What is schizophrenia? - Anees Bahji

Translator: Dawny Tsoi Reviewer: C iff

Schizophrenia was first identified more than a century ago,

思覺失調呢個病 發現咗超過一個世紀

but we still don’t know its exact causes.

我哋到而家都未知道 呢個病嘅成因

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

佢亦都係當今最被誤解 同污名化嘅疾病之一

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

咁我哋嚟講解吓已知嘅⋯⋯

症狀、病因同治療

Schizophrenia is considered a syndrome,

思覺失調被認為係一種症候群

which means it may encompass a number of related disorders

亦即係佢包含類近嘅失常症狀

that have similar symptoms but varying causes.

睇落去相似 但係成因各有不同

Every person with schizophrenia has slightly different symptoms,

每個有思覺失調嘅人 都有唔同嘅症狀

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

而最初的病徵好難察覺到⋯⋯

輕微人格轉變、易怒

or a gradual encroachment of unusual thoughts.

或者慢慢畀唔尋常嘅想法侵占

Patients are usually diagnosed after the onset of psychosis,

病人通常喺精神錯亂 開始發作時候確診

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

男性通常喺青少年到二十零歲確診

and the late twenties or early thirties for women.

而女性就通常喺二十尾三十頭確診

A first psychotic episode can feature delusions, hallucinations,

第一次精神錯亂發作嘅時候

病人可能會有妄想同幻覺

and disordered speech and behavior.

同錯亂嘅言行舉止

These are called positive symptoms,

呢啲叫正性症狀

meaning they occur in people with schizophrenia

即係思覺失調症患者先會有

but not in the general population.

普通人就唔會

It’s a common misperception that people with schizophrenia

坊間常見嘅錯誤觀念 就係有思覺失調嘅人

have multiple personalities,

有多重人格

but these symptoms indicate a disruption of thought processes,

但實際上呢啲症狀係 思維被打斷嘅表現

rather than the manifestation of another personality.

而唔係另一個人格出現咗

Schizophrenia also has negative symptoms,

思覺失調亦都有負性症狀

these are qualities that are reduced in people with schizophrenia,

呢類思覺失調患者 會缺失或降低原有能力

such as motivation, expression of emotion, or speech.

例如幹勁、情緒表達，語言能力

There are cognitive symptoms as well, like difficulty concentrating,

患者都可能有認知障礙， 例如集中唔到注意力

remembering information, and making decisions.

記性差、選擇困難

So what causes the onset of psychosis?

咁，係咩嘢導致思覺失調呢？

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

成因好大機會唔只一個

而係包含基因同環境因素等 導致呢個病嘅產生

of genetic and environmental risk factors that contribute.

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

喺所有精神疾病中 思覺失調同基因嘅關係最大

Though about 1% of people have schizophrenia,

雖然得一成嘅人患上思覺失調

children or siblings of people with schizophrenia are ten times likelier

但係思覺失調患者嘅 細路同兄弟姊妹

發病率比其他人高十倍

to develop the disease,

and an identical twin of someone with schizophrenia

如果同卵雙生嘅雙胞胎 其中一個有思覺失調

has a 40% chance of being affected.

另外一個就有四成嘅機會患病

Often, immediate relatives of people with schizophrenia

通常思覺失調患者嘅直系親人

exhibit milder versions of traits associated with the disorder—

都會有輕微嘅相關病徵

but not to an extent that requires treatment.

但係未嚴重到需要治療

Multiple genes almost certainly play a role,

而家幾乎可以肯定 多基因同呢個病息息相關

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

但我哋仲未知道 係邊種同幾多基因

Environmental factors like exposure to certain viruses in early infancy

環境因素

例如嬰兒時期接觸到某啲病毒

might increase the chance that someone will develop schizophrenia,

可能會增加大咗 患思覺失調嘅機會

and use of some drugs, including marijuana,

而服用某啲藥物 包括大麻

may trigger the onset of psychosis

都有機會導致高風險人士發病

in highly susceptible individuals.

These factors don’t affect everyone the same way.

每個人對呢啲因素 嘅反應都唔同

For those with very low genetic risk,

對低基因風險嘅人嚟講

no amount of exposure to environmental risk factors

無論佢哋接觸幾多 環境風險因素

will lead them to develop schizophrenia;

都唔會患上思覺失調

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

而高風險人士

些微嘅環境轉變 都可能會令到佢哋發病

The antipsychotic drugs used to treat schizophrenia have helped researchers

研究人員透過用嚟 治療思覺失調嘅抗精神病藥物

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

反追蹤呢個病 影響腦裡面邊個部位

Traditional antipsychotics block dopamine receptors.

傳統嘅抗精神病藥物 可以阻隔多巴胺受體

They can be very effective in reducing positive symptoms,

對於有正性症狀嘅病人好有效

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

因為正性症狀通常都係 腦裡面某啲通道分泌太多多巴胺

But the same drugs can make negative symptoms worse,

但係呢類藥物就有可能 令負性症狀更嚴重

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

研究發現 思覺失調嘅負性症狀

可能同大腦某啲區域嘅 多巴胺含量太低有關

to too little dopamine in other brain areas.

Some people with schizophrenia show a loss of neural tissue,

有啲思覺失調症患者會出現 神經組織流失嘅情況

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

我哋仲未清楚呢種神經萎縮 係呢個病而產生嘅後果

or drug-induced suppression of signaling.

定係因為藥物壓制咗神經訊號傳遞

Fortunately, newer generations of antipsychotics aim to address

好彩嘅係 近幾代嘅抗精神病藥物

可以針對多種神經傳遞素 嚟解決呢啲問題

some of these issues by targeting multiple neurotransmitters,

like serotonin in addition to dopamine.

例如血清素加埋多巴胺

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

可以確定嘅係呢啲症狀 唔係由一個神經傳遞素引起

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

而且呢啲藥物會影響 大腦同身體嘅訊號傳遞，

they can have other side effects like weight gain.

藥物可能會引起其他副作用 例如體重增加

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

雖然有副作用

抗精神病藥物仍然十分有效

especially when combined with other interventions

尤其係加埋其他介入治療

like cognitive-behavioral therapy.

例如認知行為治療

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

雖然電療法只能夠 提供病人短暫嘅舒緩

is also re-emerging as an effective treatment,

但都開始被採用為有效療法

especially when other options have failed.

尤其係當其他療法對病人 都無效嘅時候

Early intervention is also extremely important.

早期介入治療都非常重要

After months or years of untreated psychosis,

如果患上思覺失調而唔去求醫 過左一段時間之後

certain psychoses can become embedded in someone’s personality.

某啲精神錯亂可能就會 變咗病人人格嘅一部分

And yet, the dehumanizing stigma attached to this diagnosis

但因為思覺失調一路 被社會不解同標籤化

can prevent people from seeking help.

病人驚俾人歧視 而選擇唔去求醫

People with schizophrenia are often perceived as dangerous,

坊間誤以為思覺失調患者好危險

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

但實際上佢哋更有可能 係暴力嘅受害者

than the perpetrators.

而唔係施害者

And proper treatment may help reduce the likelihood of violence

適當嘅治療可以幫助降低

因為思覺失調而產生嘅暴力傾向

associated with schizophrenia.

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

所以教育大眾對病人 病人家屬同埋社區

helps erode the stigma and improves access to treatment.

可以幫助消除呢種恐懼 令病人能夠及早得到治療