第二是他道出了醫病互動和人性那種，無法用理性邏輯解釋的拉扯。它也勾起我在精神科短暫見習時的回憶，那時候我實在太想「理解」他了。跟他講話的感覺就和書裡面醫生和那位病患每次接觸並觸發的心理活動很相似。
那段經歷也是讓我認清自己，往後選專病最好別涉入精神科太深的契機。
𓍼𓈒𓂂 𓈒
我覺得，每個人都是在精神正常和精神有病之間的連續光譜上持續變動著的，精神有病才是常態。而維持著醫學定義上精神正常的身份定位，是因為大部分的人異常的時候比較少，也都沒有嚴重到去看醫生（或被強制送醫）所以沒有被安上一個診斷名。
出於某種原因，選擇持續地做出「顯得正常」的努力，所以才會累。所以才會互相指責別人奇怪，因為其實也沒說錯。
（我真的覺得保持正常很累）
𓍼𓈒𓂂 𓈒
對於非精神科或非心理治療專家的一般科醫生來說，若有這樣的病人來到門診，我們是否能提供最基本的協助？或是怎麼handle比較好呢？更重要的是，不只是醫生才會面對這種事情呀。如果你朝夕相處，或無可避免、必須頻繁接觸有精神病特質的人，可以怎麼保護自己不被「傳染」呢？這是我在思考的問題。
๋࣭𓈒𓂂 𓈒
約75%至90%的思覺失調症患者，發病前會有一段持續數週至數年的前驅期。雖然前驅期很常見，但就我個人的看法，這些症狀與其他健康狀況相似，因此常常被忽視或誤解，才會給人一種思覺失調症也可能「突然」發作的假象。
思覺失調症發病的前兆，可能是社交退縮、學習或工作表現顯著下降、易怒、恐懼、妄想、言語怪異，以及個人衛生狀況惡化。
Roughly 75% to 90% of people with schizophrenia experience a prodromal phase, which can last from a few weeks to several years. While a prodromal phase is common, in my personal opinion, these symptoms are frequently non-specific and resemble other conditions, so are often overlooked or misunderstood, leading to an impression of “sudden” onset.
Prodromal symptoms include social withdrawal, a significant drop in performance at school or work, anger, fearfulness, paranoia, strange speech, and neglected hygiene.
患者越來越不信任他人，越來越懷疑他人的動機，注意力難以集中、行為異常或輕微幻覺（聽到/看到異物），並對神秘學或古怪的信念產生強烈的關注。
思覺失調症具有強烈的遺傳傾向，而家族聚集性會顯著增加患病風險，這是遺傳因子和共同生活環境（如同樣的飲食習慣、同樣的生活方式）交互作用的結果。父母或兄弟姊妹中有罹患思覺失調症的人，個人的患病風險會比沒有的人增加7至8倍。遺傳性思覺失調症通常是在青少年晚期至30歲出頭的年紀出現前兆。
Individuals become increasingly distrustful of others and hold a growing, subtle suspicion of others‘ motives. Individuals may also experience difficulty concentrating, erratic behaviour, or mild hallucinations (hearing/seeing things) and develop intense focus on peculiar topics, such as the occult or odd beliefs.
Schizophrenia exhibits a strong hereditary component, with familial aggregation significantly increasing risk, which can result from shared genetic factors, shared environmental factors, or a combination of both. The risk for individuals with an affected parent or sibling is 7~8 times higher. Early warning signs (prodromal phase) of hereditary schizophrenia often appear in late teens to early 30s.
思覺失調症的遺傳因素來自與免疫反應和神經發育相關的基因位點，且約 30% 的病因與高齡父親（>40歲）有關，其餘 70% 則來自環境因素。高齡父親是發生新生突變的主要原因之一；這是因為持續產生的精子往往不斷累積DNA複製的錯誤和氧化傷害，減弱的DNA修復機制更使得這些突變無法被修正，導致在精子形成或受精卵早期分裂階段發生了突變。
Genetic factors that contribute to schizophrenia are genetic loci involved in immune response and neuronal development, and proximately 30% of cases are related to advanced paternal age (> 40 y/o); the remaining 70% involve environmental factors. De novo mutations are primarily driven by advanced paternal age because spermatogonial stem cells accumulate DNA replication errors and oxidative damage over time. Additionally, reduced DNA repair mechanisms in older age fail to correct these mutations, so errors often occur during sperm formation or early division stage of the zygote.
雖然基因的影響在思覺失調症佔了很大一部分，但環境因素的催化仍不容小覷。居住在城市的精神病盛行率比郊區和鄉村高出21%。這通常是由於高人口密度、社會關係零碎化、獨居、缺乏綠樹與森林、壓力、噪音、空氣污染等造成的。社會經濟劣勢也造成較高的精神病盛行率；身為邊緣人或邊緣群體，遭受孤立和排斥，也會增加精神疾病的風險，因為這類處境會影響大腦的多巴胺系統，使大腦對壓力更加敏感。
總體來說，是遺傳因素與環境因素共同決定了疾病發作的閾值。
While genetics contributes a great portion of schizophrenia onset, environmental factors often act as strong catalysts. Living in urban areas is associated with a higher prevalence of psychotic disorders than suburban and rural areas, often due to population density, social fragmentation, lone-adult households, lack of surrounding greenness, stress, noise, and air pollution. Higher prevalence is strongly associated with socioeconomic disadvantage. Being part of a marginalised group or experiencing social isolation and exclusion also contributes to higher risks of mental illness, because it can prime the brain's dopamine system, making it more sensitive to later stress.
Overall, genetic factors combined with environmental stressors determine the threshold for illness.
思覺失調症是否能治療成功，有兩個重要預測因子是早期介入（症狀持續時間較短）和患者自己的病識感。但由於前兆容易被忽略或誤認是其他問題，因此「早期介入」在實務上要做到是有一定的難度。
有一些方法和技巧有助於預防思覺失調症的超高風險族群發病，或延緩發病。重點在於改變當事人對輕微或偶爾發生的精神症狀（例如偏執、妄想，或異常感知）的解讀和反應。
Two of the significant predictors of successful management of schizophrenia include early intervention (shorter duration of symptoms) and clinical insight (the individual's awareness of their symptoms). However, these symptoms are common but not universal and often resemble other issues, making “early intervention” quite difficult in practice.
There are some methods and techniques that aim to prevent or delay the onset of schizophrenia in individuals at ultra-high risk. The main focus is on modifying how an individual interprets and reacts to mild or infrequent psychotic symptoms, such as paranoia or unusual perceptions.
具體作法包括幫助他減少災難性的恐懼；鼓勵他進行現實驗證，透過一些客觀證據去重新評估那些令他痛苦的想法，並檢驗信念，藉此找到更加貼近現實、合乎邏輯的替代解釋。
然後，雖然這可能很困難，我們可以嘗試引導患者「思考他的思考方式」（後設認知訓練）。最基本的是識別常見的認知偏誤，避免妄下結論。此外，我們還可以幫助他們發展一些應對痛苦的方法，在升級到失控之前就踩住煞車。
Specific approaches include helping the individual reduce catastrophic fears; encouraging reality testing by re-evaluating the evidence for and against distressing thoughts and finding logical, alternative explanations.
Then, although this may be difficult, we can try to guide them to “think about their thinking” (meta-cognitive training); the most basic of which is to recognise common cognitive biases and avoid jumping to conclusions. Also, we can help them enhance coping strategies to manage emerging distress before it escalates.
這些實踐必須建立在牢固的治療聯盟（治療師與患者之間建立的一種相互信任、安全、以合作為基礎的情感連結）之上，且治療師和患者必須平等地合作。如果聯盟不牢固，治療可能無效，甚至有害。
此外，治療結果也取決於患者的感知；患者越相信自己能夠被治療師信任和理解，就越有可能獲得成功的治療效果，而且這種信念比任何治療技巧都還重要。因為精神病患者常常飽受不信任或妄想的困擾，如果沒有強烈的信任關係，他們就不太可能解除防衛機制、投入挑戰自身認知的脆弱過程。
These practices must be based on a strong therapeutic alliance (also called rapport); the therapist and client must work as equals. If the alliance is poor, the therapy can be ineffective or even detrimental.
The outcome also relies on the client’s perception; the more the client believes they can trust and feel understood by the therapist, the better chance of a successful outcome they may achieve, and this belief is stronger than any specific technique. Individuals with early psychosis often struggle with mistrust or paranoia; without a solid bond, they are less likely to disarm their defences and engage in the vulnerable process of challenging their own perceptions.
另外一提，精神病也會「傳染」，不過這是形容情緒狀態或行為模式在人與人之間、群體內部產生了擴散、模仿或共享的現象。原發個體（第零號病人）成為帶原者，而繼發個體（通常是配偶、子女、親近的朋友、他的主治醫師或主要陪伴者）也開始出現類似的症狀。
封閉的環境、親近的關係，都是助長精神疾病傳遞的因素。那些常常需要「傾聽」痛苦的人，就屬於極易遭受繼發性（或替代性）精神病的高風險族群，尤其當他們本身具有高度的共情能力時就更是如此。
It's worth mentioning that mental illness can be transmitted, but here “transmit” refers to the spread, imitation, or sharing of emotional state / behavioural pattern between individuals or within groups. The primary individual (patient zero) acts as a carrier, and a secondary person in their close environment (usually spouses, children, close friends, their primary physician, or companion) begins to experience similar symptoms.
Close environment and relationships often contribute to the transmission of mental illness and psychological distress. Those who frequently need to “listen” to others’ suffering are at high risk of secondary / vicarious mental illness, due to “empathic engagement,” especially when their personal traits include a high capacity for empathy and compassion.
人在高度共情他人時，會啟動大腦的前扣帶皮質。若長期缺乏情緒排空，前扣帶皮質就會處於過度活躍的狀態，導致共情疲勞、反芻思維、痛苦感增強、無法感受快樂，或以慢性疼痛的形式表現出來。
由於精神傳染通常是無意識的（透過鏡像神經元、共情和模仿），自我保護的重點就是「識別」自己正受到他人精神狀態或情緒的影響，並積極主動地自我照顧。
為了對抗前扣帶回皮質的過度活躍，有氧運動、攝取富含色胺酸的食物（如雞蛋、火雞和堅果），以及充足的光照，皆有助於提高認知靈活性和鎮靜這個腦區。
When we deeply empathise with others, the anterior cingulate cortex (ACC) is activated. Prolonged lack of emotional release often leads to hyperactivity of ACC, leading to compassion fatigue, rumination, heightened feelings of pain, anhedonia, or manifesting as chronic pain.
Since mental transmission is often unconscious (through mirror neurons, empathy and automatic mimicry), self-protection focuses on making these processes conscious and proactive self-care.
To counteract hyperactivity in the ACC, regular cardiovascular activity, adding tryptophan-rich foods (eggs, turkey, and nuts) to your diet, and bright light exposure, can increase cognitive flexibility and help calm down the brain area.
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