Specialized disease outpatient clinic opened by Shanghai Mental Health Center , where patients with obsessive-compulsive disorder can get diagnosis and treatment. Photo by Chen Sisi, a reporter from The Paper,
. Wash your hands over and over again, but you always feel that you are not clean, repeatedly wipe off the correct homework, close the window more than ten times and have to let your family check it... These "extreme" behaviors occur, they are suffering from Obsessive-compulsive disorder.
In the field of mental illness, according to the difficulty level of treatment, although obsessive-compulsive disorder is a common disease, it can be regarded as the most difficult to treat, and even discourages many doctors. International report research data shows that the treatment of obsessive-compulsive disorder is effective at about 40-60%, but only 20% of them can achieve clinical cure.
"Obsy-compulsive disorder is mainly manifested in repeated compulsive thinking and compulsive behaviors. Although in most cases, they know that these thoughts or behaviors are not necessary, it is difficult to control themselves. This will bring life and work to themselves and even their families and people around them. Come to influence. "Recently, Wang Zhen, deputy director of Shanghai Mental Health Center and clinical psychologist, said in an interview with Pengpai News (www.thepaper.cn) that the hospital's statistics in recent years show that patients with obsessive-compulsive disorder The number of medical treatments is showing an upward trend of 10%-15% every year.
Data shows that in the Shanghai Mental Health Center alone, the number of outpatient obsessive-compulsive disorder patients visited more than 50,000 in 2020. In Wang Zhen’s outpatient clinic, the age span of this type of patients is 14 to 83 years old, and the symptoms last for a long time even more than 50 years. Not only students, but also office workers, the elderly, etc.
"Many people in society believe that poverty caused by illness will not occur in mental illnesses such as obsessive-compulsive disorder, but in fact, many people will lose their jobs, schooling, and even lose their social ability to survive." Wang Zhen called for attention to this Mental diseases, early detection, early treatment, and standardized treatment.
Most people will have compulsion, but they may not be ill
"I never tire of confirming whether I have closed the door, washed my hands over and over again, but I always feel that I am not clean, I always feel that I have written the wrong words and need to be erased and rewritten, I always feel that I have to write it wrong, I always feel that I need to erase and rewritten it, I always feel that I have always felt that I have written the wrong words and need to be erased and rewritten. I said the wrong thing to others and went to confirm repeatedly with the other party. Some people are always worried about what to do if they are bitten by a dog, and whether the red liquid on their body is blood..." This is what Wang Zhen often does in his outpatient clinic A type of patient encountered.
He still remembered that there was an old man in his 80s who came to see a doctor with his son. Because the old man was afraid of writing wrong words every day, similar obsessive-compulsive symptoms have lasted for 53 years. Every day, the old man still had to call his son. At most, I have made nearly 200 calls a day. If there is no reply from my phone, the elderly will send a lot of messages.
"'Forcing' is a phenomenon that ordinary people can also have. According to the severity, the lightest is the phenomenon of compulsion. More than 90% of people have occasionally appeared, such as worrying that the door is not locked after going out, but it will not give life If this phenomenon happens every time you go out, you even need to push the door a few times, but you don’t waste too much time, you may have reached the level of ‘obsessive-compulsive symptoms’. Due to the limited impact on life, this one is just Symptoms do not constitute a diagnosis of the disease. "Wang Zhen further stated that, however, if these behaviors are completely out of control and have to consume a lot of energy every day (such as more than an hour), causing pain and trouble to the people around him, then You need treatment.
Wang Zhen gave an example, for example, some patients always feel that the windows at home are not closed before going to bed, and they have closed them more than 10 times but still feel that they are not closed properly, and they force their families to check them over and over again. There are also young mothers suffering from obsessive-compulsive disorder after giving birth. Don't dare to hold your child, for fear of throwing it to the ground or falling out of the window, or even not sleeping well, eating, and not being able to take care of the child normally; there are people who repeatedly think about meaningless problems in their minds, knowing that there is no need to think about it, but But I can't stop; some people are always worried that they will accidentally get serious diseases such as AIDS , rabies , etc. There are also patients with severe obsessive-compulsive disorder. They are forced to sleep 24 hours a day, except for sleeping, and their social functions are almost completely lost, and even their basic ability to survive.
Wang Zhen said that there are many forms of symptoms of obsessive-compulsive disorder. From the content of the symptoms, it can be roughly divided into pollution, sex, symmetry of things, superstition or belief, or hoarding of items.
Adolescent children are the peak of obsessive-compulsive disorder
By years of clinical experience, Wang Zhen summarized: The two major peaks of obsessive-compulsive disorder are in adolescence and early adulthood (especially when you first enter the stage of social work). In his outpatient clinic, the youngest first-time patient was only 14 years old.
"Many student patients have their grades declined, and their parents take them to the outpatient clinic. There are relatively more students in the third year of junior high school and senior high school. This may be related to the high attention paid to children at this stage of study." Wang Zhen admitted that there are parents. Said that children are always used to wiping away their homework repeatedly. Even though they know they have done it right, they still can't help but rewritten it. During class, their eyes can't be facing the teacher, and they will face other places. , the child cannot control himself and his heart is very painful. There are also some adolescent students who take a shower for more than an hour, but don’t go to the toilet for a day when they are in school or outside because they feel that the toilet is dirty and don’t want to go.
Wang Zhen remembered that a little girl of sixteen or seventeen years old suffered from severe obsessive-compulsive disorder. She always thought she was paying attention to the private parts of the opposite sex. She was a very "dirty" person, so she lowered her head in class and did not dare to look at the blackboard. Once you are touched by the opposite sex, you have to keep cleaning at home.
At first, the parents thought that this was not a disease, and they never thought of bringing the child to see him, but the little girl took the New Year's money to see the patient, and the effect was very significant after treatment for a period of time. However, after parents knew about it, they did not think that this was the effect of treatment, but their own teaching and supervision played a role. The family's incomprehension forced the girl to suspend medical treatment. It can be seen that there is still a lot of work to be done to make the patient's family understand and cooperate with the treatment.
Wang Zhen said that although patients with obsessive-compulsive disorder have a biological basis of "susceptibility", the stimulation of external pressure, poor life experience and educational methods will have an acquired impact, which is often the direct cause of the patient's real illness.
"Some parents complain to the doctor that they never ask for their children's grades, but the emotions or behaviors expressed by their children's grades are seen by adolescent children. They are often very sensitive inside and pursue perfection in their own pursuits. , Children with high self-requirement are particularly prone to obsessive-compulsive disorder. The adverse external emotional impact, academic pressure, and peer competition may all become important external factors that induce obsessive-compulsive disorder." Wang Zhen analyzed.
The treatment of mental diseases must be taken seriously
"Many people in society believe that cancer will have a great impact on their families and even society, but for many mental illnesses, people do not have this awareness and believe that poverty caused by illness will not occur in cases such as forced In terms of mental illnesses such as symptom, but in fact, many people will lose their jobs, schooling, and even lose their social ability to survive." Wang Zhen said.
As early as 2019, Wang Zhen took the lead in conducting a survey covering 12 provinces and cities across the country. The direct and indirect economic losses caused by obsessive-compulsive disorder are as high as 33 billion yuan each year, including patients' medical expenses, loss of work, and transportation and accommodation. and family members’ lost wages.
In 2015, an old couple came to see the doctor with their son in their 30s. My son had good grades in high school, but he got sick in the first half of the year of the college entrance examination and developed many obsessive-compulsive symptoms. He needed to spend 3 hours to go to the toilet. He was always afraid of being dirty, hurting others, and afraid that he would say something disrespectful to others, so his grades plummeted. In the end, I only got into college.
After more than ten years of treatment, due to irregular medication, my son's health had great problems. He was also deceived for a while and spent tens of thousands of yuan to try "folk remedies", but it did not get any effect. He was misdiagnosed in a local hospital as " schizophrenia ", the family finally pieced together and saved tens of thousands of yuan to come to Shanghai for the last time for a medical treatment. Fortunately, after nearly a year of drug treatment and psychological treatment, the son's symptoms improved significantly, and the old couple repeatedly said "thank you" to Wang Zhen.
"The diagnosis and treatment of obsessive-compulsive disorder is difficult, and the treatment of some cases is long-term. Whether all over the country or other countries and regions in the world, there are irregular treatments for obsessive-compulsive disorder. If the right medicine cannot be prescribed, it is extremely It is possible that the whole family will become poor due to illness." Wang Zhen said that in the past few years, irregular treatment situations were often seen in many patients referred to in other provinces and cities. In recent years, with the professional promotion of academic groups, , drug treatment is gradually standardized, and there is still a lot of room for improvement in psychotherapy and comprehensive treatment capabilities.
China's first "brain pacemaker" clinical trial is being carried out
In Wang Zhen's outpatient clinic, most of the patients with refractory obsessive-compulsive disorder from all over the country. In the afternoon clinic, you often see 9-10 pm. Once late, it ends at 11pm, but there are few patients complaining because for patients, this is him The "terminal station" for treating obsessive-compulsive disorder that we recognize, often says: "If it cannot be cured here, then we can only give up the treatment."
"The patient group often calls "obsessive-compulsive disorder" the Mental cancer, this mainly means that obsessive-compulsive disorder is difficult to treat, but it is not incurable, it is necessary to find appropriate treatment methods. "Wang Zhen said that obsessive-compulsive disorder is 40-60% effective in the research data reported by internationally reported. But only 20% of them can achieve clinical cure. Wang Zhen further stated that in clinical practice, the misdiagnosis rate of obsessive-compulsive disorder is still high, and some patients with absurd symptoms are often misdiagnosed as other mental illnesses such as schizophrenia. At the same time, the standardization of treatment and the degree of cooperation of their families will affect the Effectiveness. The individual differences among patients are also very large. Even if psychological, drug, and neuroregulatory therapies are used, 15-20% of patients still have poor efficacy, thus developing refractory obsessive-compulsive disorder.
At present, patients with more serious obsessive-compulsive disorder who have poor drug effects or are unwilling to take medication can be treated through non-invasive transcranial magnetic stimulation, transcranial electrical stimulation, etc. The obsessive-compulsive disorder research team has also established a brain imaging efficacy prediction model , which can evaluate which types of patients are suitable for these treatments and what are possible efficacy, thereby reducing the cost of treatment.
Wang Zhen introduced that, currently, the Shanghai Mental Health Center, cooperates with the Institute of Neurology of the Chinese Academy of Sciences and an innovative company, is conducting research on the treatment of refractory obsessive-compulsive disorder in deep brain electrical stimulation (DBS), which may bring treatment to patients with refractory obsessive-compulsive disorder. Dawn.
Deep brain electrical stimulation (DBS) is also called "brain pacemaker" treatment. The national multi-center clinical registration trial that has been launched is the first project to use domestic "brain pacemaker" to treat refractory obsessive-compulsive disorder. The first large-sample clinical study to treat mental illnesses using the internationally leading dual-target stimulation technology. More than 30 refractory patients have been treated and are expected to be completed as soon as 2023.
"This clinical trial implanted an electrode with a diameter of 1.27mm into the target nucleus in the brain through minimally invasive surgery, and output stimulation signals of different parameters through implanting the stimulator under the chest to achieve the purpose of treating obsessive-compulsive disorder. This dual-target Point electrodes and stimulation chips break through the limitations of the existing technology and can output electricity of different frequencies, pulse widths and voltages for two different brain functional areas on the same electrode. Stimulation pulse is a targeted electronic drug. During the treatment process, we can also provide treatment parameters in different states such as daily life and sleep based on the patient's daily routine to improve the effect of the treatment." Wang Zhen said that this clinical trial The pre-experiment results show that 60% of patients have reached the clinical cure level, some early enrolled patients have continued to reduce stimulation parameters, and the symptoms have not rebounded, and even a small number have reached the point where the electrodes can be removed. These patients will be subject to a long-term long-term treatment in the future. Follow-up.
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