Psychosis due to systemic lupus erythematosus
Introduction
Introduction to psychosis caused by systemic lupus erythematosus Systemic lupus erythematosus is the most common type of connective tissue disease. The damage of this disease often affects the central nervous system, and 20% to 30% of people with psychiatric symptoms. Early treatment of the primary disease, curb the development of lupus erythematosus, prevent systemic seizures caused by increased intracranial pressure, hemiplegia, aphasia, dance-like involuntary movements and other neurological symptoms. The prognosis of each episode tends to be optimistic as the treatment progresses. Every effort should be made to prevent recurrent and prolonged systemic lupus erythematosus, avoiding and preventing predisposing factors such as exposure, infection and inappropriate medication, anti-tuberculosis drugs, and iodine. Anti-peony drugs, antipsychotics and antibiotics are more likely to induce lupus-like reactions. basic knowledge The proportion of illness: 0.032% Susceptible people: women Mode of infection: non-infectious Complications: hemiplegia aphasia
Cause
Causes of psychosis caused by systemic lupus erythematosus
Systemic lupus erythematosus is considered to be an autoimmune disease, and the body is damaged by multiple systems. The pathogenesis of mental disorders is complex and related to the following pathophysiological changes in the brain:
1 The blood vessel wall and choroid plexus of the brain can detect the precipitation of immune complexes and -globulin; the level of complement in cerebrospinal fluid decreases; the DNA and anti-DNA antibody immune complexes exist in the blood-brain barrier, allowing lymphocytes to pass through the blood-brain barrier. Causes extensive damage to the brain.
2 The autoantibodies have anti-brain cell protoplast antibodies, which directly damage the central nervous system.
3 due to systemic lupus erythematosus damage to the heart, liver, kidney and other important organs, secondary to serious complications caused by brain damage, mental symptoms.
Prevention
Prevention of psychosis caused by systemic lupus erythematosus
Early treatment of the primary disease, curb the development of lupus erythematosus, prevent systemic seizures caused by increased intracranial pressure, hemiplegia, aphasia, dance-like involuntary movements and other neurological symptoms.
The prognosis of each episode tends to be optimistic as the treatment progresses. Every effort should be made to prevent recurrent and prolonged systemic lupus erythematosus, avoiding and preventing predisposing factors such as exposure, infection and inappropriate medication, anti-tuberculosis drugs, and iodine. Anti-peony drugs, antipsychotics and antibiotics are more likely to induce lupus-like reactions.
Complication
Psychiatric complications caused by systemic lupus erythematosus Complications hemiplegia aphasia
Chronic persistent cases are more common in functional psychiatric-like manifestations, such as mitosis, depression, and manic state. Neurological symptoms include generalized seizures due to increased intracranial pressure, hemiplegia, aphasia, and dance-like involuntary Action, physical symptoms are the manifestations of physiological changes in the affected organs, more common EEG abnormalities, abnormal rate of 60% to 80%, mainly slow waves, changes in EEG and disappearance of central nervous system symptoms Parallel relationship.
Symptom
Symptoms of psychosis caused by systemic lupus erythematosus Common symptoms Muscle soreness, fatigue, weight loss, fingertips and fingers (toe)... Inability to mental disorders, joint deformity, obsessive conception, skin atrophy, hyperpigmentation, joint swelling and pain
Systemic lupus erythematosus is diagnosed first, and psychiatric symptoms appear at the peak of the disease and are alleviated as the physical condition improves.
First, the diagnosis of systemic lupus erythematosus
(a) symptoms
1, systemic symptoms: onset can be acute and slow, most of the early manifestations of non-specific systemic symptoms, such as fever, especially low fever common, general malaise, fatigue, weight loss, etc., often often appear slowly, infection, sun exposure Drugs, trauma, surgery, etc. can be induced or aggravated.
2, skin and mucous membranes: rash is common, about 40% of patients have facial typical erythema called butterfly erythema, acute edema, reddish color, slightly telangiectasia and scaly desquamation, severe cases of blisters, ulcers, skin Atrophy and pigmentation, palm-sized fish, fingertips and nails (peric) erythema, body skin exposed parts of maculopapular rash, purple spots, etc., all kinds of skin damage accounted for about 80% of the total number of diseases, hair easy Break, there may be alopecia areata.
3, joints, muscles: about 90% of patients have joint swelling and pain, and often the first symptom of the clinic, the most vulnerable is the proximal interphalangeal joint, knee, foot, ankle, wrist joint can be involved, joint swelling The pain is mostly symmetrical. About half of the patients have morning stiffness. X-ray examination often has no obvious changes. Only a few patients have joint deformities, muscle soreness, and weakness are common symptoms.
4, kidney: about 50% of patients have clinical manifestations of kidney disease, such as proteinuria, hematuria, tubular urine, leukocyte urine, low specific gravity urine, edema, increased blood pressure, blood urea nitrogen and creatinine increased.
5, the heart.
6, lung: lung and pleural involvement accounted for about 50%, of which about 10% have lupus pneumonia, pleurisy and pleural effusion are more common.
7, the nervous system: nervous system damage accounted for about 20%, once it appears, more often the condition is critical, brain damage can appear mental disorders, such as excitement, behavioral abnormalities, depression, hallucinations, obsessive concepts, mental disorders and so on.
8. Blood system: Almost all patients have one or several abnormal blood system at a certain stage, followed by anemia, leukopenia, thrombocytopenia, and blood stasis caused by anticoagulant substances. The incidence of anemia is about 80%. Positive cells are positive pigments or mildly hypochromic.
Examine
Examination of psychosis caused by systemic lupus erythematosus
First, the examination of lupus erythematosus
1, the general examination: patients often have anemia, white blood cells and thrombocytopenia, or manifested as a decrease in whole blood cells, erythrocyte sedimentation rate often increased, renal damage to varying degrees of urinalysis abnormalities, such as proteinuria, hematuria, plasma protein determination visible ball The protein is increased, especially in the case of renal degeneration nephritis, the white/globulin ratio is inverted, the blood cholesterol is increased, and the blood urea nitrogen and creatinine are increased in severe renal damage.
2, immunological examination: the presence of a variety of autoantibodies in the blood is characterized, anti-nuclear antibody (ANA) is almost 100% positive in the disease activity, negative replacement test may be positive, anti-nuclear antibody negative can not completely exclude this Disease, combined with clinical and other laboratory data, comprehensive analysis of anti-double-stranded DNA (ds-DNA) antibodies, but the positive rate is low, 40-75%, and disease activity and kidney damage Closely related, the antibody titer decreases with the remission of the disease, and the anti-Sm antibody is positive in about 30% SLE. Because of its high specificity, it is also called the specific antibody of this disease. For atypical, light or early cases, If the SLE standard is not confirmed, if the anti-Sm antibody is positive, it can be diagnosed in combination with other manifestations.
Second, laboratory tests for psychiatric diseases caused by systemic lupus erythematosus
Fluorescent antinuclear antibody positive is meaningful for diagnosis, psychiatric symptoms and physical condition are often proportional to their titer, mainly related to the psychological response associated with physical illness.
Diagnosis
Diagnosis and diagnosis of mental illness caused by systemic lupus erythematosus
Identify a variety of primary neurological symptoms, such as functional schizophrenia, depressive status, and manic state.
