Introduction
October 10, 2022 is World Mental Health Day . It was initiated by World Psychiatric Association in 1992. It aims to raise public awareness of mental health issues and mobilize all parties to work hard to support mental health. WHO The Comprehensive Mental Health Action Plan 2013-2030 highlights the measures required to provide appropriate services to patients with mental disorders, including schizophrenia . In 2012, my country first promulgated the " Mental Health Law of the People's Republic of China " to protect the rights and interests of patients with mental illness. " "Healthy China 2030" Planning Outline " also clearly points out the improvement of the level of intervention in the prevention and treatment of common mental disorders and the identification of psychological behavior problems, and strengthen the management of serious mental disorders.
It can be seen that all parties are paying more and more attention to mental and mental health issues, including schizophrenia.
Some facts about schizophrenia
World Health Organization data shows that schizophrenia affects about 24 million people worldwide or 1 in every 300 people . According to the latest epidemiological survey of in China, the 12-month prevalence of schizophrenia in China is 0.6%. Based on this calculation, there are about 8 million schizophrenia patients in China.
schizophrenia is one of the top 15 reasons for disabling in the world. About half of schizophrenia patients with also suffer from mental/behavioral disorders 3.
Compared with the general population, the risk of premature death in schizophrenia patients is 3.5 times higher than that in . It is estimated that life expectancy for men and women with schizophrenia is shortened by 19 years and 16 years 4, respectively. About 5% of schizophrenia patients with die of suicide, which is far higher than the general population. It is reported that the incidence of suicide attempts in schizophrenia patients is between 18% and 55% 5.
Schizophrenia patients often have sham , and dare not let others know that they have mental illness because some people may be influenced by their inherent impressions and discriminate against schizophrenia patients. More than two-thirds of psychopaths in the world do not receive professional mental health care treatment 1.
schizophrenia patients are more likely to be unemployed , homeless , poor , difficult to complete family and self-care , and highly relies on the continuous care and mental health support of their family . Schizophrenia usually occurs in the middle age of youth, which is when an individual is most likely to be financially productive. Undoubtedly, schizophrenia has caused a heavy burden on personal , family , medical and social .
It is gratifying that patients with schizophrenia currently have a large number of effective treatment options. At least one-third of schizophrenia patients can fully recover after professional treatment.
Schizophrenia patients may experience multiple symptoms. In addition to the well-known positive symptoms and negative symptoms , also has cognitive dysfunction , 8. In fact, at least 85% of schizophrenia patients have long-lasting and serious cognitive impairment , and cognitive impairment is obvious before psychotic symptoms appear, but may be ignored.
- positive symptoms refer to abnormal or "hypertensive" of mental function, which are usually manifested as delusions, hallucinations, nonsense, repeated behavioral disorders or out of control, restlessness, etc. Negative symptoms of
- refer to "decline" or lack of mental function, which are mostly manifested as minimal speech, indifferent to things, inability to experience interest or pleasure, and social withdrawal.
- Cognitive impairment refers to disorders of normal cognitive or intellectual ability. Cognition affects attention, word learning and memory, secondary memory, working memory and executive function, etc. 9,10.
Characteristics of cognitive impairment in schizophrenia patients
Cognitive impairment is not just "memory deterioration"9,10
Multiple cognitive areas of schizophrenia patients are damaged, and the seven most severely damaged cognitive areas include: processing speed, attention and alertness, working memory, word learning and memory, visual learning and memory, reasoning and problem solving, and social cognition (Figure 1).
Figure 1. The seven most severely damaged cognitive areas
2
Cognitive impairment persists, throughout the entire disease 11-14
- Pre-onset of schizophrenia: Cognitive function damage in schizophrenia may occur earlier than the onset of schizophrenia, such as childhood.
- Prodromal stage of schizophrenia: Before the disease starts, psychiatric patients have a long prodromal stage, during which most patients have mild and moderate injuries in areas such as reaction speed, word memory, and recognition of whether someone is angry or happy.
- The first attack of schizophrenia has been found to have a wide range of cognitive dysfunctions, involving all aspects of cognition, but the degree of impairment in each aspect is different. The most significant cognitive dysfunction is information processing speed, verbal memory and visual memory, and the least impaired are attention dimensions and motor processing speed.
- Chronic phase of schizophrenia: Most patients have longitudinal stability in cognitive dysfunction, but some patients, especially in later years, may experience a decrease in cognitive function.
3
Cognitive impairment seriously affects the daily life of patients
The above seven cognitive fields are damaged, causing many difficulties to patients in all aspects of their lives, such as being unable to concentrate on reading and learning, not remembering what they have just read, and even not remembering where they put their things, unable to communicate and express them normally with others, and it is difficult to complete simple daily things such as going out for a car or shopping.
4
Cognitive impairment affects employment and social functions15,16
Attention, word memory and working memory, reasoning and problem solving, and social cognition are the damaged areas that affect career functions. Attention and memory problems can affect the learning of work tasks, and executive function is particularly important in determining employment outcomes, as executive dysfunction is difficult to correct. In addition, social cognition plays an important role in determining the success of workplace communication. Patients with social cognitive deficiencies cannot accurately identify other people's emotional and psychological states, which may lead to poor interpersonal relationships.
5
Cognitive function affects adherence and prognosis 7.17
Most patients have poor adherence to medication, which is manifested as taking less, missed or premature interruption of drug treatment. The study found that memory deficits and poor ability to remember future intentions, decreased attention and low execution ability are all related to patients' medication compliance. Poor medication compliance is more likely to cause adverse outcomes such as recurrence of the disease and re-hospitalization, which seriously affects the patient's quality of life and daily functions, and brings heavy economic pressure and psychological burden to the patient, family and society.
6
Cognitive impairment is the key to the outcome of schizophrenia14,18
Study found that there is no link between changes in symptom severity and changes in cognitive function in patients with schizophrenia, and there is no evidence that there is a dose-dependent relationship between different severity.That is, the patient's cognitive function will not improve with the disappearance of psychotic symptoms, suggesting that cognitive dysfunction is an independent core symptom of schizophrenia and the key to the outcome of the disease. It emphasizes the importance of early detection and treatment of cognitive impairment in schizophrenia patients.
At present, domestic and foreign schizophrenia guidelines will improve patient function and quality of life as the treatment target 7, 19, 20. Cognitive function is significantly related to the overall and specific outcome functions of patients. Cognitive impairment should be one of the main treatment goals for schizophrenia patients.
However, there is currently no effective treatment for cognitive impairment specifically for schizophrenia, and the effect of existing antipsychotic drugs on improving cognitive function is still controversial. Cognitive correction is currently the best treatment option for cognitive impairment, and with the development of technology, computerized cognitive training, artificial intelligence and other technologies have emerged. Some drugs are under development to improve cognitive impairment in patients with schizophrenia. Among them, BI 425809, developed by Boehringer Ingelheim , has completed a global phase II clinical trial and is currently in the global multi-center phase III clinical trial stage, and China is participating in phase III clinical trials simultaneously. I believe that in the future, there will be more abundant treatment options that can help schizophrenia patients better improve their cognition and return to society 21, 22.
