| The etiology and pathogenesis of schizophrenia are uncertain .It was considered as a functional disorder in the past. With the development of image, neurochemistry and molecular biology, we have got proof that schizophrenia is a kind of organic brain disorder. But the result varies. Since chlorpromazine is applied in 1950s, the positive symptoms have been effectively treated, but the negative symptoms, quality of life and cognitive function haven't been controlled appropriately. Many researchers study on psychiatric pharmacology and psychotherapy in order to treat the symptoms. Our research focuses on neuron specific enolase and myelin basic protein in order to get evidence of brain injury in Schizophrenia patients. Meanwhile we study the curative effect of schizophrenia medicine and psychotherapy.Part I : Research of neuron-specific enolase and myel in basic protein in cerebrospinal fluid of patients with first-episode schizophrenia Objective: To study whether patients with schizophrenia have cerebral ingury . Methods: 33 cases of first episode schizophrenia who didn't take antipsy-chotics were chosen according to Chinese Classification and Diagnostic Criteria of Mental Disorders-3 and classified into two groups, 23 cases of positive group ,10 cases of negative group according to Andreasen diagnosis criterion .9 cases who were going to have operations had been choosen as control groups.The determinations of neuron-specific enolase (NSE) and myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of those cases were made by double antibody sandwich enzyme immunassay method.Results: 1. NSE contents of CSF were respectively 5.27±5.11ng/ml. 2.36±1.27ng/ml and 1.00±0.74ng/ml in negative, positive and control groups.There was significant importance in content of the negative in comparison with that of the control (p<0.01);so did thePositivewith theGontrol(p<0.05);there were no significant difference between the positive and negative (p>0.05).2. MBP contents of CSF were respectively 0.35±0.49ng/ml, 0.49±0.67ng/ml, 0.15± 0.21ng/mi in negative, positive and control groups. There were no significant difference in the negative, positive and control.(p>0.05).3. CSF-NSE was Correlated with CSF--MBP in (case)group (r=0.4533, P<0.01) and in the negative group (r=0.6177, P<0.05).Conclusion: The results suggested that schizophrenia was the cerebral injury which was caused by acquired factors. Part II: Research on middle-school student patients with first-episode paranoid schizophreniaobjectives: Study the effect of combined treatment of sertraline and sulpirde, in order to evaluate the application of hypothesis of dopamine imbalance in cortical and subcortical area.Method: 60 middle-school student patients with first-episode paranoid schizophrenia were treated with combination of sertraline and sulpirde(30 cases) or sulpride alone(30 cases) and evaluate the effect and side-effect with positive and negative symptom scale (PANSS) and teatment emergent symptom scale (TESS) before the treatment and at the end of the 2nd, 4th, 6th, 8th week after the medication respectively.Result: As for PANSS There were significant differences among negative symptoms,general pathologic symptoms,PANSS total socres by different treatment during different period,respectively (P<0.05).There were significant differences in positive symptoms during different treatmen period(P<0.05). in experiment group positive symptoms scores at the end of 4th , 6th, 8th week were significantly different in comparison with pretreatment(p<0.01) . In control group positive symptoms scores at the end of 2nd, 4th, 6th, 8th week were significantly different.(p<0.01) ; negative symptoms scores at the end of 4th, 6th, 8th week were significantly different between experiment group and control group (p<0.01) ; general pathologic symptoms and PANSS scores at the end of 2nd, 4th, 6th, 8th week were significantly different between experiment group andcontrol group (p<0.01). PANSS scores and negative symptoms scores at the end of 8th week were significantly different between the two groups (p<0.01). The effect ratio was significantly different between the two groups(x~2=6.65, p<0.05). In experiment group positive symptoms can be treated effectively after 4 weeks (p<0.01). Negative symptoms, general pathologic symptoms and total scores can be treated effectively after 2 weeks (p<0.01); in control group positive symptoms, general pathologic symptoms and total scores can be treated effectively after 2 weeks (p<0.01), negative symptoms can be treated effectively after 4 weeks (p<0.01). TESS scores of the two groups had no significant difference (p>0.05). Recovery of social function was significantly different(x~2=4.44,p<0.05).Conclusion: the consociation application treatment of sertraline and sulpirde has examined the clinical application value of the Weinberger's hypothesis of dopamine imbalance of cortex and subcortex. This kind of treatment can improve the positive symptoms as well as the negative symptoms and the emotion symptoms,and it has benefits to the recovery of the patients' social function and the obvious exaltation of the quality of life. Part III: Family therapy to the patients with schizophrenia. Objectives: Discussing family therapy to the patients with schizophrenia. Method: Treat 100 schizophrenia patients with drug therapy and positive strengthen strategy (50 cases) or drug therapy (50 cases) . Then carry through assessing of psychopathology with PANSS and SDSS respectively at the end of 6th month,lst year,2nd year.Result: As for PANSS scores,There were significant differences among negative symptoms,general pathologic symptoms,PANSS total socres by different treatment during different period,respectively (P<0.05) . There were significant differences in positive symptoms during different treatmen period(P<0.05).PANSS and component scores have no significant difference between experiment group and the control group before enroment. The PANSS total scores of experiment group and the control group are significantlydifferent (P<0.05) after 6 months' therapy. The scores of negative symptom, general pathologic symptom and the total scores are significant different (P<0.05 , P<0.05 , P<0.01)in experiment group and control group at the end of the 1st year. The scores of negative symptom, general pathologic symptom and the total scores are significant different(P<0.01) in experiment group and control group at the end of the 2nd year. The positive symptoms have no significant difference(P>0.05) comparing the experiment and control group with the PANSS before therapy respectively ;It has no significant difference (P<0.01)comparing the negative symptom at the end of the 1st and the 2nd year with that before therapy respectively ,It has significant difference (P<0.05)comparing the negative symptom of the end of the 2nd year with that before therapy; It has significant difference (P<0.05, P<0.01, P<0.01) comparing respectively the general pathologic symptom at the end of the 6th months , the 1st year , the 2nd year with that before therapy in experiment group. It has significant difference (P<0.05, P<0.01 ) comparing respectively the general pathological symptom at the end of the 1st, the 2nd with that before therapy in experiment group; it has significant difference (P<0.01) comparing respectively the total scores of 6th month, the 1st year, the 2nd year with that before therapy in experiment group; it has significant difference (P<0.05, P<0.01) comparing respectively the total scores of the 1st year, the 2nd year with that before therapy in control group; It has significant difference comparing the two group on the ratio of recurrence(x~2=7.12 , P<0.01)and reemployment(x~2=6.95, P<0.01).It has significant difference (P<0.01)comparing the experiment group with the control group about the social founction at the end of the 1st year and the 2nd year.It has significant difference(P<0.01) comparing the social founction at the end of the 6th month, the 1st year and the 2nd year with that before enroment.it has significant difference (P<0.01)comparing the social founction at the end of the 2nd year with that before enroment.Conclusion: Family therapy is suitable for Chinese .The schizophrenia patients can be treated according to different situations. Family therapy can improve the negative symptoms, promote recovery of social function, prevent from mental degeneration,decrease recurrence ratio, increase job- taking ratio and bring patients back to society.
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