I. overviewThe mental disorder caused by somatic disease is caused by physical disorders, such as body infection, internal organ diseases, e
The mental disorder caused by somatic disease is caused by physical disorders, such as body infection, internal organ diseases, endocrine disorders, nutritional and metabolic diseases, and so on.
The main pathogenesis is the role of toxins, energy supply shortage, neurotransmitter changes, hypoxia, acid-base balance disorders, etc..
Is not a physical disease factors caused only by such mental disorders, sex, age, genetic factors, personality characteristics, stress, environmental factors, lack of social support and previous history of mental illness could affect the nerve disorder.
The main clinical manifestations of mental disorders caused by somatic diseases are: consciousness disorders, cognitive disorders, personality changes, psychotic symptoms, emotional symptoms, neurological symptoms or mixed symptoms. The patient often has the ability of daily life or the damage of social function.
There are some common clinical features of mental disorders caused by different somatic diseases:
(1) there is a parallel relationship between mental disorders and the condition of the primary somatic diseases;
(2) physical disease is often caused by disturbance of consciousness, chronic somatic diseases often cause disturbance of intelligence and personality changes, mental retardation and personality changes can also be made by acute and persistent. In the acute phase and chronic phase and delayed period can be superimposed on psychotic symptoms, emotional symptoms and neurologic symptoms;
(3) the lack of unique symptoms of mental disorders, the same disease cases can show different mental symptoms, different diseases can show similar symptoms of mental illness;
(4) the treatment of primary disease and the treatment of mental disorders, can improve mental symptoms.
Diagnosis of mental disorders due to physical illness can be based on the following points:
(1) there is evidence of somatic disease, and it has been reported that this kind of somatic disease can cause mental disorder.
(2) there is evidence that mental disorders are closely related to the occurrence, development and prognosis of somatic diseases, such as somatic diseases and mental disorders. But sometimes mental symptoms are more likely to occur than physical conditions, such as depression can occur before the diagnosis of pancreatic cancer.
(3) the manifestation of mental disorders is not typical, it is difficult to form a typical mental disorder diagnosis. Such as occurs in elderly patients with schizophrenia or depression symptoms, with common symptoms, illusory olfactory or phantom touch.
Treatment principles are as follows:
(1) etiological treatment: first of all, it is necessary to treat the primary somatic diseases and to stop the drugs that may cause mental disorders;
(2) support treatment: correct acid-base imbalance and water, electrolyte disorders; nutritional supplements, vitamins and water;
(3) control of psychiatric symptoms: because of age, physical disease, drug interactions and other reasons, for mental disorders caused by physical illness patients, the use of psychoactive drugs should be careful, the initial dose should be lower, the dosage should be increased gradually, and when the symptoms should be considered stable, gradually reduce the dose. For patients with aggressive behavior or behavior disorders, consider short-term use of antipsychotic drugs. Patients with depression antidepressants, but must pay attention to the side effects of tricyclic antidepressants, particularly to disable blockages in the heart conduction, prostatic hypertrophy or glaucoma. Patients with severe insomnia and anxiety can be short-term, small use of anti anxiety drugs.
(4) nursing: quiet and safe environment, prevent accidents, pay attention to the prevention of bedsores and other complications.
Two, physical infection caused by mental disorders
Infection induced mental disorder refers to mental disorders caused by viruses, bacteria, fungi, protozoa, spirochetes or other pathogens in the body infection, and pathogen infection has no direct intracranial infection.
Most of the body infection in patients with mild and transient, such as difficulty concentrating, mild disturbance of consciousness, anxiety, depression, insomnia or sleepiness, mental fatigue, only a minority of patients with severe mental disorders.
Timely detection of infectious diseases is the key to correct diagnosis. If patients with consciousness disorder, acute cognitive dysfunction, especially in the direction of disorientation and awareness of turbidity, should be given full attention, and actively looking for a primary body disease.
Early diagnosis and early treatment is very important, because of mental symptoms can worsen body disease symptoms, such as agitation can cause cardiovascular disease and to prevent the deterioration of water and nutrient absorption. So the treatment to both at the same time, the control of primary disease and psychiatric symptoms.
The following is a brief introduction to some of the more common psychiatric disorders caused by somatic infection.
Is the most common psychiatric symptoms appear delirium condition in high fever, but in patients with viral bronchitis delirium is rare, but can exhibit anxiety, irritability, lethargy and brief disorientation.
(two) bacterial endocarditis
The disease is most often caused by streptococcal infection. Many patients can have mild mental symptoms, but rarely severe psychotic symptoms such as delirium. But endocarditis with subarachnoid hemorrhage or meningitis, often appear agitation, disturbance of consciousness, but also accompanied by local neurological signs.
(three) small chorea
The case of a small dance is also known as a case of rheumatic chorea, an autoimmune disease caused by hemolytic streptococcus infection. Symptoms usually occur within 7 to 21 days of infection, occurring in children and adolescents, and also in women during pregnancy.
The first symptoms of the disease are mostly psychiatric symptoms: irritability, emotional instability and impulsive behavior. Early dance is not obvious, easy to be ignored, after body involuntary dance like activity was more obvious, I can appear stupor and silence. If not treated, dance like movements will last 2 to 6 months. If the recurrence of the disease, can leave the personality disorder, and can appear neurasthenia and depression symptoms. Can be associated with Tourette's syndrome.
Three, endocrine disorders associated with mental disorders
(a) adrenal dysfunction
1, the glucocorticoid is too much glucocorticoid secretion, accompanied by excessive secretion of mineralocorticoid and male hormones, the main mechanism is that excessive secretion of ACTH leads to bilateral adrenal hyperplasia and adrenal cortical tumors.
More than half of the patients had symptoms of depression, and depression was the most common. However, the common cognitive impairment may be due to the impairment of attention and memory. In addition, hallucinations, delusions and depersonalization may occur in some patients. Psychiatric symptoms caused by steroid therapy or adrenal carcinoma with bipolar disorder or psychotic symptoms. Psychiatric symptoms usually occur within two weeks of steroid therapy, and the symptoms increase as the dose of steroids increases. In addition, when suddenly stop using steroids, there may be depression, emotional instability, memory impairment, delirium. ,
The first is the treatment of primary disease, usually with the improvement of psychiatric symptoms with the treatment of cortisol, but cognitive function damage to a longer time to recover. Severe depression may be required to take antidepressants. Steroid induced psychiatric symptoms. Often disappear by the end of the drug. For psychiatric symptoms but still need to use steroids with antipsychotic drugs and lithium salt helps to alleviate psychotic symptoms or symptoms of mania.
2, hypocorticoidism is due to three adrenal steroid hormones (glucocorticoids, mineralocorticoids and male hormone secretion caused by insufficient). Destruction of the adrenal gland is the most common primary damage (such as autoimmune disease, sepsis and hemorrhagic infarction, tuberculosis, metastasis, etc.), but also may be secondary to pituitary or hypothalamic dysfunction.
Acute hypocorticoidism often life-threatening, may develop delirium, coma or stupor. The symptoms of chronic adrenal cortical dysfunction are similar to depression. Typical patients can be characterized by fatigue, muscle cramps, fatigue, weight loss, loss of appetite, emotional apathy, Yi Ji provoke and depression, attention and memory can also be affected, hallucinations, delusions are rare.
Replacement therapy can relieve physical and mental symptoms. Impairment of primary adrenocortical function, should also be treated with prednisone treatment and mineralocorticoid preparation.
(two) abnormal parathyroid function
1, hyperparathyroidism caused by parathyroid adenoma often due to benign hypercalcemia and the emergence of a variety of clinical symptoms.
1, mental symptoms are common, mainly for the performance of similar depression: depression, fatigue, lack of initiative and irritability, also can appear memory loss and slow thinking. If the onset of occult, symptoms may be ignored and missed diagnosis. "Parathyroid crisis" can appear acute organic mental disorder, manifested as consciousness clouding, hallucinations and delusions and aggression, patients can be repeated convulsions, lethargy and coma. After resection of thyroid adenoma, physical and mental symptoms can be alleviated, and the recovery process is parallel to the decrease of serum calcium level. Patients with severe depression should be treated with antidepressants.
2. Hypoparathyroidism is usually caused by the removal or destruction of the parathyroid gland during parathyroidectomy. Parathyroid hormone deficiency caused a decrease in serum calcium and serum phosphorus. In the "pseudo hypoparathyroidism", parathyroid function is normal, but the organization is resistant to hormones, so there is the phenomenon of low serum calcium and serum phosphorus.
Common psychiatric symptoms, usually occurs in thyroid surgery, because the blood calcium decreased to cause delirium. In idiopathic patients, the onset of occult, can show that the attention is difficult to concentrate, intelligent damage and "pseudo neurosis". Pseudoneurosis showed anger and night terrors in children, in adults, manifested as depression and irritability.
3, thyroid dysfunction
(1) hyperthyroidism: due to excessive secretion of thyroid hormones. Women are more common than men, and women are 20 to 30 years old.
The main symptoms of mental symptoms of psychomotor excitement, including insomnia, words, irritability, irritability, etc.. There may be severe psychotic symptoms such as hallucinations, hallucinations and paranoia. Mental disorder caused by hyperthyroidism patients despite the lack of typical cheerful state of mind, but the spirit of the operation level often increased significantly, there are similarities with manic performance, with a history of misdiagnosis.
The symptoms of thyroid crisis is an emergency, usually occurs in untreated patients with hyperthyroidism treatment, due to acute disease and surgery induced by thyroid hormone level pay surge, characterized by fever, delirium and coma.
Apathetic hyperthyroidism is rare, occurring in middle and old aged people. Symptoms of apathy, depression, depression, weight loss, loss of appetite, concentration and memory loss, clinical symptoms similar to dementia.
When the patient's thyroid function is normal, depression and anxiety symptoms often do not need treatment can disappear. Psychiatric symptoms should be treated with psychotropic drugs.
(2) hypothyroidism: thyroid hormone concentrations were lower than normal in patients with elevated TSH. Thyroid hormone levels were normal in patients with clinical hypothyroidism, but TSH levels were elevated. Hypothyroidism can be secondary to pituitary or hypothalamic damage, more common in women.
Hypothyroidism due to surgical resection of the onset of acute onset, and other reasons for the onset of hidden, easily missed diagnosis.
Patients often suffer from depression: slow speech, unresponsive, memory loss and lack of concentration. Severe patients presented with apathy, withdrawal, and dementia. May be accompanied by hallucinations and delusions.
Subclinical hypothyroidism can cause depressive symptoms and cognitive impairment. It is associated with rapid cycling bipolar disorder, which can increase the risk of depression by 2 times. Subclinical hypothyroidism can develop into a clinical deceleration, especially in women. Hypothyroidism is associated with refractory depression.
Both physical and mental symptoms could be relieved after thyroxine replacement therapy. Thyroxine dosage should be gradually increased, especially for the elderly, poor health and cardiovascular disease. The patient's depressive symptoms usually disappear after thyroid hormone is normal. In rare cases, T4 added early instead of psychiatric symptoms, more manic performance. Patients with severe psychotic symptoms should be treated with antipsychotic drugs, but it should be noted that the use of phenothiazine drugs may lead to hypothyroidism. If the disease is not treated for a long time, cognitive impairment will persist.
Pheochromocytoma can produce excessive amounts of epinephrine and norepinephrine.
According to the intermittent or persistent nature of catecholamine release, symptoms can be classified as episodic or occult. There may be autonomic hyperactivity symptoms manifested as palpitations, tachycardia, sweating, flushing, dizziness, hand tremor and nausea and vomiting, the patient can have a sense of impending doom and extreme anxiety, occasionally appear clouding of consciousness.
The symptoms of mental disorders and other mental disorders caused by mental disorders have many similarities, so it should be included in the differential diagnosis of generalized anxiety disorder, panic disorder, temporal lobe epilepsy, alcohol withdrawal syndrome, hyperthyroidism, hypoglycemia and paroxysmal arrhythmia.
Four, connective tissue disease with mental disorders
Connective tissue diseases often have multiple systems, multiple organ involvement, complex symptoms, often accompanied by neuropsychiatric disorders, some patients can be the first manifestation of neuropsychiatric symptoms.
1, rheumatoid arthritis is a chronic, progressive, inflammatory, systemic disease. Psychiatric symptoms associated with rheumatoid arthritis can be understood in two ways:
(1) hand dysfunction often makes the patient's work, family life and sex life is limited, which can lead to emotional disorders, such as anxiety, depression and treatment of non cooperation psychological treatment can improve psychiatric symptoms, increase compliance, relieve pain and improve function of social psychological therapy.
(2) drugs used in patients with rheumatoid arthritis can lead to psychiatric symptoms. Non steroidal anti-inflammatory drugs (NSAIDS) can cause cognitive impairment, delirium, depression, manic and psychotic symptoms, older people are more prone to such side effects. NSAID steroids can cause emotional instability, sleep disorders, mental illness and delirium symptoms, and the symptoms and drug dose related.
Clinical use of psychotropic drugs in patients with rheumatoid arthritis, the use of small doses of second generation antipsychotics. Depression can be used in patients with depression.
2, systemic lupus erythematosus (SLE) is a kind of unknown etiology, recurrent connective tissue disease, often multiple organ involvement, including skin, joints, kidneys, blood vessels and central nervous system, etc..
When the disease involves the central nervous system, can produce neuropsychiatric symptoms. The occasional neuropsychiatric symptoms earlier than other system involvement.
Neuropsychiatric symptoms often occur in the later stages of the disease, but also in the early stages of the disease. Due to the lack of specificity and diversity of symptoms, it is easy to cause misdiagnosis. More acute cerebral organic mental disorder, manifested as clouding of consciousness and delirium, accompanied by paranoid delusions and hallucinations, emotional disorder and movement disorders. Chronic brain organic mental disorder is rare, can have cognitive impairment, and even develop dementia. Affective symptoms and split like symptoms are relatively rare, usually with organic mental symptoms at the same time. There are also symptoms of anxiety, depression, social withdrawal and depersonalization.
Attention should be paid to the identification of mental disorders due to steroid therapy, or SLE itself.
SLE with central nervous system disease, can use steroids or immunosuppressive therapy in large doses, mental symptoms of anti psychotic drug cases and mood stabilizers, should pay attention to in the treatment of SLE itself can cause psychiatric symptoms.
Five, internal organs disease with mental disorders
(I) liver disease
1, Wilsom 's disease, also known as hepatolenticular degeneration, is a recessive disorder of copper metabolism disorders. The main reason is the case of physiological changes of ceruloplasmin decreased, resulting in the deposition of copper lenticula, liver, kidney and cornea.
Mental symptoms can occur in the early stage of the disease, with the development of the disease, mental symptoms are becoming apparent. In childhood onset, rapid progression of the disease, can be manifested as emotional instability, followed by Pseudobulbar cases (pseudobulbar palsy) and extrapyramidal symptoms such as muscle spasms and myotonia. In adolescents and adults from disease, disease extension, tremors and rigidity and movement is reduced, in rare cases, people can then be accompanied by convulsions; sentiment into hallucinations - delusional syndrome, there can be other hostility and antisocial personality change, not for a long time for the development of dementia.
No specific symptoms, according to the clinical diagnosis of corneal K-F ring, urinary and fecal excretion of copper and ceruloplasmin increased, reduce the diagnosis.
2. Hepatic encephalopathy is a neurological disorder caused by severe liver disease. The causes include fulminant hepatitis, subacute hepatitis, chronic hepatitis, cirrhosis and liver cancer.
In the early stage, the mood change and abnormal behavior. Can be fast or emotional indifference, accompanied by fatigue, dull and so on. It can be expressed as disturbance of consciousness, and disorientation and cognitive impairment, including memory impairment, can appear delirium and hallucinations, visual hallucinations, especially. There are asterixis and abnormal eeg. In the early stage, the change of brain wave is slow wave, and then the three phase wave.
In the late lethargy, neurological signs and mental symptoms, hallucinations. If the condition can not control, can appear coma.
There is no special treatment for this disease, and the comprehensive measures are adopted. As a result of liver function damage, the metabolic function of the drug weakened, in principle, do not use antipsychotic drugs, need to be cautious when using.
(two) kidney disease
1, uremia is a kind of disease with a variety of metabolic disorders characterized by the accumulation of toxic substances such as nitrogen metabolites. Can be caused by acute or chronic renal failure. Psychiatric symptoms may manifest as consciousness disorder, manic depression, and neural symptoms, chronic uremia can occur in patients with intellectual disabilities increased.
Treatment on the basis of the treatment of primary disease, the choice of psychotropic drugs to consider the toxicity of small drugs to the kidney.
2, dialysis caused by some of the patients with mental disorders after dialysis will produce dialysis encephalopathy or balance disorder syndrome. This is because dialysis can lead to urea in the blood and cerebrospinal fluid imbalance, cerebrospinal fluid osmotic pressure increased, resulting in increased intracranial pressure and brain cell swelling, manifested as dizziness, headaches, mood swings and disturbance of consciousness.
Chronic effects of dialysis can lead to persistent neurological symptoms and progressive decline in intelligence. Can also be manifested as dementia, the so-called dialysis dementia. This syndrome usually occurs in patients with dialysis for more than two years. The study shows that it may be related to the dialysate containing high aluminum. This problem has been significantly reduced after removal of harmful aluminum.
(three) respiratory diseases
Almost all serious respiratory diseases can produce mental symptoms. Dyspnea can cause anxiety, hypoxemia and hypercapnia. Hypoxemia can cause cognitive impairment and mental disorders. Moderate hypercapnia can cause headaches, dizziness, forgetfulness, indifference, and severe hypercapnia can lead to coma or stupor.
Chronic obstructive pulmonary disease (COPD) patients with anxiety symptoms are common, the incidence rate is about 8%-24%, and most of the panic disorder. Patients with severe COPD have depressive symptoms. Treatment of COPD induced psychiatric symptoms should first pay attention to the side effects of drugs, although benzene two nitrogen is an effective anti anxiety drugs, but its inhibition of the respiratory center limits their use. In general, antidepressants are safer, but lower doses.
Pulmonary embolism may be characterized by a sudden panic attack. Therefore, a sudden panic attack in patients with postoperative or phlebitis should be noted for pulmonary embolism.
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