affective disorder
Introduction
Introduction to affective disorder Affective mental disorder (mood disorder) is characterized by significant and persistent high or low mood, accompanied by corresponding thinking and behavioral changes, and repeated attacks, complete remission in intermittent periods, and slower symptoms can not reach mental illness. Mental disorder. The general prognosis is good, a small number of patients can be prolonged and prolonged unhealed, the onset of this disease can be manifested as manic or depression. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Cause of affective disorder
First, the cause is unknown, the relevant factors are:
(1) Logic factors:
1. The epidemiological results of genetic factors indicate that genetic factors are one of the important factors in the pathogenesis of this disease. The same disease rate in the family of the first-infected patients is 30 times that of the general population, and the expected incidence of first-degree relatives is 7.2-16% in the North Sea. The closer the blood relationship is, the higher the incidence rate is, the single-child twins (69-95) are significantly higher than the twin-child twins (12-38%), and the children of the patients are even shortly after birth. That is, it is fostered in a normal home, and the prevalence rate is still high in the future.
2. Pre-existing personality characteristics: The characteristics of the ring character are the basis of the disease, divided into three categories of quality:
1 The quality of depression is calm, serious, serious, and sentimental. In the event of setbacks, it is easy to fall into Xiaoji.
2 The quality of frivolous performance is cheerful and optimistic, enthusiastic and active, enterprising and energetic, often with emotional ups and downs.
The three-ring quality is the alternating appearance of the above two qualities, each of which can last for several months.
(2) Psychosocial factors: often act as a triggering factor.
Second, the pathogenesis
(1) Central neurotransmitter metabolic disorder hypothesis: If the catecholamine (CA) hypothesis is considered to inhibit CA deficiency in the brain of patients with depression, the metabolite of dopamine (DA) is reduced by high vanillic acid (HVA); when mania is increased, serotonin ( 5-HT) hypothesis that the increase and decrease of HT in the brain is related to depression and mania and depression. It is suggested that cholesteric (Ach) can be a norepinephrine (NE) activity balance disorder hypothesis, suggesting that Ach can be hyperactive The decrease in NE activity may be related to the inhibition of the onset of depression; on the contrary, it is related to the onset of mania.
(B) neuroendocrine disorders hypothesis: the content of plasma corticosteroids and 17-hydroxycorticosteroids in patients with depression increased, after taking dexamethasone, there is no inhibition, at the same time, thyrotropin response to thyrotropin-releasing factors is slow or disappear It is speculated that these abnormalities in endocrine reactions may be related to dysfunction of the diencephalon and hypothalamic biogenic amines.
Prevention
Affective disorder prevention
Prevent recurrence:
Lithium salt can reduce the complexity of mania, and it also has a certain preventive effect on depression. It has a good preventive effect on manic and depressive episodes in bipolar cases. After clinical relief of depression, continue to take tricyclic antibiotics. Depressive drugs for more than 6 months were reduced by half compared with placebo.
Nursed back:
The patient's room should be quiet and comfortable, keep the air fresh, avoid the sun's stimulation, respect the patient, let the patient be in the normal material and spiritual life, often talk with him, conduct psychological counseling, pay close attention to the patient's mental state, and be emotionally excited. If the behavior cannot be self-made, it must be prevented from causing damage to the person; for those who are depressed, it must be prevented from committing suicide. For those who have a few diets, they should be fed, watered, urged to eat, and eat fish, eggs, Vegetables, fruits, etc. are appropriate, avoiding spicy taste, smoking, and wine.
Complication
Affective disorder complications Complication
Suicide is the most serious complication of patients with mood disorders. 15% to 25% of untreated mood disorders die from suicide; 50% to 70% of committed suicides are not detected or not due to depression. Proper treatment. Suicide is most common among young people and the elderly who do not have good social support, often occurring within 4 to 5 years of the first clinical onset. When depression begins to recover (the mental motor ability returns to normal and the mood remains poor), the mixed state of the bipolar disorder, the premenstrual period and the important anniversary of the individual are the main dangerous periods (see Section 190). Long-term abuse of alcohol and addictive substances can also increase the risk of suicide. Serotonin dysfunction appears to be one of the biochemical factors of suicide, and lithium (which stabilizes serotonin delivery) is effective in preventing suicide.
Among the drugs for the treatment of mood disorders, heterocyclic antidepressants or lithium agents (see Table 307-3) are the most likely to be life-threatening; alcohol also tends to complicate the situation. Excessive amounts of heterocyclic antidepressants lead to atropine-like coma; the cause of death is usually arrhythmia or epilepsy. Due to protein association, urinary excretion and hemodialysis are ineffective, and treatment focuses on stabilizing heart and cortical function. When the amount of lithium is excessive, diuretic with sodium chloride or mannitol, alkalized urine or hemodialysis can save lives. Monoamine oxidase inhibitors have been used less frequently and rarely cause excess. New antidepressants (eg, selective serotonin reuptake inhibitors, venlafaxine, nefazodone, betahazar, butanone) are generally not fatal when suicidal overweight, which is also One of their main advantages.
Symptom
Symptoms of Affective Disorders Common Symptoms Illusion, auditory hallucinations, irritability, schizophrenic personality disorder, depression, mechanical repetition, mental disorder, paranoid paranoia
1, single-phase affective disorder: visible depression, irritability, or anxiety, or a mixture of their performance, but in occult depression, but can instead experience depression in the mind, replace this depression What appears is physical discomfort, and even with a smiley face as a defensive mask (smiling depression), some may complain of all kinds of pain, fear of disaster, or fear of madness, some cases have been morbid because of illness Reaching the depth of "scrapping without tears", if you can restore your ability to cry, indicating that your condition has improved, patients with this type of depression will complain that they cannot experience ordinary emotions, including compassion, joy and happiness, and feel The world has become devoid of glory, lifelessness, morbid state of mind can be accompanied by self-blame, the idea of smearing on your face, can not concentrate on thinking, hesitating, less interest in daily activities, social withdrawal, helplessness and disappointment, and Repeated thoughts about death and suicide.
In the monophasic and biphasic depression stages, there are obvious signs of mental exercise and autonomic nervous system. Patients show psychotic retardation, or slow thinking, language and general movements, and even develop into depressed stiff. At this point, all autonomous movements disappear completely at this time, about 15% of depression can have psychotic symptoms, most commonly seen in depression.
2, bipolar disorder: typical mood of mania is high mood, but high irritability, hostility, temper and difficult to control are also very common, the patient's entire experience and behavior are brought with this pathological The mood of the heart makes them believe that they are in the best state of mind. At this time, the patient is impatient, careless, and frequently disturbs others. If they are opposed, they will make a big noise and the result will be friction with others. This produces a secondary paranoid delusion, thinking that he is being persecuted, and the acceleration of mental motor function makes the patient experience that the thought is like a race. It can be called erratic thoughts. If it is serious, it is difficult to be schizophrenia. The thinking is scattered and the difference is very easy to pay attention to. The patient often shifts from one subject to another. The realm of thought and activity is very broad, and then develops into a delusional exaggeration. Sometimes it will appear in the extremes of mania. The auditory hallucinations or illusions, but all have an understandable connection with the morbid state of mind, the sleep needs to be significantly reduced, and the mania patients do not appear in various activities. Tired, overactive, acting with emotions, and regardless of danger, when the condition reaches extremes, it may seem so crazy that there is no understandable connection between emotions and behavior, presenting as a meaningless agitation The state is called a savage mania.
Examine
Affective disorder examination
[Physical examination and nervous system examination ]
Systematic examinations are performed according to physical examination and neurological examination requirements.
[Mental condition check]
In addition to the requirements of the "Code of Medical Record Writing", we should focus on the following aspects:
1. The occurrence, development, duration of symptoms, symptoms, symptoms, severity of symptoms, onset of symptoms, prominent symptom groups, etc.
2. Whether there are mild depression, mild mania, occult depression, seasonal affective disorder, rapid circulation and other emotional disorders.
3. Are there symptoms associated with psychosis? If so, is it coordinated with the disease? Symptom duration.
4. If there are symptoms that are inconsistent with the disease, except for the duration of the symptoms, the main clinical situation, whether it is coordinated with the surrounding environment, and the results of the auxiliary examination, the patient's age, education, place of life, etc. Aspects should also be considered.
Auxiliary inspection
Laboratory examination
In addition to the necessary routine examinations, combined with medical history and clinical manifestations, specific examinations such as fasting blood glucose, thyroid function, and blood concentration determination are performed in a targeted manner.
2. Psychological testing
Standardized diagnostic psychopsy tools (eg PSE, SCID, SCAN, CIDI), psychiatric symptom rating scales (eg SDS, HMDS, HMAS, Mania Rating Scale, etc.) and examinations related to psychological testing scales.
Diagnosis
Diagnosis of affective disorder
diagnosis
Diagnosis is based on clinical evidence: symptom manifestations, course of disease, and family history, and sometimes the effects of physical therapy.
The most common diagnostic error is the diagnosis of affective disorder as schizophrenia or schizoaffective psychosis. It is important to identify schizophrenia and affective disorder, not only because lithium is effective for the latter (but there is potential for schizophrenia). Neurotoxicity), and patients with affective dyskinesia should avoid late-onset dyskinesia. In fact, there are no specific signs that can be identified. It is necessary to make a comprehensive diagnosis of clinical manifestations, family history, course of disease, and other aspects.
Differential diagnosis
1. Schizophrenia: Adolescents have emotional expressions. When they are excited or inhibited, they are easily misdiagnosed as bipolar disorder. The former is emotional, the thinking and will are uncoordinated, and the reality is dominated. The latter is coordinated. There is no deviation from the actual performance, in addition, the onset of disease, the stage of disease, residual symptoms after a previous episode, family history and treatment response, are helpful to identify.
Second, reactive psychosis: There are strong mental factors before the onset, the symptoms reflect the inner experience, the duration is short, can be quickly improved after rest or appropriate treatment, no similar history of episodes, no recurrence.
Third, neurasthenia: mild depression often early insomnia, headache, fatigue similar to neurasthenia, so often misdiagnosed, but depression is more anxious, the interest in the outside world becomes indifferent or disappear, there is a feeling of inferiority, and It is not as good as death, and it is not urgent to ask for treatment. Antidepressant treatment is effective.
Symptoms and brain organic psychosis: A flat, adrenal cortex hormone, isoniazid, blood and blood equal drug use, hyperthyroidism and brain tumors, encephalitis and other organic diseases, can also appear dizzy Symptoms, but there are clear causes and positive signs can be found, there may be varying degrees of disturbance of consciousness and mental retardation, can be identified.
