Delirium syndrome and related disorders
Introduction
Introduction to sputum syndrome and related diseases Deirium syndrome (deliriumsyndrome) is a group of syndromes characterized by a wide range of cognitive disorders, especially with disturbance of consciousness. Often caused by diffuse brain, temporary poisoning infections or metabolic disorders. Because it often occurs in acute onset, short course of disease, rapid development of poisonous infections, brain trauma and other diseases, it is also called acute encephalopathy syndrome (acutebrainsyndrome) or acute disorder state (acuteconfusionalstate). The sputum syndrome is the most common mental disorder in general hospitals, accounting for 5% to 15% of internal and surgical patients, and most of them can be recovered. The diagnosis of sputum syndrome is not difficult according to the characteristics of sudden onset of illness, disturbance of consciousness and other symptoms of cognitive impairment. Accompanied by physical illness, craniocerebral trauma, and a history of alcohol and drug dependence, can help diagnose. When the sputum syndrome is clear, the basic cause should be clarified. When patients with acute schizophrenia and mania are in a state of confusion, they can be identified from medical history and mental examination. If in doubt, you can do an EEG check. The sputum state is often accompanied by diffuse slow waves, which are parallel to the severity of cognitive impairment and can be identified. basic knowledge The proportion of illness: 0.023% Susceptible people: no specific population Mode of infection: non-infectious Complications: dementia
Cause
Phlegm syndrome and related diseases
Organic causes (45%):
1 diseases that originate in the brain, such as infection, tumor, trauma, epilepsy and stroke; 2 systemic diseases that act on the brain, especially metabolic and endocrine diseases, systemic infections, cardiovascular diseases and collagen diseases; Source material poisoning, that is, poisoning from drugs, industrial, plant or animal sources; 4 withdrawals caused by the abuse of addictive items, mostly occur in alcohol and sedative and hypnotic drug dependence.
Individual factors (45%):
Age-related and associated brain lesions, visual and auditory disorders, decreased neurotransmitter synthesis (especially acetylcholine is the most important), age-related pharmacokinetics and pharmacodynamic changes, high disease of chronic physical illness Rate and susceptibility to acute illness, weakening of the homeostatic regulation mechanism formed by the hypothalamic-pituitary-adrenal axis, sleep or sensory deprivation, inflexible limb activity, and psychosocial stress (such as funeral or migration) Environment, etc.).
Pathogenesis
The cognitive impairment of paralyzed patients and the simultaneous slow activity of brain waves are due to the general decrease in brain oxidative metabolism. Any disease or toxic substance can cause paralysis as long as it can reduce the supply, intake and use of substances related to brain metabolic activity. A decrease in the oxidative metabolic rate of the brain leads to a decrease in the synthesis of acetylcholine, which constitutes one of the characteristic manifestations of metabolic-toxic encephalopathy, namely sputum.
Prevention
Sputum syndrome and related disease prevention
There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention.
Complication
Sputum syndrome and related disease complications Complications dementia
With psychomotor excitement, the emotions are fearful, agitated or confused. Under the control of illusory delusions, dangerous attacks or evasive behaviors can sometimes occur, which can lead to accidents.
Symptom
Symptoms of sputum syndrome and related diseases Common symptoms Intelligent hypothyroidism, madness, cognitive dysfunction, dementia, disturbance of consciousness
The symptoms of rapid onset, disturbance of consciousness, and other symptoms of cognitive impairment are not difficult to diagnose. Accompanied by physical illness, craniocerebral trauma, and a history of alcohol and drug dependence, can help diagnose. When the sputum syndrome is clear, the basic cause should be clarified. When patients with acute schizophrenia and mania are in a state of confusion, they can be identified from medical history and mental examination. If in doubt, you can do an EEG check. The sputum state is often accompanied by diffuse slow waves, which are parallel to the severity of cognitive impairment and can be identified.
Examine
Examination of sputum syndrome and related diseases
It is necessary to do some auxiliary examinations, such as electrocardiogram, chest X-ray, abdominal ultrasound, liver function, EEG, head CT or MRI.
For schizophrenia, the main examination item is a mental examination. The mental examination requires a professional psychiatrist to contact the patient, face-to-face conversation, through which the positive and negative symptoms of schizophrenia are found, and the disease is acquired. The basis for diagnosis. When performing a mental examination, the doctor needs to make a careful judgment of the patient's general performance, cognitive process, emotional performance, will and behavior.
At the beginning of the psychiatric examination, it is first necessary to assess the general performance of the patient, to check whether the patient's consciousness is clear, to answer questions about cooperation, and how to live and sleep. For the examination of patients' cognitive processes, attention should be paid to whether their attention is concentrated, whether there are hallucinations and perceptual disorders, and whether there are mental disorders. Observe the patient's emotional performance by observing the patient's expression, posture, speech tone, and body movements, paying attention to the decline or enhancement of the will, whether there are strange behaviors, and whether the instinct activities such as diet and sexual desire increase or decrease.
Diagnosis
Diagnosis and identification of sputum syndrome and related diseases
diagnosis
The diagnosis of sputum syndrome is not difficult according to the characteristics of sudden onset of illness, disturbance of consciousness and other symptoms of cognitive impairment. Accompanied by physical illness, craniocerebral trauma, and a history of alcohol and drug dependence, can help diagnose. When the sputum syndrome is clear, the basic cause should be clarified. When patients with acute schizophrenia and mania are in a state of confusion, they can be identified from medical history and mental examination. If in doubt, you can do an EEG check. The sputum state is often accompanied by diffuse slow waves, which are parallel to the severity of cognitive impairment and can be identified.
In the diagnosis, special circumstances of elderly patients should be considered. When the elderly are paralyzed, there may not be a very obvious disturbance of consciousness: in the elderly who have had mild dementia, as long as some minor physical dysfunction, such as severe constipation and mild bronchitis, can lead to cognitive dysfunction; Infections in the elderly can be occult, and sputum can occur before signs and special symptoms, such as so-called asymptomatic pneumonia, which makes diagnosis difficult, such as elderly patients with myocardial infarction without pain history and signs, due to cardiac output and brain The decline in blood flow, accompanied by hypotension and a large increase in catecholamine secretion, will suddenly appear paralyzed, this case is not uncommon, it is easy to cause misdiagnosis. In the differential diagnosis of senile sputum, the possibility of drug poisoning should be considered. Older people often suffer from a variety of medical conditions at the same time, which can affect each other between treatment and disease, leading to adverse reactions. A case of foxglove poisoning caused by renal dysfunction is a typical example. The identification of typical sputum and dementia is generally not difficult, but sometimes it is difficult to develop sputum in patients with Alzheimer's disease and vascular dementia. There is a history of mental decline, especially before acute cognitive impairment occurs, dementia has already appeared, which can help identify. When dementia patients have acute changes in the cognitive and attentional processes, suggesting that there is a possibility of paralysis, it is necessary to comprehensively observe and explore the cause (or multiple causes).
Differential diagnosis
Performance sputum, dementia, acute onset, often slow volatility during the night, sometimes awake during the day; no increase in the day during the night, the disease period of hours to weeks or years, the awareness is reduced, clear, The alarm is abnormally reduced or increased, generally normal, lack of directionality and selectivity, attention to dispersion, fluctuations within a day are relatively unaffected, orientation is generally time-oriented, and the familiar place and characters are sparse. , often have obstacles, immediate memory and near memory impairment, near and far memory are impaired, thinking is disorderly and poor, perceptual illusion and hallucinations (visual aspects) are common, less speech incoherence, slow or fast performance with difficult words, sleep - Awakening is often disrupted, waking up when sleeping, periodic physical illness or drug poisoning, which can often be seen alone or simultaneously, especially Alzheimer's disease.
