Crow (1980) thinks that the main clinical manifestations of schizophrenia are hallucinations, delusions and formal thinking disorders in acute stage; The chronic stage is mainly the negative symptoms of poor thinking, indifference and weak will. Of course, acute patients can also have negative symptoms, and chronic patients can also have positive symptoms.
According to the clinical characteristics of schizophrenia, Shen Yucun and others in China divide mental symptoms into characteristic symptoms and other common symptoms. The main feature of the former is "schizophrenia", that is, mental activities are divorced from reality, uncoordinated with the surrounding environment, and uncoordinated with thinking, emotion and will activities. Other common symptoms are not found in all types, but they can be the main or prominent symptoms of this disease in a certain type and stage, and such symptoms can also appear in other functional or organic mental disorders. These common symptoms include hallucinations, delusions, complex sensory disorders, behaviors and behavioral disorders. Also known as additional symptoms.
(1) 1 Characteristics of symptoms of thinking association disorder The lack of coherence and logic in the thinking association process is the most characteristic symptom of schizophrenia. Its characteristic is that the patient's association is loose or broken in the conscious state, lacking concreteness and reality. Bruller pointed out that association disorder is one of the characteristic symptoms of this disease. Specifically, the association is loose or slack, and the thinking lacks logic so that it cannot be understood. Comelen thinks that patients' association lacks proper connection. He replaces normal and regular thinking with some connected thinking, and can't rule out unnecessary connection, so that he can't grasp the main points and often uses some inaccurate words. Lenovo is not easy to find under natural circumstances, such as letting it report itself or being exposed when it is nervous. Lighter, generally can understand its meaning, but the structure is loose, the purpose is not clear enough. Sometimes the answer is not correct and to the point, and the narrative is irrelevant and irrelevant, which makes people feel that the questions he asked seem to be not understood, but the answers are related. What's more, Lenovo loses its normal rules, its thinking structure is rambling, even incoherent, or its paragraphs are irrelevant, so it appears rambling and disorderly, or its sentences are irrelevant, which is called thinking fracture. In severe cases, words are fragmented, and even individual words lack connection. This situation is called "mixed words".
Another form of thinking disorder is that patients use some common words, nouns and even actions to express some special meanings that others can't understand except the patients themselves. This kind of thinking is called symbolic thinking of disease causes. For example, a patient holds a watch tightly and claims to have mastered the time. A patient suddenly jumped under a speeding car tire, asked why, and said that he was going to be reborn. At this time, patients often use the same method to create new words, and put two or more unrelated concepts, words or incomplete words together to give them special meaning, which is called new words. The thinking association obstacle of schizophrenia is not limited to the connection between concepts, but also manifested in several steps of the thinking process, which makes its reasoning and judgment specious, illogical or self-contained. It is often manifested in two forms: one is absurd and bizarre logical reasoning (logical inversion thinking), and the other is introverted thinking. Patients are obsessed with concepts, theories, fantasies or research inventions that only they know but others can't understand, and some are obsessed with designing various spaceships, submersible pumps or perpetual motion machines on paper, which is obviously wrong for others, while patients are narcissistic and even forget to eat and sleep. In addition, patients also have various abnormal manifestations in the process of thinking. For example, some people think too fast like mania, demanding to speak urgently, while others think too slowly like depression, and the content is empty and poor. What is more prominent is thinking disorder (thought interruption), in which patients suddenly stop, after a while, or continue the previous topic, or change irrelevant topics without being affected by external factors. Some patients suddenly have a lot of forced thinking in their brains when they are talking. The association disorder of the latter two types of patients is often accompanied by obvious involuntary feeling. It is difficult for patients to control their own thoughts and often make delusional judgments, such as thinking that their thoughts are manipulated or controlled by external forces.
Some patients show unpredictable and ineffective empty talk (sophistry). For example, a patient thinks that he has innovative ideas in philosophy and wrote an article on Several Questions about Dialectical Logic. The excerpt is as follows: The Law of Dialectical Logic: A Scope: We judge that a thing is knowable and can explain its nature, so we need to understand and grasp its main contradictory aspects. That is to say, if you grasp the essence of things, you will master the transformation to the opposite, see the things themselves, see the emergence of new things in other things, and learn to swim. For example, we say that eggs will become chickens under certain conditions. When we grasp its main contradiction and make it clear that it is an egg and a form of protein, we have the conditions to become a chicken. Therefore, as long as we grasp the characteristics of an egg, that is, the main contradiction about becoming a chicken, we can understand all the phenomena of chicken formation and find out the particularity from the universality. From one thing to another. So it has all the phenomena. After understanding, the analysis process from the outside to the inside has been completed, and the main contradiction has been grasped. "
2 Schizophrenia patients common thinking association disorder
(1) Thinking relaxation: also known as loose thinking, loose thinking refers to that patients replace the thinking with clear thinking and rigorous structure with a group of more or less interrelated thinking in a state of clear consciousness, and the thinking activities lack themes, and the content and structure are loose and disorderly. Although there are no obvious mistakes in the grammar of individual sentences, there are obstacles in the application of some concepts in the process of thinking. At the same time, the connection between the preceding and following sentences is mechanical association, or there are some sudden inherent concepts that have nothing to do with reality, which makes thinking deviate from the original track. There is no logical connection between sentences. In addition, the whole thinking content does not reflect the real situation, so it is puzzling. For example, when a patient saw the words "Shandong Mental Hospital", he said, "This is a green hill, and there are mountains outside the window, not mountains, but hills. East is east, east, west, north and south, east … winter is Jiaodong. Saving means saving, everyone saves, and everyone has food. The province is smaller than the country. There are counties in the province and towns in the county. Shandong Province is smaller than other provinces, Shanxi, Hebei, Henan, Jiangsu and Jiangxi. The food stamp says Shandong province, but you can't eat it. I eat two steamed buns, less than half a catty of food ... "
(2) Broken thinking: called broken thinking. Under the condition of clear consciousness, no intellectual damage and emotional excitement, the structure and content of patients' thinking association obviously lack coherence and logic, and their words and words have no theme. Some sentences are mechanically associated, while others are not continuous at all. There are no big mistakes in the content and grammar of each single sentence, but quite a few single sentences are fragmented in content and grammar. The concept is endogenous and does not reflect the reality, and "new words" can appear. Severe patients can't make sentences alone, but only pile up unrelated words, which is called "crossword puzzle" in clinic. For example, a patient said, "I am the solar system, the earth and the motherland ... this is not a question of holding the moon, but a question of saving mercury." There are two people in Taiwan Province, the moon has no satellite, and I am just an unlit star. " "I am in the mud, I know you, your name is Pavlov, Canadian, and Bethune calls you sir. Ah, Baliva sells soap! Vega is eight times bigger than the sun, so if you come out next week, a week is equal to eight days, and you are 1979. Deal. "
(3) Poor thinking: it means that the number of thinking associations is reduced, the concept is poor, and the content is empty. Patients usually have no active words, and can often answer questions, which are generally related, but the content is monotonous and empty, presenting a brief description of pathology, and only answering: "Nothing, ……' I don't know'". The patient's experience is "nothing to think about, nothing to say". The patient took it in stride. Poor thinking, apathy and lack of will often appear one after another, which constitute the three basic symptoms of schizophrenia.
(4) Thinking interruption: also known as thinking block. Refers to the sudden interruption of thinking association activities and the sudden pause of thinking process. The patient felt that his mind was blank. It is characterized by a sudden pause in speech and repeated speech after a while, but it is not the original topic. The patient can't explain this. At that time, there were no unconscious obstacles, forgetfulness, absence or distraction, no external stimuli and auditory hallucinations, nor was it for words or other thoughts, but a short pause of unprovoked mental agitation. There is a clear sense of involuntarily, accompanied by fear and emotional reaction. If the patient feels that the thought at that time was taken away, it is called that the thought was taken away. Patients often make delusional explanations for these involuntary thinking activities.
(5) Thinking gathering: also known as forced thinking. The patient feels that a series of associations suddenly appear in the brain, which is involuntary. Sometimes he feels that others impose on him and he can't control it. This kind of association has many contents and great changes. There may be no connection between before and after, its appearance can not be expected by patients, and its content has no practical significance. Although patients feel that the content of Lenovo is rich and varied, if the content of Lenovo is recorded, it is found that the concept of Lenovo is limited, and even many of them are repeated before and after. Choice is the difference from the idea of accelerating Lenovo. This symptom is often related to thinking insertion, which is one of the manifestations of schizophrenia and a characteristic symptom of schizophrenia. For example, a patient described: "Sometimes, words and phrases from past and forgotten articles that have nothing to do with reality suddenly appear in my mind, sometimes from this book, sometimes from that book, and sometimes mixed with various anecdotes at home and abroad, which makes my brain ache, but I can't stop." Occasionally, all kinds of ideas will suddenly disappear, disappear without a trace, and nothing can be remembered. "
(6) Thinking into people: also known as thinking into or forced thinking. It means that patients feel that some thoughts are not their own, but are forcibly inserted by others. It is even said that one's own mind is a rented screening place, and others borrow his mind for thinking activities, which is one of the symptoms of mental automaticity.
(7) Symbolic thinking: refers to the patient replacing concrete concepts with abstract concepts that only he can understand consciously, that is, giving concrete concepts to an ordinary concept, speech or action that only the patient can understand. Thus confusing the original and familiar connotations of concrete concepts and abstract concepts, but this pathological transformation is not unrelated, and there may be some connection in image or meaning. This symptom is one of the characteristic symptoms of schizophrenia. For example, a patient wears cotton-padded clothes inside out (blue inside and white outside) to show "innocence". Another patient put a pair of shoes on the beam above the high window to show "standing high and seeing far".
(8) Neologism: It means that patients melt, condense or piece together irrelevant concepts and create some words, words, concepts, figures, symbols or languages to replace some special concepts when their consciousness is clear. Its meaning can only be understood by himself, but it is absurd to others. Several commonly used words are often condensed, processed and transformed into a word without a dictionary. For example, the self-created "bright sky" means bright, which means that it only shines when the sun and the moon are hanging in the air at the same time; "Men and women" means equality between men and women is "good"; "Black phase" refers to ideals and so on. This symptom is also one of the characteristic symptoms of schizophrenia.
(9) Logical inversion thinking: This is mainly manifested in the obvious obstacles of logic in the process of thinking association, which may have no antecedent, no conclusion, or even causal inversion, and the reasoning process is absurd and bizarre, which is difficult to understand. For example, whenever a female patient meets the opposite sex, regardless of age, familiarity and strangeness, she wants to hug and even have sex on her own initiative. Asked why, he said: I love my husband and give him everything selflessly. The party is selfless. The party calls on everyone to make selfless contributions. I love the party and ask to join the party organization, so I will make selfless contributions to everyone like my husband.
(10) Precision: refers to the pathological change of the content and application scope of the concept by patients, denying its certainty, thus highlighting the logical laws of thinking and the serious obstacles to reasoning and argumentation. The patient's argument has no practical significance and foundation, but he talked from one question to another and talked with Kan Kan for a long time. Its diction and sentence-making are generally smooth, its form is logical, its reasoning is correct, and its grammatical structure is basically free from major mistakes. For example, a patient wrote in an article: "Men should always have their hair cut. Women should always comb their hair. " . In the social division of labor, many people take hairdressing as their occupation, and the professional name of hairdressing is' barber shop' or' barber shop'. When a barber sees a barber's shop or barber's shop, he goes in and cuts his hair. The barber in a barber's shop or barber's shop knows to cut his hair after receiving customers. This is the law of human life, the working law of hairdressing industry and the progress of mankind. However, a woman who combs her hair all day is called combing her hair, not combing her hair. If the barber shop is renamed the barber shop and the barber shop is renamed the barber shop, people will not know whether the barber shop and the barber shop are for people or animals. If a barber enters a barber shop or barber shop, it is a haircut, not a haircut, so the barber doesn't know whether to cut the hair on his head or on his body. Some people call the hair on the other person's head hair, so calling the hair on the other person's head hair is swearing. Therefore, Guo Moruo wrote the script of the ballet White-Haired Girl in Japan, performed the ballet White-Haired Girl in Japan, performed the opera White-Haired Girl in China, the feature film White-Haired Girl in Beijing Opera and White-Haired Girl in China Ballet. The title of the play is an insult to Yang Xier and the women in the oppressed and exploited stage. In primitive society, the hair on people's bodies and heads was called hair, and there was no distinction between hair and hair. Of course, men don't cut their hair and women don't comb their hair, so the difference between human head and body is hair, beard and hair. This is the progress of human beings and society, which is the difference between human beings and other mammals. However, the imperialists and reactionaries in the Qing Dynasty called the Taiping Army led by Hong Xiuquan "long hair", and they called the people's uprising against the reactionaries "long hair uprising" to slander the people's revolutionary struggle. Yang Xier is a slave girl who was seized by Huang Shiren, a pseudo-village head and a big landlord. Under the pressure of Huang Shiren, the big landlord, Yang Xier fled into the mountains and lived a savage life. It is possible that political oppression and life torture make young Yang Xier's hair turn white. Even if Yang Xier's hair turns white, she should be called "white-haired girl" instead of "white-haired girl"! "
(1 1) Contradictory thinking: also known as opposing thinking or contradictory ideas. It means that there are two contradictory concepts in the patient's thinking activities, which compete with each other and are deadlocked, and it is impossible to judge right and wrong. For example, when patients are eating, they repeatedly put down their rice bowls and put them down again and again, so it is difficult to decide whether to eat or not. Asked why, he said, "I think I should eat, but at the same time I don't think I should eat, so I don't know if I should eat."
(12) Contact digression: also called irrelevant words, answer irrelevant questions. It refers to the incomplete digression of schizophrenic patients in conversation. The patient's answer is often related to the question, but then it digresses, and then it is related again and again. It doesn't matter, but it's not irrelevant. A more vivid metaphor for this phenomenon is "playing the edge ball." Compared with pure "nonsense", this disease is more characteristic of schizophrenia, because this phenomenon is absolutely difficult to disguise.
(13) compulsive thinking: also known as the concept of compulsion. Refers to patients who think that the same content appears repeatedly and involuntarily in their minds. I know I shouldn't think so, and I have a strong desire to get rid of it, but I just can't control it, so I am very upset. The content and form of compulsory concept can be varied. If a concept or sentence appears in the patient's mind, he will immediately associate it with another concept or sentence, which is called forced association. If the concept of association is just the opposite of the original concept, as soon as you think of friends, you immediately think of enemies; When you think of war, you immediately think of peace. This is called compulsive opposing thinking. If you always doubt the correctness of your thoughts, words and actions and check them repeatedly, it is called compulsive doubt and compulsive inspection. If you think about some natural phenomena repeatedly, trace back to the source, for example, a patient repeatedly asks "which came first, the chicken or the egg?" Why is one plus one equal to two? Such things are called compulsive exhaustion. You can't recall some things from past experiences repeatedly. This is called compulsive memory. Involuntary repeated counting is called compulsive counting. Obsessive-compulsive thinking, compulsive behavior and compulsive intention together constitute obsessive-compulsive symptoms.
(14) Introverted thinking: It means that in a state of clear consciousness, the patient indulges in meditation alone, and the whole mental activity is completely isolated from the external realistic environment. You can laugh at yourself, or you can bow your head and not touch it. What I think is unrealistic and I can't answer it perfectly. For example, a patient recalled that he thought about many problems during his illness. Why does a person want a nose? Why is the big head facing down? Why do Shandong radishes germinate when released? And Luo H in Beijing is not cute? These questions cannot be answered by themselves.
(15) continuous speech: refers to the thinking activities that are stuck in a certain concept, and cannot blindly continue a concept with the environment. When asking a series of questions to the patient, the patient repeats what he said in the first answer every time. If you ask the patient your name? A: "Last name is Liu". Ask again: "How old"? Still answer: "Last name is Liu."
(16) Repetition: refers to the patient repeating the last few words or words of a sentence many times. This phenomenon is not caused by emotional tension. At that time, patients could realize that this situation was unnecessary, but they could not overcome it themselves and did not change with the influence of the environment. If you ask the patient, "What's the matter?" Answer: "I mainly feel uncomfortable, uncomfortable, uncomfortable ..."
(17) Stereotyped speech: refers to that patients always mechanically and rigidly repeat some words or sentences irrelevant to the present situation. For example, a patient keeps repeating, "I go home, I go home, I go home."
(18) Imitation of speech: It means that the patient imitates what people around him say, and the patient repeats what people around him say. For example, the doctor asked the patient, "What's your name?" The patient also asked, "What's your name?" The fork asked, "Where do you live?" The patient is still in the representative theory: "Where is home?"
(19) Silence: The patient has no verbal activity and communication, and no one answers a word after all. However, some patients can express themselves through writing and acting. This symptom is neither aphasia caused by language center, nor diseases of vocal organs such as tongue and vocal cords. The patient doesn't want to speak voluntarily.
(20) Monolingual disorder: refers to patients who do not communicate with others, but speak alone, even as a dialogue with others. As a mental symptom, soliloquy is very common in clinic. Talking to yourself is only a superficial symptom, and many psychological abnormalities may lead to it. Give priority to with auditory hallucination, with auditory hallucination dialogue; Dominated by delusion, external forces control him to speak, or ghosts and gods speak with their mouths and fight back with words when they are delusional. Of course, soliloquy can also appear in depressed patients (but for a short time), normal people or children.
(2 1) Approximate answer: Also called appropriate answer. When the patient answers the doctor's question, the answer is related to the question, but it is not exact, like talking nonsense. If you ask him his age, answer 10 (actually 2 1 year) and ask 54 =? A: 10. Can be seen in adolescent schizophrenia, but also in unconscious or hysterical patients (Ganser syndrome).
(2) Emotional disorder
1 Symptoms and characteristics of emotional disorder Emotional disorder is one of the important characteristics of schizophrenic patients, mainly manifested as indifferent or dull emotional response, which is not in harmony with external stimuli and thinking content. The earliest involved are subtle emotional reactions, such as caring for colleagues and sympathizing with relatives. Emotional response is dull and unnatural, becoming dull or dull. Not interested in work and study, not motivated, less interested. With the progress of the disease, the patient's emotional experience is getting worse and worse, and he is indifferent to everything. They all adopt an "indifferent" attitude and lose their emotional connection with their surroundings. Even for those events that bring great pain to ordinary people, patients are indifferent. For example, relatives come all the way to visit, and patients treat them as passers-by, which can't arouse any emotional resonance of patients. When the emotional response is indifferent, patients may have explosive emotional response to small events.
In addition, some patients will make disproportionate emotional responses to objective stimuli, such as being delighted at the death of their loved ones (emotional inversion), which is the disharmony between emotions and the external environment. When some patients talk about their unfortunate experiences or delusions, they lack appropriate emotional experience or show disproportionate emotions, which is the disharmony between emotions and internal thinking. In the early stage of the disease, sometimes patients can perceive their emotional changes, such as patients saying, "Although I am laughing, I am not happy in my heart". Some patients' performance is not so, but can be manifested as depression, anxiety, irritability, fear, tension, sentimentality, irritability, joy, excitement and so on. But apathy or dullness is one of the early characteristic symptoms of schizophrenia.
2 Schizophrenia patients with common emotional disorders
(1) Emotional apathy: patients lack corresponding emotional response to external stimuli, which belongs to the reduction of emotional response. When external stimuli act on patients or events involving patients' interests occur, they lack corresponding inner experience and no corresponding facial expression changes, so they turn a blind eye. Indifferent to relatives, treat guests from home as passers-by, and indifferent to what is happening around them. When it is serious, the accident is not unexpected, and it is not angry to be teased. This symptom is characterized by weakening or disappearance of emotional tendency, deep damage or loss, poor curative effect or even loss, but emotional activities remain, especially those related to meeting biological needs can be relatively active. This symptom is often accompanied by a decline in will.
(2) Emotional dullness: also known as emotional dullness. In degree, it is lighter than emotional indifference. When the stimulus that should cause obvious emotional response acts on the patient, it is dull and lacks the corresponding inner experience. Generally speaking, it is mainly manifested in the gradual loss of advanced emotions and subtle emotions, such as lack of affection for relatives, friendship with friends, enthusiasm for colleagues, lack of sense of responsibility for work, unclear emotional response, etc., which is more common in the early stage of schizophrenia. If it continues to develop, it will become obvious emotional indifference.
(3) Emotional decline: it is more serious than emotional indifference in degree, which refers to the extreme defect or loss of emotional response. Patients lack emotional response to external stimuli, and have neither inner experience nor changes in facial expressions, or giggle all day without inner experience, and their facial expressions are childish. However, the stimulation of pain and the most basic physiological needs will cause some emotional reactions. This symptom is generally a part of the continuous irreversible degradation of the whole mental activity, which is common in the late stage of schizophrenia.
(4) Emotional numbness: also known as emotional body grams. Refers to the temporary suppression of emotional response caused by strong mental stimulation. Although the patient is extremely sad or frightened, he lacks inner experience and expression changes, and even does not respond to pain stimuli, showing numbness.
(5) Emotional inversion: This means that the emotional response of patients is opposite to the direction of external stimuli. Happy things can cause sad emotional experiences, while sad things can cause happy emotional reactions. For example, a patient received a phone call about his father's death, and he smiled and was very excited. Sometimes when it comes to people who persecute him by various cruel means, it feels painful as if nothing had happened. They even told their misfortunes with a smile. This symptom belongs to the disharmony and division between emotional reaction and thinking activity or external environment.
(6) The expression is upside down: it means that the expression changes are inconsistent with the inner experience. When I am in pain, I smile, but when I cry, I have no experience of pain and sadness and even feel happy. The patient can't explain why this change happened. This belongs to the disharmony and division within emotional activities.
(7) Contradictory emotions: It means that patients have two completely opposite and contradictory emotional experiences for the same person, phenomenon or thing at the same time. These two experiences are not primary and secondary, but appear at the same time. For example, a patient has an emotional experience of liking and hating the same thing and a love-hate attitude towards the same person. He can't realize that the two are contradictory, nor can he judge which attitude is right and which is wrong. The patient can't feel the pain and can't feel it himself. This symptom often coexists with contradictory thoughts and intentions.
(8) Emotional discomfort: also known as emotional disharmony. Refers to the emotional response is inconsistent with the external stimulus or mental excitement. A trivial matter may arouse the patient's strong emotional reaction, for example, when he is sad, the patient's mood is high, instead of frowning when he is sad. It may be just the opposite. In the face of things that should cause emotional reactions, patients are indifferent. It also belongs to the disharmony between emotional response and external stimulus, but the emotional reversal did not reach the opposite degree.
(9) Imposed emotion: it means that the emotional experience experienced by the patient is not spontaneous, but is imposed on him by external forces, just like being implanted in his experience. For example, when the patient is in contact with the doctor, he is very frightened and nervous, saying that he doesn't know why he has this experience. Although he did experience it, it was not his own experience. It may be imposed on itself by an unknown group through a means that he still doesn't understand. Together with other passive experiences, it constitutes mental automatism.
(10) Emotional impermanence means that there is no corresponding causal relationship between emotional changes and objective situations and scenarios. It is moody and unpredictable, accompanied by some strange and childish expressions, with stupid excitement or/and pranks.
(1 1) impatience: refers to the patient's strong emotional reaction under slightly unpleasant circumstances. Show excitement, anger and impulse. Generally, the duration is relatively short. No or no obvious disturbance of consciousness.
(12) Pathological passion: refers to sudden, short-lived and violent emotional outburst without cause, accompanied by destructive impulsive behavior. There were many obstacles to consciousness, and the patient couldn't control it at that time. Then he forgot. This symptom is rare in schizophrenia.
(13) Pathological euphoria: refers to the monotonous feeling of joy, happiness and happiness without corresponding objective incentives, accompanied by stupid, childish, humorous and joking behaviors (humorous euphoria). The patient has no self-knowledge, giving people a sense of irony.
(14) Pathological dysthymia refers to the patient's dissatisfaction, grievance, sadness, anger, excitable emotions and aggressive behaviors without any psychological factors for a period of time.
(15) Emotional depression: It refers to the enhancement of negative emotions in a period of time under the stimulation of intentional or unintentional reasons. Patients are depressed, depressed, pessimistic, worried, uninterested, libido decreased, and sleep disorders. They always observe and treat everything with sad light and attitude. It seems that all the endings are unfortunate and desperate. Schizophrenia patients can have this symptom under the domination of crime, hypochondriasis and delusion or during the recovery period. (16) Fear: This symptom may appear when patients are delusional, ranging from paranoia and fear to panic, running and shouting, hiding, accompanied by autonomic nervous function changes such as palpitation and palpitation. This kind of emotional reaction is unreasonable, which is beyond the normal range in severity and duration.