精神分裂症诊疗新进展PPT课件

精神分裂症的流行病学普遍认为，精神分裂症无论何时、何地、何种性别，终生患病率(lifetimeprevalence)均为1%左右。（在移民人群中稍高）2008年McGrath等的分析显示时点患病率终生患病率(Prevalence)约为0.46%约为0.7%艺术家Sue Morgan患精神分裂症20年，在症状缓解以后，他试图通过15名10名这幅画传达精神分裂症男性女性所引起大脑的可怕混乱每10万人中每年发病(Incidence)感。Morgan表示，连接到大脑的这些线条表达的感患病率不变，遗传度最觉：“我感受到的无形信高，为什么病因和发病机理至今不明？号和连接（多而杂乱无章)Owen MJ,et al.Schizophrenia.Lancet.2016;388(10039):86-97.NJAMA NetworkSchizophrenia-Clinical CourseJAMA Psychiatry.Published online October 30,2019.1-10 doi:10.1001/jamapsychiatry.2019.3360PrenatalChildhoodProdromeFirst-episodeTreatmentRelapseChronicpsychosisphasePositive symptomswusNegative symptoms.Genetic·Childhood·Acute stress·TreatmentfactorstraumaSubstance usediscontinuationPerinatalUrban living.Substance usecomplications。Ethnic·StrC5sminoritystatus.Altered.AlteredDisrupted excitatory/inhibitory balancesynaptogenesissynapticGray matter losspruningDopamine dysfunctionnaNTimeThe Clinical Course of Schizophrenia People who go on to develop schizophrenia may show subtle motor and cognitive deviation in childhood but do not show the marked developmentaldelays associated with autism and intellectual disabilities.During late adolescence or early adulthood,a prodromal phase characterized by attenuated psychotic,negative,and cognitivesymptoms and functional impairment often precedes the first psychotic episode.The first psychotic episode occurs when symptoms meet the threshold for a clinical diagnosis,as opposedto the subthreshold symptoms seen in the prodrome (although these may still be debilitating).The first psychotic episode is frequently the first contact with services,although patients areincreasingly seeking help in the prodromal period.The positive symptoms generally respond well to antipsychotic medication,but negative and cognitive symptoms show less response andmay even be exacerbated by antipsychotic medication in some cases.Most patients will relapse after stopping antipsychotic treatment,and the risk of relapse is reduced by continuedantipsychotic treatment even when psychotic symptoms have fully resolved.This Figure also highlights some key risk factors for the development of schizophrenia together withneurobiological changes thought te be relevant to the development of symptoms.Note that altered synaptegenesis and synaptie pruning have not been clearly demonstrated in vivo,andthe precise timing regarding all the changes listed remains unclear.病因相关因素与目前假说遗传多个基因的SNP异常（如：ZNF804A);拷贝数变异(22g11缺失)；罕见变异(SETD1A早期环境孕期营养不良、感染；(农村出生)？；童年心理创伤；冬天出生社会因素移民；少数族群（国外，中国不同：多个少数民族）；使用兴奋剂（大麻）假说（进展）神经发育障碍；基因环境交互作用多巴胺；谷氨酸；神经环路失连接；免疫/炎性异常