I told the patient that I needed to fill out some paperwork, but in reality I'm not sure how I should proceed on this one. It might just be a classic case of the mental disorder called schizophrenia, but something doesn't seem right.

While no one is totally sure what causes schizophrenia, we do know some things that increase the chances of getting the disease. There are definitely a few red flags in this patient's background. First of all, his sister has been diagnosed with schizophrenia, meaning he has a 6.5% chance of developing it himself. What's more, the patient has a history of drug abuse involving marijuana and cocaine. That can be another contributing factor. He’s also twenty years old, which is about the time when schizophrenia usually starts to manifest itself.

It's certainly true that his symptoms don't resemble the paranoid type of schizophrenia. He isn't hearing any voices in his head, thinking he's better than everyone else, or becoming suspicious that people are out to get him. However, he is definitely displaying symptoms of other kinds of schizophrenia. He has isolated himself from his friends, doesn't display much emotion, and can't sleep at night. Most troubling, he's having problems formulating sentences. His speech is becoming distorted because his mind cannot think in an orderly and logical fashion. This might be a sign that he's developing a case of disorganized schizophrenia.

He could be one of the 3.2 million Americans who suffer from schizophrenia, or he could just be a depressed young man who has fried his brain with illegal drugs.

I always want to be absolutely sure before I diagnose schizophrenia because the antipsychotic drugs used to treat it can be very damaging. The last person I prescribed antipsychotic drugs to suffered from side effects such as dizziness, tremors, and weight gain. He even started to move in slow motion sometimes. On the other hand, bad things can happen if schizophrenia goes untreated. Not only do most patients eventually try to medicate themselves with illegal drugs, but over one-third of them will attempt suicide at some point during their illness. I think I'll wait and see how his symptoms develop. I'll tell him to come back in a month.

我告訴病患我需要填寫一些文件，但事實上我不知道該怎麼處理這個病例。他可能只是罹患了一種典型精神疾病，思覺失調症，但還是有些地方不太對勁。

沒有人能百分之百的確定引發思覺失調症的原因，但我們明確知道哪些因素會增加罹患這種疾病的機率。這個病患的背景中確實隱藏了一些危險性指標。第一，他的姊姊曾被診斷出罹患思覺失調症，這表示他有6.5%的機會得病；再者，他有濫用大麻與古柯鹼這類毒品的紀錄，這是另一個助長病發的因素。最後，他今年20歲，也是思覺失調症好發的年齡。

可以確定的是，他的症狀並不屬於偏執型思覺失調症。他的腦海中沒有出現任何聲音，也不自認比其他人優越，或是懷疑有人要來抓他。然而，他的確表現出其他精神分裂的症狀。他將自己孤立於朋友之外，不顯露太多的情緒，而且晚上無法入睡。最麻煩的是，他無法有條理地說出句子。他說出來的話變得扭曲，因為腦筋無法有條有理的思考，這可能表示他罹患了混亂型思覺失調症。

他可能是三百二十萬罹患思覺失調症的美國人之一，或只是一個被非法毒品殘害腦袋的憂鬱青年。

在我診斷病患為思覺失調症之前，總是想要百分之百地確診，因為用來治療的抗精神病藥物非常傷身。我上一次開給病患抗精神病藥物時，他得忍受像是暈眩、顫抖和變胖的嚴重副作用，甚至有時候會行動緩慢。另一方面，如果思覺失調症不接受治療的話，可導致嚴重後果。許多病患最後會嘗試用非法毒品來治療自己，而且有超過三分之一的人會在病程中試圖自殺。

我想我會再等等，看他的病情如何發展。我會告訴他一個月後再回來看診。