2018/11/16,1,精神分裂症与其他精神病性障碍 (schizophrenia and other psychotic disorders),中南大学精神卫生研究所 陈晓岗 The mental health institute of south-central university Chen Xiaogang MD.,Ph.D.,2018/11/16,2,学习目标,1掌握精神分裂症的临床表现、诊断和鉴别诊断、治疗和预防复发策略 2掌握精神分裂症疾病的分型、预后特征 3了解精神分裂症疾病的病因学,2018/11/16,3,The definition of Schizophrenia in CCMD-3,Schizophrenia comprises a group of psychotic disorders of unknown specific etiology often presented with a gradual onset of abnormalities in perception, thought, motion and behavior since young adulthood. Consciousness is usually maintained. Intelligence is intact, but in some cases, there is some degree of cognitive impairment. The natural course of the disorder is chronic remitting but sometimes deteriorating.,2018/11/16,4,Epidemiology 1,Prevalence ： Point prevalence in China (1982): 4.75（rural area 3.42，urban 6.06 )。 Total prevalence in China(1982):5.69，(6.55 1999)。 Lifetime prevalence in USA（1988）13。,2018/11/16,5,Epidemiology 2,Age：the age of onset in 50% of patients is 2030 year old，over 80% of patients is 1635year old. Gender： Schizophrenia occurs equally in men and women(in abroad) The prevalence in men is more than women (1.6:1) in China. The mean age of onset is about 2 to 5 years earlier in men than women.,2018/11/16,6,History（1）,Schneider -first rank symptoms（首级症状） 1.thought hearing (思维化声) 2. Third-person hallucinations (争论性幻听) 3. Hallucinations in the form of a commentary(评论性幻听) 4. thought withdrawal or insertion (思维被夺/被插入) 5. Thought broadcasting /diffusion(思维被广播或扩散) 6. Forced feeling (强加的情感) 7. forced impulsive (强加的冲动) 8. forced behavior (强加的行为) 9. somatic passivity experience (躯体被动体验) 10. delusional perception (妄想性知觉),2018/11/16,7,Etiology,一、 biological factors 1genetics 2The neurodevelopmental hypothesis 3Changes in brain structure 4Biochemical abnormalities 二、personality factors 三、psycho-social factors,2018/11/16,8,Genetics 1,Studies Method: Family studies Twin studies Adoption studies,2018/11/16,9,Genetics 2,The results of family studies: The risk of Schizophrenia. Schizoaffective disorder, and schizotypal personality is increased in first-degree relatives of patients with Schizophrenia. The risk of both Schizophrenia and mood disorder is increased in first-degree relatives of patients with schizoaffective disorder. The risk of bipolar illness is not increased in first-degree relatives of patients with schizophrenia.,2018/11/16,10,Genetics 3,The results of twin studies concordance rates among MZ pairs is higher than that among control(35-60 times) concordance rates are about 50% for MZ and about 10% for DZ. It might be expected that some environmental factors relevant to etiology. The risk of schizophrenia in the offspring of an unaffected twin is the same as that of an affected twin. This means that an unaffected twin has the same genetic susceptibility to developing Schizophrenia, but for some reason the susceptibility is not expressed.,2018/11/16,11,Genetics 4,The results of adoption studies The rate for Schizophrenia is greater among the biological relatives of the Schizophrenia Adoptees than among the relatives of control. The finding supports the genetic hypothesis.,2018/11/16,12,Molecular genetic studies,Two main approaches: 1. linkage analysis It is applied to multiply affected families(高发家系）, but no linkage markers have been clearly identified. 2. Candidate gene approaches Genes for biological mechanisms that may be involved in Schizophrenia have been localized and cloned. Using this technique, a number of genes coding for DA and 5-HT receptors have been excluded from linkage to Schizophrenia in various pedigrees（家系）.,2018/11/16,13,Biochemical studies,The dopamine hypothesis. 5-HT hypothesis. Amino acids in Schizophrenia,2018/11/16,14,Etiology studies-conclusions 1,There is strong evidence that schizophrenia has important genetic causes, but the mode of inheritance is not known. There is increasing evidence that many cases are of neurodevelopmental origin, but whether neurodevelopmental abnormalities are present in all patients is not clear. Most believe that Sch. results from an interaction of genetic predisposition and environmental factors. Stressful life events often provoke the disorder, but non-specific events to schizophrenia.,2018/11/16,15,Etiology studies-conclusions 2,Schizophrenia May be preceded by cognitive and social impairment in childhood, and that the presence of these impairment and certain kind of personality disorder are forms of expression of schizophrenia genotype,精神分裂症病人可能在儿童期就有认知和社会功能损害，这些损害及某些人格障碍的出现是精神分裂症基因型表达的一种形式,2018/11/16,16,Etiology studies-conclusions 3,The deficits of temporal and frontal structural and function are associated with non-progressive neuropsychological impairment. Dopamine receptor are blocked by drugs that control symptoms , but there is no compelling evidence at present that over-activity of DA systems is the central disorder in schizophrenia.,颞叶与额叶的功能和结构的缺陷与非进展性的神经心理损害有关 多巴胺受体阻断能控制症状，但尚无确信证据表明多巴胺功