Unlocking the “revolving door” dilemma, this disease can be clinically cured | World Mental Health Day

Some people say that after suffering from schizophrenia, it is easy to fall into a \”revolving door\”. After receiving treatment, you are discharged, and soon you have to return to the hospital due to a relapse of the disease. Like a never-ending revolving door, patients never seem to be able to truly walk out of the hospital and move toward a healthy life. October 10 is World Mental Health Day. Professor Li Qingwei, director of the Psychiatry Department of Tongji Hospital Affiliated to Tongji University and director of the Psychiatric Disorders Diagnosis and Treatment Center of Shanghai Mental Health Center, pointed out that schizophrenia can be clinically cured. At present, the public has many misunderstandings about schizophrenia. For example, they mistakenly believe that anxiety disorder will develop into schizophrenia. In fact, they are two different diseases; some people think that having schizophrenia means \”crazy\” or \”crazy\”. Incurable disease” requiring social distancing. In fact, as long as they follow medical advice and adhere to long-term and continuous standardized treatment, most patients have the opportunity to achieve clinical cure and return to society as soon as possible.

The biggest obstacle is insisting on long-term and continuous standardized treatment

This is a young piano-playing girl, and she is also the patient who impressed Li Qingwei the most. Auditory hallucinations, visual hallucinations, and gibbering. Once due to schizophrenia, it was like walking into a complex maze. It was difficult to find the exit, unable to play, and unable to live a normal life.

After receiving standardized and continuous treatment, the sunshine returned, and the girl returned to the right track of life again. She was accompanied by the piano, could teach students, got married and had children, and found happiness in life.

“This disease is misunderstood by many people. They are not just diseases, but more importantly people. We need to help them become healthy people.” In Li Qingwei’s view, this is the biggest road to treatment. The biggest stumbling block is insisting on long-term and continuous standardized treatment. A sad reality is that one of the essential characteristics of the disease is that treatment compliance is generally low, with less than half of people able to adhere to a certain level of treatment.

“There are many reasons for this, and some patients There is a sense of shame, inner resistance to drug treatment, and some families lack awareness of the need for ongoing treatment.”

The consequences of this are also unimaginable. Relevant data show that if medication is interrupted for 1 to 10 days a year, the patient\’s risk of rehospitalization will increase by 1.98 times.

The relapse rate of schizophrenia patients within 1 year after discharge is as high as 33.5%, the readmission rate within 1 year is 18.9%, and the relapse rate within 5 years exceeds 80%. The main reason for recurrence is interruption of treatment or voluntary tapering. The risk of relapse was five times higher for those who discontinued medication than for those who continued medication.

Each relapse accelerates the \”revolving door\”, which may lead to further reduction of gray matter in the patient\’s brain, severe impairment of cognitive function, and gradual decline in social function.

Multiple relapses not only increase the readmission rate, but also significantly extend the number of days required for relapse treatment to achieve recovery. Multiple relapses can also lead to prolonged disease course, increased treatment difficulties, decreased efficacy, residual symptoms, and increased risk of suicide; the risk of physical diseases such as cardiovascular disease and digestive system diseases also significantly increases.

Unlock the \”revolving door\” and make joint decision-making between doctors and patients

Schizophrenia is a chronic and persistent disease. Therefore, ensuring long-term and continuous treatment is crucial to prevent relapse and even maintain social function. However, this is difficult to achieve with oral antipsychotics. Li Qingwei said that as an alternative to oral drugs, long-acting antipsychotic injections are an important method to ensure long-term treatment, improve treatment compliance and maintain treatment effects. Studies have confirmed that long-acting injections not only reduce the risk of hospitalization for mental illness, but also reduce the risk of hospitalization for other illnesses, reducing the risk of hospitalization for all causes by 33%.

At present, expert consensus states that

Long-acting injections are suitable for all stages of the disease process, especially in the early stages of the disease, covering the acute phase, consolidation phase and maintenance phase. The whole course of the disease.

The long-acting injections used clinically have different administration cycles, including one injection every half month, one injection every month, etc. or even longer administration cycles. For example, the injection of risperidone microspheres (II) is given once every half a month, and the paliperidone palmitate injection is given once a month. After entering the consolidation period and maintenance period, long-acting injections can be used for one month or three months.

From the perspective of global treatment concepts and trends, the use of long-acting injections will also be an important or even first-line treatment for schizophrenia in the future. More efforts are needed to promote the promotion and clinical application of long-acting injections for schizophrenia. Establish a treatment alliance and use the doctor-patient joint decision-making model to help patients choose and adopt the most suitable treatment plan.

Integrate treatment plans with the ultimate goal of returning to society

The treatment concept of schizophrenia has changed from controlling symptoms to improving cognition, promoting recovery, and ultimately Return patients to society.

“Every patient is special, and the treatment and management of schizophrenia must combine group intervention and individualized management.” Li Qingwei pointed out that from a group perspective, it can be carried out through peer assistance and other methods. From the perspective of individualized management, the treatment of schizophrenia requires case management, and medication adjustments and psychological intervention need to be carried out according to the specific conditions of each patient.

In addition, appropriate family support and emotional expression are crucial to patient recovery. It is important for family members to understand the disease, the need for treatment, and how to care for and love the patient appropriately.

In the process of long-term treatment and recovery, the patient’s confidence is the most important. Patients should be encouraged and helped as much as possible to participate in normal work, life and study activities, and to do things that should be done at this age. Do what you should do at this time in your life.

Treatment of schizophrenia requires an integrated treatment plan. Experts also called on society to pay more attention to the onset, diagnosis and treatment of schizophrenia.