What is schizophrenia? - Anees Bahji

翻译人员: Elena Wu 校对人员: Yolanda Zhang

Schizophrenia was first identified more than a century ago,

精神分裂症第一次被发现， 是一个多世纪以前的事，

but we still don’t know its exact causes.

但我们至今仍不知道其确切的病因。

It remains one of the most misunderstood and stigmatized illnesses today.

如今，它仍是被误解 和污名化最严重的疾病之一。

So, let’s walk through what we do know— from symptoms to causes and treatments.

那么，让我们来谈一谈我们知道的事情 ——从症状到病因及治疗。

Schizophrenia is considered a syndrome,

精神分裂症是一种综合症，

which means it may encompass a number of related disorders

这说明它可能包含多种相关的病症，

that have similar symptoms but varying causes.

这些病症有相似的症状， 却有着不同的病因。

Every person with schizophrenia has slightly different symptoms,

精神分裂症患者的症状都略有不同，

and the first signs can be easy to miss— subtle personality changes, irritability,

且最初的迹象很容易被忽视—— 人格的微变、易怒，

or a gradual encroachment of unusual thoughts.

或思维逐渐被不寻常的想法侵占。

Patients are usually diagnosed after the onset of psychosis,

病人通常在病发后才被确诊，

which typically occurs in the late teens or early twenties for men

男性通常在二十岁左右发病，

and the late twenties or early thirties for women.

而女性一般在三十岁左右发病。

A first psychotic episode can feature delusions, hallucinations,

精神病首次发作可能 表现为妄想、幻觉，

and disordered speech and behavior.

以及错乱的言行举止。

These are called positive symptoms,

这些被称为阳性症状——

meaning they occur in people with schizophrenia

只有精神分裂症患者才会出现，

but not in the general population.

一般人不会有。

It’s a common misperception that people with schizophrenia

一个常见的误解是

精神分裂症患者都有多重人格，

have multiple personalities,

but these symptoms indicate a disruption of thought processes,

实际上，上述症状只表明 患者的思考过程被打乱，

rather than the manifestation of another personality.

并非另一个人格的形成与出现。

Schizophrenia also has negative symptoms,

精神分裂症也有阴性症状，

these are qualities that are reduced in people with schizophrenia,

这些是精神分裂症患者 会缺少的一些特质，

such as motivation, expression of emotion, or speech.

例如行动力、情绪表达能力或言语能力。

There are cognitive symptoms as well, like difficulty concentrating,

认知方面的症状也会显现出来， 比如难以集中注意、

记住信息，以及做出决定。

remembering information, and making decisions.

So what causes the onset of psychosis?

那么究竟是什么原因 导致了精神分裂症发作？

There likely isn’t one single cause, but a combination

病因应该不止一个，

而是基因与环境风险因子 结合所导致的。

of genetic and environmental risk factors that contribute.

Schizophrenia has some of the strongest genetic links of any psychiatric illness.

精神分裂症与基因的连结 在所有的精神疾病中最强。

Though about 1% of people have schizophrenia,

虽然只有 1% 的人患有精神分裂症，

children or siblings of people with schizophrenia are ten times likelier

精神分裂症患者的 孩子或亲人的发病率

to develop the disease,

比其他人高十倍。

and an identical twin of someone with schizophrenia

如果同卵双胞胎中 有一人患有精神分裂症，

has a 40% chance of being affected.

另外一人会有四成的几率被影响。

Often, immediate relatives of people with schizophrenia

通常，患者的直系亲人

exhibit milder versions of traits associated with the disorder—

也会呈现与该病症 相关的轻微特性——

but not to an extent that requires treatment.

但没有严重到需要治疗的程度。

Multiple genes almost certainly play a role,

我们几乎可以确定精神分裂症 与多个基因相关，

but we don’t know how many, or which ones.

但我们并不知道 这些基因的具体个数和类型。

Environmental factors like exposure to certain viruses in early infancy

环境因子，比如婴儿期 初期接触到某些病毒，

might increase the chance that someone will develop schizophrenia,

可能会增加患上精神分裂症的机会。

and use of some drugs, including marijuana,

服用某些药物，包括大麻，

may trigger the onset of psychosis

也可能促使

in highly susceptible individuals.

高风险者发病。

These factors don’t affect everyone the same way.

这些因子对不同个体的影响存在差异。

对那些基因风险很低的人来说，

For those with very low genetic risk,

no amount of exposure to environmental risk factors

不论多少环境因子

will lead them to develop schizophrenia;

都不会使他们患上精神分裂症；

for those with very high risk, moderate additional risk might tip the balance.

而对于患病风险非常高的人，中等的 额外风险也可能会破坏这种平衡。

The antipsychotic drugs used to treat schizophrenia have helped researchers

治疗精神分裂症的药物 能协助研究者

work backwards to trace signatures of the disorder in the brain.

追踪这种病症在大脑中呈现的特征。

Traditional antipsychotics block dopamine receptors.

传统的抗精神疾病药物 会阻隔多巴胺受体，

They can be very effective in reducing positive symptoms,

对于减轻阳性症状效果显著，

which are linked to an excess of dopamine in particular brain pathways.

因为这些症状和大脑中 特定通路的多巴胺含量过高有关。

But the same drugs can make negative symptoms worse,

但是，同样的药物也可能 恶化阴性症状，

and we’ve found that negative symptoms of schizophrenia may be tied

研究发现， 精神分裂症的阴性症状

与大脑其他区域的 多巴胺含量太低有关。

to too little dopamine in other brain areas.

Some people with schizophrenia show a loss of neural tissue,

个别患者会出现 神经组织萎缩的状况，

and it’s unclear whether this atrophy is a result of the disease itself

我们还不清楚这种萎缩 是由于疾病本身，

or drug-induced suppression of signaling.

还是由药物导致讯号传输 被压制的结果。

Fortunately, newer generations of antipsychotics aim to address

幸运的是，近代的抗精神病药物

some of these issues by targeting multiple neurotransmitters,

致力于通过针对多种神经传递介质 来解决这些问题，

like serotonin in addition to dopamine.

比如血清素加上多巴胺。

It’s clear that no one transmitter system is responsible for all symptoms,

可以确定的是：所有的症状 并不是由单一传递介质系统造成的，

and because these drugs affect signaling throughout the brain and body,

而且，因为这些药物会影响 大脑和身体各处的信号传递，

they can have other side effects like weight gain.

服用药物可能引起 其他副作用，比如体重增加。

In spite of these complications, antipsychotics can be very effective,

虽然存在病发症的风险， 抗精神病药物仍然有着积极的作用，

especially when combined with other interventions

尤其是与其他医疗方式结合时，

like cognitive-behavioral therapy.

比如认知行为治疗。

Electroconvulsive therapy, though it provides relatively short-lived relief,

电痉挛疗法尽管只能短暂的缓解症状，

is also re-emerging as an effective treatment,

但已经作为一种有效的方法 被越来越多人采纳，

especially when other options have failed.

尤其是在缺乏更有效的疗法时。

Early intervention is also extremely important.

早期介入治疗也非常重要。

After months or years of untreated psychosis,

如果患上精神病后的 数月或数年没有接受治疗，

certain psychoses can become embedded in someone’s personality.

有些精神异常可能 转变成患者人格的一部分。

And yet, the dehumanizing stigma attached to this diagnosis

然而，精神病的诊断 会使人背上非人化的污名，

can prevent people from seeking help.

患者会因此选择不去求助。

People with schizophrenia are often perceived as dangerous,

精神分裂症患者 一般被认为很危险。

but are actually much more likely to be the victims of violence

实际上，他们更可能是暴力的受害者，

than the perpetrators.

而非加害者。

And proper treatment may help reduce the likelihood of violence

适当的治疗也许可以帮助降低

associated with schizophrenia.

患者实施暴力行为的可能性。

That’s why education— for patients, their families, and their communities—

这就是为什么对病人、 家属以及社会的教育

helps erode the stigma and improves access to treatment.

能帮助消除污名， 并让更多人及时获得治疗。