delirium syndrome
Introduction
Introduction to sputum syndrome 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 following six types of patients are more likely to develop sputum: 1 old age, 2 children, 3 heart surgery, 4 burns, 5 brain damage, 6 drug dependent. Recently, two general hospitals in foreign countries conducted epidemiological studies and found that 30% and 50% of the elderly aged 70 years and older were found to have signs of sputum. However, because most elderly patients with physical illness are accompanied by mild mental confusion, they are often treated at home, so the incidence of convulsions in the elderly seems to be much higher than the general estimate. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: disturbance of consciousness
Cause
Cause of sputum syndrome
is a wide range of brain dysfunction caused by many quality factors, and the organic causes can be divided into four groups:
1 diseases that originate in the brain, such as infections, tumors, trauma, epilepsy and stroke;
2 systemic diseases that act on the brain, especially metabolic and endocrine diseases, systemic infections, cardiovascular diseases and collagen diseases;
3 Exogenous substance poisoning, that is, poisoning of drugs, industrial, plant or animal sources;
4 The withdrawal phenomenon caused by the abuse of addictive items occurs mostly in alcohol and sedative and hypnotic drug dependence.
Older patients are more likely to develop sputum and appear to be associated with the following factors: advanced age and associated brain lesions, visual and auditory disorders, decreased neurotransmitter synthesis (especially acetylcholine is the most important), age-related pharmacokinetics and Changes in pharmacodynamics, high prevalence of chronic physical illness and susceptibility to acute illness, weakening of the homeostatic regulation mechanism of the hypothalamic-pituitary-adrenal axis, sleep or sensory deprivation, limb activity Flexibility and psychosocial stress (such as the death of a loved one or the migration of a new environment), due to the lower tolerance of the elderly to drugs, drug poisoning is a common cause of senile sputum, and can even occur when the therapeutic dose of commonly used drugs, such as Diuretics, digoxin, anti-Parkinson's disease drugs, antipsychotics, antidepressants and sedative hypnotics, all drugs with anticholinergic activity are easy to cause senile convulsions. Common causes of senile sputum include: congestion Heart failure, pneumonia, urinary tract infection, cancer, hypokalemia, dehydration, sodium depletion, cerebral infarction, etc. Some of the physical diseases that do not directly affect the brain, Hip fractures, minor surgery, mild respiratory infection and severe constipation can lead to delirium under local anesthesia.
At present, there is not much understanding of the pathogenesis of sputum. The cognitive impairment of sputum patients and the simultaneous slow activity of brain waves are caused by the general decrease of brain oxidative metabolism. Any disease or toxic substance can reduce the activity of brain metabolism. The supply, intake and use of related substances can cause paralysis, and the decrease of brain oxidative metabolic rate can lead to the reduction of acetylcholine synthesis. Choline deficiency constitutes one of the characteristic manifestations of metabolic-toxic encephalopathy, namely sputum.
Prevention
Sputum syndrome prevention
Life restraint pays attention to rest, work and rest, life is orderly, and maintaining an optimistic, positive and upward attitude towards life is of great help in preventing diseases. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
Complication
Complications of hernia syndrome Complications
With psychomotor excitement, emotions are fearful, agitation or confusion. Under the control of illusion delusions, dangerous attacks or escapes can sometimes occur, which may lead to accidents.
Symptom
Symptoms of sputum syndrome common symptoms emptiness syndrome hypothermia drug dependence cognitive dysfunction drug poisoning consciousness disorder dementia vascular dementia mania
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 hernia syndrome
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
Diagnostic identification of hernia syndrome
diagnosis
The diagnosis of hernia syndrome is based on the onset of illness, the disturbance of consciousness and other symptoms of cognitive impairment, and the general diagnosis is not difficult. It is accompanied by physical illness, craniocerebral trauma and history of alcohol and drug dependence. Diagnosis, when the 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, they can be used. EEG examination, sputum status is often accompanied by diffuse slow waves, and parallel with the severity of cognitive impairment, can be identified.
In the diagnosis, the special circumstances of the elderly patients should be taken into account. When the elderly are paralyzed, there is not necessarily a very obvious disturbance of consciousness: in the elderly who have had mild dementia, as long as there are some minor physical dysfunctions, such as severe constipation. Mild bronchitis can lead to cognitive dysfunction; infection 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, and if there is no history of pain and Signs of myocardial infarction in the elderly, due to decreased heart rate and cerebral blood flow, accompanied by hypotension and a large increase in catecholamine secretion, will suddenly appear paralyzed, this case is not uncommon, but also easy to cause misdiagnosis, identification of senile sputum When diagnosing, the possibility of drug poisoning should be considered. The elderly often suffer from multiple medical diseases at the same time. There is a mutual influence between the therapeutic drug and the disease, which leads to adverse reactions. The digitalis poisoning caused by renal dysfunction is a typical example. The identification of typical sputum and dementia is generally not difficult (see Table 23-6), but in Alzheimer's disease and blood When patients with tube dementia are accompanied by convulsions, sometimes difficulties occur, and there is a history of mental decline, especially before acute cognitive impairment occurs. Dementia has already appeared, which may help identify the acute changes in cognitive and attentional processes in patients with dementia. , suggest that there is a possibility, at this time you need to fully observe and explore the cause (or multiple causes).
Differential diagnosis
Different from dementia.
