Mental disorders associated with medical illnesses
Introduction
Introduction to mental disorders associated with physical illness Mental disorders caused by physical infections refer to extracerebral systemic infections caused by viruses, bacteria, spirochetes, fungi, insects or other microorganisms, parasites, etc., such as sepsis, syphilis, typhoid, typhus, falciparum malaria, schistosomiasis Mental disorders caused by illness, human immunodeficiency virus (HIV) infection, and no evidence of direct infection in the brain. According to clinical symptoms, low-dose antipsychotics, antidepressants, and anxiolytics can be administered. If it is a disturbance of consciousness, it is mainly based on supportive therapy. If there is obvious irritability, it can be given fentanyl injection or oral treatment. Nursing is vital. Environmental and psychological care can help eliminate patients' fears and anxiety. Patients with conscious disorders should pay special attention to safety care to prevent accidents such as self-injury, falls, and impulses. Patients with depressed mood should be alert to their suicide attempts and given prevention. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: reactive psychosis schizophrenia epilepsy
Cause
Causes of mental disorders associated with physical illness
Etiology
Invasion of the body by external viruses, bacteria, spirochetes, fungi, protozoa and parasites causes disease.
Pathogenesis
The occurrence of mental disorders is related to the above-mentioned pathogens entering the body, but there are other factors involved.
The following points are important:
1. Viruses, bacterial toxins cause direct damage to brain cells.
2. Hypermetabolism due to disease causes intermediate metabolites to accumulate in the brain.
3. Acute cerebral edema and cerebral hypoxia during acute infection.
4. Because the infection causes high heat in the body, a lot of sweating, patients can not eat normally and cause physical exertion, lack of nutrition, exhaustion, insufficient energy supply, acid-base imbalance, electrolyte imbalance, affecting brain function activities.
5. Individual differences, such as the elderly, children, that is, those who are not physically strong are prone to mental disorders when the body is infected.
In the combined effects of the above factors, the nature of the infection (such as the affinity of the pathogen to the brain cells), the degree, the speed, the number of pathogens, the duration of action, and the effectiveness of anti-infective measures have a crucial role in the occurrence of mental disorders.
Prevention
Prevention of mental disorders associated with physical illness
Mainly to prevent various primary diseases on the body.
AIDS has become a public health issue of concern to all countries in the world. There is no good treatment. The anti-viral agent and immune enhancer can be tried. The key is to popularize relevant scientific knowledge, strictly manage blood products and serious life, so as to prevent it. Mainly.
For malaria, kidney hemorrhagic fever and other epidemics, pay attention to environmental sanitation, clean up sewage debris, anti-mosquito and anti-mouse and rodent control measures can have a certain effect on prevention.
Mental disorders associated with rabies can be immunized in time after being bitten by a virus-infected dog.
Environmental and psychological care can help eliminate patients' fears and anxiety. Patients with conscious disorders should pay special attention to safety care to prevent self-injury, falls, impulsive accidents, and be alert to suicidal patients with depression. Attempt to give prevention.
Complication
Complications of mental disorders associated with physical illness Complications, reactive psychosis, schizophrenia, epilepsy
Dizziness, palpitations, insomnia, fatigue, shortness of breath, laziness, numbness or numbness, pale or sallow, pale lips, fatigue, pale complexion, less bloating, loose stools, dizziness, women's menstrual flow Less, pale tongue, thin white fur, weak pulse. At the same time, due to the onset of mental illness, cognitive decline may occur, and accidental injury may occur. Patients with concurrent mental illness also prove that the patient's disease infection is relatively serious, so active treatment is needed.
Symptom
Symptoms of mental disorders associated with physical diseases Common symptoms Dementia, mental disorders, anorexia, inability to convulsion, indifferent consciousness, fuzzy fatigue, directional stress disorder
The clinical manifestations of mental disorders caused by infection are based on acute infection or chronic infection. Acute infections lead to acute mental disorders, mainly conscious disturbances. Chronic infections are more common in chronic infections, such as schizophrenia and depression. Manic state, personality change, and intellectual barriers.
Mental disorders seen in several common infectious diseases:
(1) Mental disorders caused by influenza
As an acute infectious respiratory disease caused by influenza virus, the virus has a strong affinity for the central nervous system, which leads to mental disorders. It has been reported that the incidence rate is 25% to 35%. The main clinical manifestations are: predecessors Symptoms are headache, weakness, fatigue, sleep-wake rhythm disorder, followed by sleepiness, sensory impairment, non-photorealism, high-heat or severe cases can cause disturbances of consciousness, such as consciousness or paralysis, as the condition improves Entering the recovery period, the main manifestations are depression and cerebral weakness syndrome. In a few cases, symptoms of encephalitis can occur, the disease period is short, and the general prognosis is good.
(2) Mental disorders caused by pneumonia
In acute lung infections, there may be disturbances of consciousness at the peak of the disease. Most of them are confused and sometimes paralyzed. Chronic pulmonary infections such as tuberculosis mainly show depression and memory loss, difficulty in concentration and slow thinking.
(3) Mental disorders caused by malaria
Ordinary type may appear in the high fever stage, consciousness, disorientation and perceptual disorder, falciparum malaria, or cerebral malaria. The malaria parasite has the characteristics of strong venom and neuropathy, which can form pathological changes such as focal necrosis and hemorrhage. And cerebral edema, found in malaria endemic areas or patients with poor immunity, psychiatric symptoms: severe headache with nausea, vomiting, irritability, followed by the expression of consciousness disorders such as paralysis or paralysis or even coma, at this time the nervous system can be detected Obvious pathological signs or manifestations of convulsions or paralysis, patients with apathy, patients in the recovery period showed depression or cerebral weakness syndrome, severe cases can occur in the late stage of intelligent disorders.
(4) Mental disorders caused by epidemic hemorrhagic fever
Epidemic hemorrhagic fever is a contagious disease that is popular in autumn and winter. The pathogen may be a virus. The pathogenesis of the disease is not clear. The main manifestations are fever, hemorrhage, clinically divided into fever, hypotension, and oliguria. During the polyuria and recovery periods, 53 cases (30.6%) of the 173 patients with hemorrhagic fever had central nervous system symptoms, all showed mental disorders. Pathological anatomy showed hyperemia and vasodilation in the brain surface and brain parenchyma. And the death of the blank, psychiatric symptoms occur mostly in the hypotensive phase and oliguria, mainly manifested as wrong sleep, paralysis, confusion; or excitement, restlessness, lasting 1 to 2 weeks, the same period of neurological symptoms and Pathological signs.
(5) Mental disorders caused by rabies
The disease is caused by rabies virus, which is invaded by the dog or other animal with virus or bite. The Negri body can be found in the brain parenchyma and basal ganglia. The clinical manifestations are violent and sputum type. Headache, restlessness, low fever, healed wounds have abnormal feelings such as itching or numbness. After 2 to 3 days, the violent type shows fear of water, fear of wind, fear of light, water, wind and light can stimulate the onset of reflex throat. Tension, fear, irritability, the condition gradually worsens, and there are general sputum, neck stiffness, increased salivation, high fever, heart failure, respiratory paralysis, ineffective treatment can suddenly die, sputum type mainly manifests as limb paralysis, coma and death.
(6) Mental disorders caused by AIDS
AIDS, also known as acquired immunodeficiency syndrome (AIDS), is caused by human T-lymphocyte virus type III (HILV-III) or lymphadenopathy-associated virus (LAV), which is mainly transmitted through sexual contact. Blood and mother-to-child transmission, if the virus invades the central nervous system, neuropsychiatric symptoms may occur. About 30% to 40% of AIDS patients have central neuropathological changes: reduced neurons, brain atrophy, glial nodules and small focal Demyelination, patients in the early stage of the disease are often affected by psychosocial factors and manifest as anxiety and depression. As the condition worsens, the patient exhibits dementia status, such as forgetfulness, delay, lack of concentration, ability to solve problems, and difficulty in reading. The expression is indifferent, the initiative is poor, the society is shrinking, the physical symptoms are drowsiness, anorexia and diarrhea and the weight is significantly reduced, and some patients have seizures, silence and coma.
Examine
Examination of mental disorders associated with physical illness
The disease belongs to a mental disorder. Because the disease needs to be differentiated from organic brain lesions, it is necessary to perform head CT and MRI examinations. If necessary, cerebrospinal fluid examination is needed to determine whether there is an intracranial infection.
Psychological counseling and examination, as well as psychological counseling, can clearly identify the starting mental factors of the disease.
More common is the mental illness caused by anemia, so it is necessary to have blood routine examination, bone marrow puncture examination, and reticulocyte examination.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with physical diseases
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
The disease needs to be differentiated from the following diseases:
1. Anemia-induced or associated functional psychosis When a mental disorder caused by a physical illness is similar to a schizophrenia-like state, a depression state, a manic state, or a brain-debilitating syndrome, it is sometimes difficult to accompany a clinical condition from a physical disorder. Functional or mental disorders such as schizophrenia, affective disorder, and neurasthenia are differentiated, but it is not difficult to identify the disease process, positive physical signs, and laboratory findings.
2. Mental disorders caused by brain organic diseases In the brain, obvious pathological changes in the brain can be detected, and positive findings such as brain CT and cerebrospinal fluid examination and localized neurological signs can be identified.
