Mental disorders associated with polymyositis and dermatomyositis
Introduction
Introduction to mental disorders associated with polymyositis and dermatomyositis Polymyositis is a connective tissue disease of unknown cause. If the disease is accompanied by dermatitis, it is called dermatomyositis. The accompanying mental disorder mainly refers to skeletal muscle or skin and rich in loose connective tissue. When skeletal muscles are damaged together, inflammatory changes involve various organs and nervous systems, while mental disorders and neurological symptoms are produced. Inflammatory changes involving various organs and nervous systems can lead to neuropsychiatric symptoms. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: Schizophrenia Mental disorders associated with physical illness
Cause
Causes of mental disorders associated with polymyositis and dermatomyositis
Insufficient energy supply (20%):
The common pathophysiological change of physical illness associated with mental disorders is the change of diffuse brain energy demand. Due to physical disorders caused by physical diseases, the energy supply is insufficient, and the brain is very sensitive to energy requirements. When the body suffers from diseases, the brain responds to energy. The demand for growth, at this time the body's energy supply and demand contradictions, resulting in normal brain physiological disorders, which is the main mechanism of such mental disorders.
Brain hypoxia (10%):
Physical diseases, especially cardiovascular diseases, cause circulatory disorders in the body and brain, lung diseases or anemia cause insufficient oxygen carrying capacity, or microcirculatory disorders in the body under the influence of harmful factors, etc., can cause blood supply to the brain, and insufficient oxygen supply. Impaired brain function, which is also an important mechanism for the occurrence of mental disorders.
Biotoxin action (15%):
In the case of physical illness, exogenous substances such as bacteria, viruses, parasites, chemicals, and harmful gases invade the body, and their toxins or intermediate metabolites directly act on brain cells, causing damage to brain cells and brain disorders leading to mental illness. obstacle.
Some bacteria, viruses produce toxins have a strong affinity for the central nervous system, more likely to cause mental disorders, and some body diseases cause accumulation of toxic metabolites such as ammonia, sputum, pyruvic acid, etc., affecting the normal functional activities of the brain. Factors that cause mental disorders.
Body metabolic disorder (20%):
In physical diseases, fluid metabolism and acid-base balance disorders such as acidosis, alkalosis, hypokalemia and hyperammonemia, changes in endocrine hormones such as adrenocorticotropic hormone, cortisol, estrogen, progesterone, prolactin, Drastic changes in the levels of thyroid hormones, as well as the lack of certain vitamins, can lead to metabolic enzyme activity disorders, which in turn affect metabolism, resulting in insufficient energy supply, which will inevitably affect brain function and neuropsychiatric disorders.
Stress response (10%):
In the case of physical diseases, exogenous harmful factors, including biological stressors and psychological stressors, act on the body, and through a variety of physiological and biochemical reactions through neurophysiological, neurobiochemical, neuroendocrine and immune mechanisms, in these reactions, The brain either directly participates in or receives tiredness, causing its normal physiological function to be affected, leading to the occurrence of mental disorders.
Central neurotransmitter changes (15%):
In the case of physical illness, certain harmful substances, drugs or essential substances in the body can directly cause abnormal metabolism of monoamine transmitters in the brain. For example, metal manganese selectively acts on globus pallidus and hypothalamic, which can inhibit the activity of dopamine decarboxylase. Decreased dopamine content, hemorrhagic disease and psoriasis associated with mental disorders were found to have varying degrees of tryptophan metabolism disorders, some neuropsychiatric symptoms of hepatic encephalopathy may also be related to neurotransmitters, in some The neurotransmitters produced during the disease process, such as hydroxyphenylethanolamine and norfosflinine, cause emotional, behavioral, and conscious disturbances when they interfere with the delivery of norepinephrine; dopamine during delivery After being replaced by a pseudo-neurotransmitter, symptoms of flapping tremor or tremor palsy may occur.
Individual susceptibility (10%):
Clinically, it can be seen that the probability of suffering from various infectious diseases in the population is very high, but only a very small number of patients have an infectious mental disorder; on the contrary, the same patient has the same form in many different physical diseases. Symptoms of sputum, which may be related to genetic factors and individual quality or personality defects, such as family history, mental illness caused by physical illness accounted for 2% to 8%, higher than the general group; introverted, impatience, stubborn, willful physical illness It is prone to mental disorders; those with poor brain function, such as the elderly and children with physical diseases are prone to paralysis.
Studies have shown that the site of immune response to polymyositis begins in connective tissue, followed by muscle, skin, blood vessel wall, myocardium, serosa, and nervous system. Under electron microscopy, in the muscle and skin vascular endothelial cells of the disease. Virus-like particles similar to mucinous or mucinous viruses have been found, but the pathogenesis of polymyositis associated with mental disorders is still lacking evidence, because polymyositis associated with mental disorders is a physical disorder associated with mental disorders, so the body Whether the disease is associated with the general pathogenesis of mental disorders can provide a reference.
Polymyositis is a connective tissue disease of unknown cause. It is currently considered to be an autoimmune disease. In recent years, it has been considered that cellular immunodeficiency has important pathogenic significance. Some people think that this disease is closely related to malignant tumors. 50% of patients with dermatomyositis over 40 years old have cancer, vascular injury may have pathogenic significance, infection, sun exposure, drugs and other factors can induce it, polymyositis is the main factor in the onset of mental disorders Brain dysfunction leading to mental disorders is secondary to physical diseases. However, only a small number of patients with polymyositis develop mental disorders. Therefore, polymyositis is not the only cause of mental disorders. There are other factors and The occurrence of mental disorders, such as other biological factors, including the patient's gender, age, genetic factors, personality characteristics, and past neuropsychiatric history; psychological factors include stress, long-term psychological contradiction; environmental factors, Such as crowded living, noisy environment, humidity, air pollution, etc., the above factors can be associated with polymyositis associated with mental disorders Factor.
Prevention
Prevention of mental disorders associated with polymyositis and dermatomyositis
There are currently no effective preventive measures for collagen system diseases. A better personality and psychology will help to alleviate the development of mental symptoms after illness.
Complication
Complications of mental disorders associated with polymyositis and dermatomyositis Complications schizophrenia with physical disorders associated with mental disorders
Polymyositis is a connective tissue disease of unknown cause, such as dermatomyositis when the disease is accompanied by dermatitis. The accompanying mental disorder mainly refers to inflammatory changes involving skeletal muscles or skin and skeletal muscles that are rich in loose connective tissue, and inflammatory changes involve various organs and nervous systems, resulting in mental disorders and neurological symptoms, and their inflammatory properties. Changes involving various organs and nervous systems can lead to neuropsychiatric symptoms.
Symptom
Symptoms of mental disorders associated with polymyositis and dermatomyositis Common symptoms Cerebral dysfunction syndrome Illusion intelligent disorder Joint pain Difficulty swallowing Personality changes Fevering dysfunction of mental disorders (border clear...
1. Mainly with muscle and skin symptoms, the two may not be parallel. The muscles are mainly trunks and limbs, often accompanied by pain. The skin lesions mainly include scalp, limbs, edema symmetry of edema, and systemic symptoms may have fever. Joint pain and different organ damage.
2. Mental disorders
(1) Non-specificity of mental symptoms.
(2) In general, those with more acute onset are acute organic mental disorders (consciousness disorder), which occur mostly at the peak of physical illness; chronic onset and early stage of disease and recovery are often characterized by cerebral weakness syndrome Lord; chronic organic mental disorders may occur in the later stages of the disease, characterized by personality changes or intellectual disabilities.
(3) Mental disorders and primary somatic diseases - polymyositis often has a parallel relationship, and its clinical manifestations change with the severity of the primary disease, and can change from one state to another. All kinds of mental disorders are often repeated, intertwined, complicated, and this disease is less common with mental disorders, but there are reports of depression, hallucinations or delusions, schizophrenic psychosis, disturbance of consciousness (mostly sputum state), sometimes It is a state of paralysis.
3. Neurological symptoms
The most common form of neuritis, there may be epileptic seizures, other visible seizures, optic disc edema, dysphagia, pathological reflex and other central nervous system symptoms, may be associated with associated cerebrovascular disease.
Examine
Examination of mental disorders associated with polymyositis and dermatomyositis
It is consistent with laboratory positive changes in polymyositis and dermatomyositis.
Meet the results of polymyositis and dermatomyositis tests.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with polymyositis and dermatomyositis
Diagnostic criteria
1. The basis of multiple myositis and dermatomyositis lesions.
2. The appearance of psychiatric symptoms has a temporal relationship with the progress of polymyositis and dermatomyositis. Generally, the primary disease is first, and the psychiatric symptoms occur later, but some of the primary diseases are difficult to find in the early stage, which is relatively hidden. Or failed to attract attention, and caused the illusion that mental symptoms first appeared.
3. Psychiatric symptoms often improve with the relief of polymyositis and dermatomyositis, or worsen as it worsens.
4. Mental symptoms cannot be attributed to other mental illnesses.
Differential diagnosis
It should be differentiated from other mental disorders caused by connective tissue diseases and other functional psychosis such as schizophrenia, snoring and depression.
