis due to hypocalcemia. California Medicine. 1956-09, 85 (3) [2022-11-13]. ISSN 0008-1264. PMC 1531921 可免费查阅. PMID 13356186. （原始内容存档于2022-11-13）.</ref>
- 高钙血症<ref name="Rosenthal_et_al_1997">Rosenthal, M.; Gil, I.; Habot, B. Primary hyperparathyroidism: neuropsychiatric manifestations and case report. The Israel Journal of Psychiatry and Related Sciences. 1997, 34 (2) [2022-11-13]. ISSN 0333-7308. PMID 9231574. （原始内容存档于2022-11-13）.</ref>
- 高钠血症<ref name="Jana_1973">Jana, D. K.; Romano-Jana, L. Hypernatremic psychosis in the elderly: case reports. Journal of the American Geriatrics Society. 1973-10, 21 (10) [2022-11-13]. ISSN 0002-8614. PMID 4729012. doi:10.1111/j.1532-5415.1973.tb01212.x. （原始内容存档于2022-11-13）.</ref>
- 低血钠症<ref name="Haensch_et_al_1996">Haensch, C. A.; Hennen, G.; Jörg, J. [Reversible exogenous psychosis in thiazide-induced hyponatremia of 97 mmol/l]. Der Nervenarzt. 1996-04, 67 (4) [2022-11-13]. ISSN 0028-2804. PMID 8684511. （原始内容存档于2022-11-13）.</ref>
- 低血钾症<ref name="Hafez_et_al_1984">Hafez, H.; Strauss, J. S.; Aronson, M. D.; Holt, C. Hypokalemia-induced psychosis in a chronic schizophrenic patient. The Journal of Clinical Psychiatry. 1984-06, 45 (6) [2022-11-13]. ISSN 0160-6689. PMID 6725222. （原始内容存档于2022-11-13）.</ref>
- 低血镁症<ref name="Konstantakos_2006">Hypomagnesemia: Practice Essentials, Pathophysiology, Etiology. 2022-07-19 [2022-11-13]. （原始内容存档于2019-07-24）.</ref>
- [[:{{#if:高血镁症|高血镁症|Hypermagnesemia}}|{{#if:高血镁症|高血镁症|Hypermagnesemia}}]]<ref name="Velasco_et_al_1999">Velasco, P. J.; Manshadi, M.; Breen, K.; Lippmann, S. Psychiatric aspects of parathyroid disease. Psychosomatics. 1999-11, 40 (6) [2022-11-13]. ISSN 0033-3182. PMID 10581976. doi:10.1016/s0033-3182(99)71186-2. （原始内容存档于2022-11-13）.</ref>
各别地域[编辑 | 编辑源代码]
香港[编辑 | 编辑源代码]
2001年香港医院管理局启动的一项专为early psychosis人士设立的服务，为消除歧视，特别创立了思觉失调这个新的中文医学名词<ref>思觉失调 – 思觉基金. [2022-10-13]. （原始内容存档于2022-10-13） （中文（香港））.</ref>。同年，香港医院管理局也开始筹办一个医疗服务，目的是要针对及早治疗精神症患者，减轻其病情。于是一群精神科医生计划有策略地向大众宣传及教育有关精神分裂症、妄想症、躁狂抑郁症。考虑到这些早期症状，有可能以心理学的角度及少量镇静剂治疗。
据2018年医管局数字显示，香港思觉失调患者超过4万人<ref>思觉失调患者拒绝求诊 透过教练服务助其家人. The Companions 匡仁心理辅导. 2019-07-01 [2019-08-09]. （原始内容存档于2021-01-22） （中文（繁体））.</ref>。
参见[编辑 | 编辑源代码]
参考文献[编辑 | 编辑源代码]
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<references group=""></references>外部链接[编辑 | 编辑源代码]
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| |||||||||||||||||||||||||||||||||||||||
Lua错误 在Module:Authority_control的第772行：attempt to index field 'wikibase' (a nil value){{#switch:||Category={{#ifeq:|
|
|{{#ifeq:Lua错误 在Module:Wikidata的第446行：attempt to index field 'wikibase' (a nil value)|
|
|
{{#ifeq:|Lua错误 在Module:Wikidata的第446行：attempt to index field 'wikibase' (a nil value)
|
|
}}
}}
}}
}}
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