What is schizophrenia? - Anees Bahji

譯者: Lilian Chiu 審譯者: 潘 可儿

Schizophrenia was first identified more than a century ago,

初次發現思覺失調症 是至少一個世紀以前的事，

but we still don’t know its exact causes.

但我們目前仍然不知道 它的確切成因。

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

它仍然是現今最被誤解 及汙名化的疾病之一。

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

那麼，咱們來談談那些已知的事實 ——從症狀到成因及治療。

Schizophrenia is considered a syndrome,

思覺失調症被認為是一種症候群，

which means it may encompass a number of related disorders

意思就是說，它可能 包含多種相關的病徵，

that have similar symptoms but varying causes.

具有類似的症狀， 但各式各樣的成因。

Every person with schizophrenia has slightly different symptoms,

每位有思覺失調症的人 都有些微不同的症狀，

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

且最初的徵兆很容易被忽視——

人格發生些微改變、易怒，

or a gradual encroachment of unusual thoughts.

或漸漸被不尋常的想法給侵占。

Patients are usually diagnosed after the onset of psychosis,

病人通常是在精神病 發作之後才被診斷出來，

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

男性多半會發生在 接近二十歲或二十歲初頭時，

and the late twenties or early thirties for women.

女性多半會發生在 接近三十歲或三十歲初頭時。

A first psychotic episode can feature delusions, hallucinations,

在第一次精神病發作時， 可能會有妄想、幻覺，

and disordered speech and behavior.

以及錯亂的言行舉止。

These are called positive symptoms,

這些叫做正性症狀，

meaning they occur in people with schizophrenia

意即，思覺失調症患者才會有，

but not in the general population.

一般人則不會。

It’s a common misperception that people with schizophrenia

常見的錯誤觀念是， 有思覺失調症的人

have multiple personalities,

就會有多重人格，

but these symptoms indicate a disruption of thought processes,

但實際上這些症狀是 思考過程被打斷的表現，

rather than the manifestation of another personality.

而並非另一個人格的形成出現。

Schizophrenia also has negative symptoms,

思覺失調症也會出現負性症狀，

these are qualities that are reduced in people with schizophrenia,

也就是有思覺失調症的人 身上會缺乏這些特性，

such as motivation, expression of emotion, or speech.

比如動力、情緒表達，或語言能力。

There are cognitive symptoms as well, like difficulty concentrating,

也有一些認知症狀， 比如難以集中注意力、

remembering information, and making decisions.

記住資訊，以及做決策。

So what causes the onset of psychosis?

所以，造成精神病發作的原因是什麼？

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

成因很可能不是單一的，

而是基因與環境風險因子 結合在一起所導致。

of genetic and environmental risk factors that contribute.

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

在所有的精神疾病中， 思覺失調症和基因的連結最強。

Though about 1% of people have schizophrenia,

雖然約有 1% 的人有思覺失調症，

children or siblings of people with schizophrenia are ten times likelier

思覺失調症患者的 孩子或手足的發病率，

可能會比其他人要高十倍。

to develop the disease,

and an identical twin of someone with schizophrenia

如果同卵雙生的雙胞胎中一人 有思覺失調症，

has a 40% chance of being affected.

另外一人則有四成的機會被影響到。

Often, immediate relatives of people with schizophrenia

通常，思覺失調症患者的直系親人

exhibit milder versions of traits associated with the disorder—

也會呈現出該病症的相關特質， 只是比較輕微——

but not to an extent that requires treatment.

還沒有到需要治療的程度。

Multiple genes almost certainly play a role,

幾乎可以確定思覺失調症 和多個基因相關，

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

但我們還不知道 基因的具體個數和類型。

Environmental factors like exposure to certain viruses in early infancy

環境因子，如在嬰兒期 初期接觸到某些病毒，

might increase the chance that someone will develop schizophrenia,

可能會增加患思覺失調症的機會，

and use of some drugs, including marijuana,

而服用某些藥物，包括大麻，

may trigger the onset of psychosis

可能會促使易受影響者發病。

in highly susceptible individuals.

These factors don’t affect everyone the same way.

這些因子對每一個人的影響不同。

For those with very low genetic risk,

對基因風險非常低的人來說，

no amount of exposure to environmental risk factors

不論暴露在多少量的 環境風險因子之下，

will lead them to develop schizophrenia;

都不會讓他們發展出思覺失調症；

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

至於風險非常高的人，

只要減少額外風險 就有可能會破壞平衡。

The antipsychotic drugs used to treat schizophrenia have helped researchers

用來治療思覺失調症的 抗精神疾病藥物能協助研究者

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

追蹤這種病症在大腦中的特徵。

Traditional antipsychotics block dopamine receptors.

傳統的抗精神疾病藥物 會阻隔多巴胺受體。

They can be very effective in reducing positive symptoms,

對於減輕正性症狀很有效果，

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

因為這些症狀和大腦中 特定通路的多巴胺含量過高有關。

But the same drugs can make negative symptoms worse,

但，同樣的藥物也有可能 讓負性症狀更嚴重，

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

研究已經發現， 思覺失調症的負性症狀

可能和大腦其他區域的 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,

有些思覺失調症患者會出現 神經組織流失的狀況，

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

我們仍不清楚這種萎縮 是該疾病本身的直接結果，

or drug-induced suppression of signaling.

或是藥物導致訊號傳遞被壓制的結果。

Fortunately, newer generations of antipsychotics aim to address

幸運的是，近幾代的抗精神病藥物

都是透過針對多種神經傳遞介質 來解決這些問題，

some of these issues by targeting multiple neurotransmitters,

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,

可以確定的一點是，所有症狀 並不是單一傳遞介質系統造成，

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

而且，因為這些藥物會影響 大腦和身體各處的訊號傳遞，

they can have other side effects like weight gain.

服藥可能會引起其他 副作用，如體重增加。

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

儘管有併發症， 抗精神病藥物仍然非常有效，

especially when combined with other interventions

特別是與其他醫療介入方式結合，

like cognitive-behavioral therapy.

比如認知行為治療。

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

雖然電痙攣療法僅能提供 相對短暫的舒緩，

is also re-emerging as an effective treatment,

但也被再次用作有效治療方式，

especially when other options have failed.

特別是在其他療法都無效時。

Early intervention is also extremely important.

早期介入治療也非常重要。

After months or years of untreated psychosis,

如果得了精神病後的 數個月或數年沒有去治療，

certain psychoses can become embedded in someone’s personality.

某些精神異常可能就會 變成病人人格的一部分。

And yet, the dehumanizing stigma attached to this diagnosis

然而，由於精神病的診斷 會讓人背上沒人性的汙名，

can prevent people from seeking help.

人們會因此而選擇不去求助。

People with schizophrenia are often perceived as dangerous,

一般認為思覺失調症患者很危險，

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

但實際上，他們更有可能是 暴力的受害者

than the perpetrators.

而並非加害者。

And proper treatment may help reduce the likelihood of violence

適當的治療能協助降低

思覺失調症相關暴力 發生的可能性。

associated with schizophrenia.

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

那就是為什麼教育——對病人、 其家屬、其社區的教育——

helps erode the stigma and improves access to treatment.

能協助消除汙名， 並讓更多人得到治療。