Mental disorders associated with abnormal glucose metabolism
Introduction
Introduction to mental disorders associated with abnormal glucose metabolism Abnormal glucose metabolism is an endocrine and metabolic disease, in which blood sugar is elevated and decreased. Diabetes is a group with elevated blood glucose as the main manifestation. The main pathogenesis is due to the absolute or relative deficiency of insulin secretion and/or the disorder of glucose, protein, fat and water and electrolyte caused by the decreased sensitivity of target cells to insulin. Glucose is a physical symptom and a sign of blood glucose lower than 2.8 mmol/L caused by various causes, and is often accompanied by signs of increased sympathetic excitability and/or brain dysfunction. Mental disorders associated with hypoglycemia refer to mental disorders and neurological symptoms caused by various factors, both internal and external, that cause blood glucose to fall below 50% to 55%. basic knowledge The proportion of illness: 0.0013% Susceptible people: no specific population Mode of infection: non-infectious Complications: hypoglycemia
Cause
Causes of mental disorders associated with abnormal glucose metabolism
(1) Causes of the disease
Because the etiology and pathogenesis of diabetes are still not fully understood, it is generally believed that the complex interaction between genetics and psychology and social environment is the main factor in the pathogenesis of diabetes. Therefore, the cause of diabetes associated with mental disorders is relatively more complicated. In addition to the pathogenic factors of diabetes, it is also related to different types of diabetes. (The WHO Committee of Diabetes Experts proposes to classify the clinical types of diabetes into insulin-dependent and non-insulin-dependent types.) Metabolic disorders caused by insufficient insulin secretion can lead to ketones. Acidosis, arteriosclerosis and microvascular disease, which in turn leads to insufficient blood supply to the brain and brain dysfunction, is the biological basis for the development of neuropsychiatric symptoms.
The cause of hypoglycemia with mental disorders is mainly the neuropsychiatric symptoms caused by hypoglycemia and brain dysfunction.
(two) pathogenesis
1. The pathogenesis of diabetes associated with mental disorders
(1) Genetic factors: The incidence of type I diabetes has a certain relationship with heredity. According to the study of monozygotic twins, the co-dominance of diabetes is close to 50%, and the relationship is more closely related to type 2 diabetes. Many patients have positive families. History, the monoclinic rate of single-oval twins is as high as 90%.
(2) Psychological factors: Some clinical observations clarify that diabetes attacks are related to catastrophic events, especially acidosis or coma, which is often thought to be caused by emotional stimuli. Gao Beiling (1996) pointed out that people with type 1 diabetes before the onset of symptoms The incidence of life events such as parental death and family breakdown is high, while type II suffers from more catastrophic life events. Tang Yawen et al. (1996) reported that among 47 patients with diabetes, all patients had major events before the onset of illness. 79% of them occurred 2 years ago. Many studies have pointed out that people with diabetes also have many characteristics, such as introversion, emotional instability, passiveness, dependence, naivety, insecurity, indecision, etc. These factors contribute to the emergence of mental disorders. The extent also has a certain relationship.
(3) ketotoxicity caused by diabetes and combined arteriosclerosis, microvascular changes are also related to the occurrence of mental disorders. Before the application of insulin and antibiotics, the main cause of death in diabetic patients is ketoacidosis and co-infection, and now, chronic vascular disease It has become the main cause of neuropsychiatric symptoms and death in diabetes. Vascular lesions include large and medium blood vessels and microvessels, which are mainly characterized by abnormal functions of various systems and organs caused by arteriosclerosis and various physical, neurological and psychiatric symptoms.
(4) Changes in the nervous system often occur in patients with long course of disease and poor disease control. The peripheral nerves and autonomic nerve damage are the most common, accompanied by a variety of autonomic dysfunction symptoms, and the mechanism may be related to vitamin deficiency and long-term caused by diabetes. Related to metabolic disorders.
(5) Vitamin deficiency and metabolic disorders: Some people have neuropathy based on diabetes similar to vitamin B1 deficiency and chronic alcoholism. Some cases have improved symptoms after multivitamin B and B12, and some clinical changes in diabetes are related to this, but There are also many people who hold different opinions. When considering diabetes coma, serious neuropsychiatric symptoms are not necessarily consistent with blood glucose levels, but they are closely related to the degree of comprehensive metabolic disorders such as ketoacidosis. Therefore, hyperglycemia is not a neurological damage. The direct cause, and the pathogenesis of various secondary metabolic disorders caused by diabetes is accepted by most scholars.
2. Hypoglycemia with mental disorders normal blood glucose concentration fluctuations in the range of 3.38 ~ 8.3mmol / L (60 ~ 150mg / dL), because blood sugar is the main source of brain cell energy, transient hypoglycemia can affect brain function, in In the normal body, the stability of blood glucose concentration is mainly regulated by autonomic and endocrine. When the blood glucose concentration is higher than normal, the excitability of the hypothalamic vagus nerve center is increased, and the blood sugar is decreased. When the concentration is lower than normal, the sympathetic nerve center is excitatory. If the blood sugar rises, the food intake is insufficient, the digestion and absorption are poor, the glycogen storage is insufficient, the hormones with elevated blood sugar are insufficient, the tissue energy consumption is excessive or the vagus nerve is excessively excited, etc., hypoglycemia and hypoglycemia can occur. The clinical symptoms are roughly divided into two categories, one is functional hypoglycemia, which is caused by taking hypoglycemic agents, injecting insulin, drinking alcohol, gastrointestinal anastomosis, most of the gastric resection, and autonomic dysfunction.
One of them is called idiopathic functional hypoglycemia, which is the most common type of spontaneous hypoglycemia. It is mainly seen in middle-aged women with emotional instability and nervousness. The reason is not clear, probably due to insulin secretion. Or the regulation of glucose metabolism is not stable, or the gastric vaginal acceleration is accelerated due to increased vagal tone, and insulin secretion is excessive. The other type is organic hypoglycemia, which is mainly caused by insulinoma (also known as islet -cell tumor). Others may also be caused by liver disease, pituitary gland, thyroid function, etc., because the brain tissue itself has less glycogen, especially the cerebral cortex (only 73mg%), so the effect on the body when blood sugar is too low. With the largest nervous system, especially the brain and sympathetic nerves, the impact on the brain is the most developed, the most functional part is the easiest, the first to be affected, from the cerebral cortex, gradually along the subcortical, including the basal ganglia, hypothalamus And the autonomic nerve center, and finally affect the midbrain and cerebral ventricle, so hypoglycemia will produce a variety of neuropsychiatric symptoms.
Prevention
Prevention of mental disorders associated with abnormal glucose metabolism
Effective prevention of physical illness with mental disorders is to prevent primary physical diseases. At the same time, to strengthen the development of good character before illness and the maintenance of mental health after illness, the prevention of diabetes is as follows:
Primary prevention: Primary prevention measures are targeted at the general population, with the aim of controlling various risk factors and reducing the incidence of diabetes. Also known as primary prevention, primary prevention measures include:
1. Health education Diabetes prevention is the cause of prevention. The most important measure is to educate the public about health and raise awareness of the dangers of diabetes in the whole society. The education target is not only for diabetic patients and their families, but also for public for prevention purposes. Education has enabled society as a whole to raise awareness of the dangers of diabetes to change bad lifestyles.
2. Prevention and control of obesity and obesity is a certain risk factor for diabetes. Obese people, especially those with high blood pressure and obesity, can reduce the incidence of diabetes by reducing weight. Obese people should strictly limit the consumption of high-sugar and high-fat foods. Vegetables and fruits containing cellulose and vitamins to prevent excessive intake of energy.
3. Strengthen physical exercise and physical activity Regular participation in appropriate physical activities can reduce weight and enhance cardiovascular function, thereby preventing diabetes and its complications.
4. Promote dietary balance to promote dietary balance First, adjust the diet, avoid excessive intake of energy, replace complex carbohydrates with easily absorbed carbohydrates, dietary fiber is beneficial for controlling blood sugar, improve lipoprotein composition, and therefore rich in cellulose Natural foods such as cereals, fruits, and vegetables should be preferred. Secondly, reduce the intake of saturated fatty acids. Serum cholesterol is a sign of high levels of saturated fatty acids. People with a positive family history of diabetes and high serum cholesterol should pay special attention to avoiding saturated fatty acids. Excessive intake, promote low-fat and high-carbohydrate dietary structure, carbohydrates can account for 50% to 60% of total calories, limit fat intake to less than 30% of total calories, including saturated fatty acids, polyunsaturated fatty acids and The ratio of unsaturated fatty acids was 1:1:1.
5. Quit smoking, limit alcohol
Secondary prevention: secondary prevention is aimed at prevention of high-risk groups. Early screening, early diagnosis and early treatment, prevention of delays in the occurrence and progression of diabetes and its complications, and secondary prevention emphasize high risk of diabetes through regular screening. Population monitoring and regular screening, early detection, early diagnosis, early treatment, the main measures are screening for diabetes and impaired glucose tolerance in high-risk groups, screening for diabetes not only to detect hidden diabetes, not For people with dominant diabetes who are paying attention, and to detect IGT (low glucose tolerance), IGT is a transitional state between normal and diabetes, and its outcome is bidirectional, which can be converted to diabetes or normal. Therefore, taking measures at this stage has important public health significance and clinical significance.
High-risk groups: ages over 45, family history of diabetes-positive, obese, women with gestational diabetes, women who have given birth to large children, high blood pressure, high blood lipids, for people over 45 years old, Blood glucose testing should be performed once every 3 years for early detection, early diagnosis, and early treatment. For obese or overweight people, one test is performed every 1-2 years.
Tertiary prevention: It is a preventive measure for patients, emphasizing the standardized treatment and disease management of diabetes, and preventing the occurrence of complications and improving the quality of life through standardized treatment and management of diabetic patients.
Complication
Mental disorders associated with abnormal glucose metabolism Complications hypoglycemia
Generally no complications.
Symptom
Symptoms of mental disorders associated with abnormal glucose metabolism Common symptoms Single eye diplopia Attention deficit Intensive behavior Symmetrical muscle weakness Blood sugar elevation Nausea sensory disturbance Weakness hallucination
1. Diabetes with mental disorders
(1) Mental symptoms:
1 neurasthenic syndrome: more often in the early stages of the disease, showing burnout, fatigue, boredom, memory loss, inattention, lack of energy, etc., but autonomic symptoms are not obvious.
2 Depressed state: reduced interest, low mood, pessimism, negative, self-blame, self-sin, pessimistic, low sexual desire, etc. Depression is often accompanied by obvious anxiety, which may be a reason for the strong suicidal tendency of patients in this group. Bu et al (1994) used 70 cases of type 2 diabetes patients with depression scale (SDS), found 43 cases (61%) with mild depression, 11 cases (15.7%) with moderate depression, and 1 case with severe depression ( 1.4%), the incidence rate is much higher than the general population, depression is more important for women than men, and the longer the course of disease, the more severe the depression.
3 Anxiety: The anxiety of diabetic patients is also very prominent. The patients are anxious, nervous, depressed, fearful, irritating, emotionally unstable, accompanied by palpitations, sweating, pulse rate, restlessness, multiple medical treatments, etc. Emotions affect the recovery of blood sugar, but not proportional to the level of blood sugar. The two states of anxiety and depression are often mixed and intertwined.
4 Illusion state: I have a flash of light, lightning or illusion of various colored objects.
5 disturbance of consciousness: early performance can be lethargy, mostly occurs after the physical symptoms aggravate and the blood sugar rises or approaches coma. As the blood sugar level changes, the sleepiness can be fluctuating. When the blood sugar rises, the patient is lethargic, the condition deteriorates, and the disturbance of consciousness Deepening, coma occurs more when diabetes worsens, first thirst, nausea, vomiting and dehydration, and then respiratory acidosis, and finally into a coma, during which there may be a state of confusion, it is worth mentioning the emergence of mental symptoms, The type and duration of the disease and the level of blood sugar do not always have a parallel relationship, and the individual differences are quite large.
(2) Neurological symptoms: Diabetic neuropathy affects almost the entire nervous system, including the brain, spinal cord, spinal nerve roots, peripheral nerves, autonomic nerves, etc., and the above lesions can be affected alone or simultaneously.
1 Sensory Disorder: Sensory disturbance is the most common symptom, including spontaneous dull pain and paresthesia, such as burning sensation, cold feeling, ant walking feeling, abnormal numbness and so on.
2 changes in motor reflex: the most common occurrence of Achilles tendon reflexes, such as concomitant cerebrovascular disease, hyperreflexia and pathological reflexes, the motor system often involves the proximal muscles of the extremities, and the paralyzed parts are often accompanied by pain, which is clinically It is called "diabetic muscle atrophy", "asymmetric motor neuropathy" and so on.
3 autonomic nerve changes: autonomic nervous symptoms have not been paid much attention in the past. In recent years, autonomic nerve damage has been found to occur earlier and the incidence rate is higher, accounting for more than 85%. Among them, autonomic nervous symptoms and polyneuritis are more common, many Diabetic patients have sympathetic degeneration of blood vessels, causing skin and subcutaneous tissue atrophy, hypertrophy, edema, erythema, sweating or less sweat, retinal changes, etc., in addition to other organs autonomic dysfunction symptoms, common cardiovascular and gastrointestinal Symptoms of autonomic dysfunction, such as heart palpitations, excessive sweating, hand tremors, pulse rate, urinary incontinence, urinary retention, etc., impotence, menstrual abnormalities account for about 50%.
4 stroke: caused by vascular disease, may also be associated with seizures.
2. Hypoglycemia with mental disorders
(1) Mental disorders:
1 disturbance of consciousness: similar to the clinical manifestations of insulin shock treatment, there are lethargy, consciousness, slumber, until different degrees of coma, can also appear paralyzed state, before the coma can appear sports excitement, irritability, restlessness, shouting, impulsive or Attack behavior, etc., sometimes the disturbance of consciousness can be intermittently short-lived loss of consciousness. For example, when the blood glucose drops rapidly, the clinical manifestations are abnormal behaviors such as mental behavior, epileptic seizures, and disturbance of consciousness. It is easily misdiagnosed as a mental illness or an instrument. Sexual encephalopathy (encephalitis, etc.), because blood sugar does not fully reflect the amount of sugar in the brain, so blood sugar can not be used as a standard for coma.
2 If it is a subacute disease, the performance is lack of self-control, control, etc., some loneliness, ignorance, less movement, personality disintegration, etc., and some impulsive wounds and other behaviors, similar to the drunken state of acute alcoholism.
3 chronic illness can occur emotional instability, irritability, irritability, anxiety, fear, depression, etc., can also appear illusion, auditory hallucinations and delusions, can also be seen in a manic state, frequent authors due to brain softening can cause emotional apathy Personality changes and mental retardation, memory loss, difficulty in understanding, lack of thinking, etc.
(2) Neurological symptoms:
1 autonomic symptoms: dizziness, headache, sweating, hunger, pale, palpitations, rapid pulse, tremor, nausea, vomiting, abdominal pain, double vision, mouth and fingertips, acupuncture or burning sensation, etc. .
2 central nervous system symptoms: vision loss, diplopia, tremor, increased muscle tone, pathological reflex positive, slow movement, ataxia, dance-like or hand-foot-like movement, transient monosexual or hemiplegia, severe speech disorder There may be seizures.
(3) Muscle symptoms: After multiple coma, there may be symmetrical muscle weakness in the distal extremities, muscle atrophy, sputum reflex or disappear, clinically known as hypoglycemic muscle atrophy.
Examine
Examination of mental disorders associated with abnormal glucose metabolism
Conforms to laboratory tests for abnormal glucose metabolism (diabetes or hypoglycemia).
Diagnosis
Diagnosis and diagnosis of mental disorders associated with abnormal glucose metabolism
Diagnostic criteria
The diagnosis must be established with the following points:
1. There is a basis for abnormal glucose metabolism (diabetes or hypoglycemia) in physical diseases.
2. The appearance of mental symptoms is related to the progress of abnormal body metabolism (diabetes or hypoglycemia). Generally, physical illness occurs first, and psychiatric symptoms occur later, but some physical diseases are difficult to find in the early stage. Concealed, or failed to attract attention, and caused the illusion that mental symptoms first appeared.
3. Psychiatric symptoms often improve with the relief of abnormal glucose metabolism (diabetes or hypoglycemia), or worsen as it worsens.
4. Mental symptoms cannot be attributed to other mental illnesses.
5. Severity reached:
1 The actual inspection capability is reduced;
2 social function decline.
Differential diagnosis
Physical illnesses associated with mental disorders and other functional psychosis such as schizophrenia and depression should be excluded.
1. Functional disorders caused by abnormal glucose metabolism (diabetes or hypoglycemia) when clinically abnormal glucose metabolism (diabetes or hypoglycemia) accompanied by mental disorders like schizophrenia-like state, depression state, madness State or brain weakness syndrome, etc., when it is difficult to distinguish from functional mental disorders, attention should be paid to the identification by mastering the disease process, positive physical signs and laboratory findings.
2. Brain organic diseases associated with mental disorders The primary disease in the brain can be found in obvious brain pathological changes, brain CT, cerebrospinal fluid examination and other positive findings and localized neurological signs can be identified.
