somatosensory disorder
Introduction
Introduction to somatosensory disorders Somatosensory disorder is a neurological condition characterized by a persistent belief in beliefs or beliefs in various physical symptoms. The patient was repeatedly treated as a doctor, and various medical tests and doctors' explanations could not dispel their doubts. Even when a patient does have a physical disorder, it cannot explain the nature, extent, or suffering of the patient and the concept of preemption. These physical symptoms are thought to be caused by psychological conflicts and personality tendencies. Even if the symptoms are closely related to stressful life events or psychological conflicts, patients refuse to explore the possibility of psychological causes. Often accompanied by anxiety or depression. basic knowledge The proportion of illness: 0.015% Susceptible people: no specific population Mode of infection: non-infectious Complications: syringomyelia
Cause
Cause of somatosensory disturbance
The exact cause of the disorder in this group is unknown. Studies in recent years have suggested that such diseases are related to the following factors:
1. Genetic reports suggest that somatoform disorders are associated with genetic predisposition. A study of a group of chronic functional pain demonstrated a positive family history that was significantly higher than organic pain; multivariate analysis showed a positive correlation between family genetic history and pain.
2. Personality authors' research found that both male and female patients have MMPI profiles of 1, 2, 3, and 7 types, and their two-point coding basically conforms to the personality characteristics of neurosis. Patients with "nervous" personality focus more on their physical discomfort and related events, leading to a lower sensory threshold, increased sensitivity to body sensation, and a variety of physical discomfort and pain. Sterm's research found that patients with somatoform disorders often have certain personality disorders, and passive-dependent, performance-type, and sensitive attacks are more common.
3. Neurophysiological and neuropsychological studies It has been found that patients with somatoform disorders have changes in brainstem reticular structure attention and arousal function. Studies on brain function asymmetry change the feelings, attention and mood changes of the transition disorder to the right hemisphere of the brain. The way the information processing process is linked, the brain research on somatoform disorders points to the second sensory zone (S11), which seems to be particularly well-suited to explain its neurophysiological and neuropsychological dynamics. Some people think that in the emotional conflict, neuroendocrine, autonomic nerve and blood biochemical changes in the body lead to changes in blood vessels, internal organs, muscle tension, etc. These physiological reactions are perceived by the patient as physical symptoms.
4. Psychosocial factors:
(1) Subliminal benefit: The psychoanalytic school believes that such physical symptoms can provide patients with two benefits in the subconscious. One is to relieve emotional conflict through disguised venting, and the other is to avoid the problem by presenting a sick person. Willing to take responsibility and get care and care.
(2) Cognitive role: the patient's personality characteristics and bad mood can affect the cognitive process, leading to sensitivity and enlargement of perception, making the person's feelings about the body information stronger, selectively paying attention to the body sensation and interpreting it with physical diseases. This tendency enhances the association and memory associated with the disease and the negative evaluation of one's own health.
(3) Alexithymia: Some people think that low-cultural people are not good at expressing their deep feelings in words, the so-called alexithymia. Lesser believes that alexithymia is a long-standing personality trait. Patients are not good at expressing their inner conflicts. It is easier to describe the body than emotional expression, and even to achieve indistinguishable inner feelings or physical sensations. Some people think that patients have serious defects in the self-perception and verbal expression of emotional experience. Their emotional experience is not transmitted to the cerebral cortex and expressed through linguistic symbols, but is released through the formation of so-called "organ language" by the nerves.
(4) Life events: Dantzer emphasizes the connection between life events and the body. Bacon found that life events were directly proportional to body complaints. The authors' study also found that the stimuli of negative events were higher in the study group than in the control group, and life events were positively correlated with the amount of pain. The total social support score of the study group was significantly lower than that of the control group and negatively correlated with the amount of pain. Long-term stress is the main cause of life.
(5) Social and cultural factors: Some studies have found that physical form disorders are particularly common in middle-aged and older women with lower culture. Studies have also shown that chronic functional pain is also more common in women with lower levels of education. Some people think that the expression of emotions is influenced by specific social culture. Whether in the Western society before the 20th century or the grassroots society in today's developing countries or developed regions, negative emotions are often seen as an expression of incompetence and shame. The direct expression of this kind of emotion, and the complaint of physical discomfort is a "legal" way. In this cultural context, patients will consciously or unconsciously conceal, deny, and even not feel their emotional experience, but pay attention to their physical discomfort. Although the onset and persistence of symptoms are closely related to unpleasant life events, difficulties, psychological factors or internal conflicts, patients often deny the existence of psychological factors and refuse to explore the possibility of psychological causes.
Prevention
Somatosensory disorder prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Somatosensory complication Complications syringomyelia
The main complication can be associated with exercise in the corresponding area and autonomic dysfunction, such as multiple neuropathy. The third (mandibular) branch of the trigeminal nerve is damaged, the mandibular (except the mandibular angle), the front of the tongue 2/3, the bottom of the mouth, the lower teeth and the gums, the external auditory canal and the tympanic membrane, and other mucous membrane dysfunction, with masticatory tendon, mouth and mandibular deviation Side (sports branch and mandibular branch). Can be associated with post-root radiation pain (root pain). Found in the central part of the spinal cord such as early intramedullary tumor, syringomyelia and so on.
Symptom
Symptoms of Somatosensory Disorders Common Symptoms Radioactive Pain Sensation Inversion Psychology Excessive Phantom Limb Pain Symptoms Segmental Separate Sensory Disorder Spinal Cord Spinal Hemisection Syndrome Deep Sensory Disorder Somatization Disorder
The clinical manifestations of sensory disturbances are diverse and may vary from lesion to lesion.
1. Terminal type :
The distal symmetry of the limb is completely sensational, with a glove-sock shape distribution, with corresponding zone movement and autonomic dysfunction, such as multiple neuropathy.
2. Peripheral nerve type :
It can manifest a sensory disturbance in a peripheral nerve innervation zone, such as ulnar nerve injury involving the forearm ulnar side and 4, 5 fingers. Such as a limb, most peripheral nerves, various sensory disturbances, nerve trunk or nerve plexus injury; such as the third (mandibular) branch of the trigeminal nerve, the lower jaw (except the mandibular angle), 2/3 in front of the tongue, the bottom of the mouth, the lower teeth and the gums Skin and mucous membrane dysfunction, such as external auditory canal and tympanic membrane, with masticatory tendon, and the mandibular jaw is biased to the affected side (sports and mandibular branches).
3. Segment type:
(1) posterior root type: unilateral segmental complete sensory disturbance, such as extramedullary tumor compression of the spinal nerve root, may be associated with post-root radiation pain (root pain).
(2) posterior angle type: unilateral segmental dissociative sensory disturbance, seen in one side posterior horn lesion such as syringomyelia.
(3) anterior commissure: bilateral symmetrical segmental dissociative sensory disturbance, seen in the central part of the spinal cord such as early intramedullary tumor, syringomyelia and so on.
4. Conducted beam type:
(1) Brown-Sequard syndrome: below the lesion plane, the contralateral pain is lost, and the ipsilateral deep sensory loss, such as extramedullary tumor early, spinal cord trauma.
(2) Transverse injury of the spinal cord: complete conduction beam dysfunction below the lesion plane, such as acute myelitis, late spinal cord compression.
5. Cross type :
In the same side, the contralateral body pain is reduced or absent, such as the dorsolateral (Wallenberg) syndrome, the lesion involving the trigeminal ridge, the spinal nucleus and the crossed spinal thalamus side bundle.
6. Partial type:
Contralateral partial body (including facial) feelings of decline or loss, seen in the pons, midbrain, thalamus and internal capsule lesions, one side of the pons or midbrain lesions can appear in the ipsilateral cranial nerve motor neurons. Thalamic lesions have deeper sensory disturbances, heavier distal ends, often accompanied by spontaneous pain and hypersensitivity, analgesics are ineffective, and antiepileptic drugs may be relieved. Damage to the internal capsule can cause a triple bias.
7. Single limb type :
The sensory loss of the contralateral upper limb or lower limb may be accompanied by a composite sensory disturbance, which is a lesion in the cerebral cortex. The stimulating lesion in the cortical sensory area may cause a contralateral focal sensory seizure.
Examine
Physical sensory examination
The necessary selective laboratory tests include: blood routine, blood electrolytes, blood sugar, and urea nitrogen.
The necessary optional auxiliary inspection items include:
1. Bottom of the skull, CT and MRI examinations.
2. Cerebrospinal fluid examination.
3. Chest, ECG, ultrasound.
Diagnosis
Diagnosis and diagnosis of somatosensory disturbance
Symptoms usually appear before sensory signs, but patients with sensory symptoms and lack of signs are not completely prompted for psychogenic diseases. The distribution of sensory signs may indicate the type of lesion and the level of localization in the nerve axis. Time course may indicate the cause.
Detailed neurological examinations should be performed, especially the distribution of sensory disturbances, combined with medical history and other clinical features to make an etiological diagnosis.
