Mental disorders associated with respiratory diseases
Introduction
Introduction to mental disorders associated with respiratory diseases Mental disorders associated with respiratory diseases, also known as mental disorders caused by lung diseases, are among the types of mental disorders caused by physical diseases, mainly due to respiratory physiology, hematology and brain metabolism caused by various lung diseases. Changes in the aspect, resulting in respiratory insufficiency leading to cerebral hypoxia and mental disorders, its occurrence is closely related to blood pH reduction, hypercapnia and hypoxia. Pulmonary encephalopathy (pulmonary-encephalopathy) refers to pulmonary dysfunction caused by chronic lung disease, mental disorders and neurological symptoms, also known as respiratory encephalopathy. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock, arrhythmia, diarrhea, upper gastrointestinal bleeding
Cause
Causes of mental disorders associated with respiratory diseases
Exogenous causes (10%):
(1) Inhaling specific and non-specific substances present in the air, such as pollen, dust mites, animal dander, drugs, certain foods (milk, seafood), etc. These substances have certain antigenicity in humans. An allergic reaction occurs in the body.
(2) The change of each factor in the temperature, humidity, air ion and other components can constitute a stressor for people with allergies.
Endogenous causes (15%):
(1) Abnormal neurological mechanisms, such as hypercholinergic hyperfunction, increased alpha-adrenergic effects, and/or low beta-adrenergic effects, can lead to high reactivity of the airways and asthma attacks.
(2) Respiratory tract or other infections.
(3) In all bronchial asthma, psychosocial factors (psychological stress) play an important role in the occurrence, development and prognosis of asthma. Statistics show that only 15% of individuals with a single mental factor contribute to asthma, allergic reactions 50% of people with mental factors, in addition, often accompanied by anxiety, depression, fear and other emotions in asthma attacks, which will further affect the condition of asthma, form a vicious circle, make the episode more frequent and sustained, in addition, bad life behavior Modes such as smoking, alcoholism, overwork, etc. can induce asthma. According to the survey, family members of asthma patients (mainly mothers) have more neuroticism (feeling, sensitive, excessive love, etc.), which may lead to strong dependence. Sensitive, cowardly personality, which also plays a role in the occurrence of mental disorders associated with asthma attacks.
Pathophysiological changes (25%):
The basic pathophysiological changes of this disease are CO2 retention and cerebral hypoxia. It is called CO2 poisoning, CO2 anesthesia or respiratory acidosis. When chronic respiratory dysfunction is common, heart function is also affected, which can lead to pulmonary heart disease. When there is a sudden change in the weather, overwork, lung infection or some stress factors, it will increase the burden of lung function, pulmonary insufficiency, lack of ventilation, etc., alveolar PO2 reduction, PCO2 increased Due to the increase of PCO2 in arterial blood, high-carbonation reaction and electrolyte imbalance occur in pH lowering, respiratory acidosis occurs, and CO2 anesthesia is caused, resulting in hypoxia of brain tissue and brain edema, which seriously affects the central nervous system and causes mentality. Obstacles, therefore, most scholars believe that pH reduction is the main mechanism of pulmonary encephalopathy.
There are many causes of this disease, in addition to chronic lung diseases (chronic emphysema, chronic bronchitis, pulmonary fibrosis, tuberculosis, etc.), other diseases that affect respiratory function such as lateral sclerosis, muscle atrophy, polio, severe Muscle weakness, scoliosis, heart failure, increased intracranial pressure and idiopathic alveolar ventilation can also be triggered, and infection is an important trigger.
Prevention
Prevention of mental disorders associated with respiratory diseases
Because the basic pathophysiological changes of this disease are CO2 retention, CO2 poisoning, CO2 anesthesia, pH lowering, respiratory acidosis, and cerebral hypoxia leading to mental disorders, actively treating the primary disease, preventing and correcting respiratory insufficiency, improving Blood oxygen concentration, increasing cerebral oxygen levels, is essential to prevent the occurrence of mental disorders.
Because there are more people with respiratory tract infections in winter and spring, it is easy to damage the upper respiratory tract mucosa, and its non-specific immunity is reduced. Various pathogenic microorganisms are easy to take advantage of, which increases the chance of infection of respiratory diseases, so different people Prevention means also have corresponding changes, prevention of healthy people: drink more water, pay more attention to personal hygiene, timely increase or decrease of clothing according to weather changes, should actively participate in various sports activities, enhance physical fitness, actively prevent colds, avoid eating civet, dead poultry Foods that may spread the virus, prevention of asthma patients: spring outings, walking, walking, try to avoid contact with pollen, patients with surface hormones, in the winter and spring this day and night temperature difference is greater, try not to reduce the dose, so as not to Cause recurrence, in addition, you can eat more food such as garlic, onions, prevent colds, so as not to induce asthma attacks, patients with chronic respiratory diseases: should keep warm, keep indoor air circulation, avoid staying in the wind, because these people are physically resistant Weak force, once you have a cold (upper respiratory tract infection), very Spread down to the lung infection, avoid cold when taking a bath. Also, try not to go to a large gathering, not to go to a crowded, airy place, in the diet, edible bird's nest, Ganoderma lucidum, Cordyceps, Beibei, etc. Food, improve your own immunity, patients who are thin should eat more protein-rich foods such as milk, eggs, fresh fish, lean meat and other foods.
Develop a scientific and healthy living habit on weekdays:
1. Wash your hands frequently: After sneezing, coughing and cleaning your nose, wash your hands with soap and running water. After washing your hands, dry or dry with a clean towel and paper towel. Do not share towels. Do not touch your face or eyes before washing your hands. Mouth, change the habit of rubbing your nose and rubbing your eyes, avoid invading the body with germs on your hands, and do not wash your hands immediately. You can disinfect your hands with a disinfectant wipe.
2. Frequent ventilation: ventilation in the living room and office is very important. It is best to breathe fresh air after 1~2h indoors. Stay indoors for a long time, open the window, ventilate and keep the air fresh, go to work. Go out, pay attention to the quality of the vehicle, the air quality of the place, try to stand in the air-free place, avoid the unpopular air and dense public places in the epidemic season.
3. Drink plenty of water: keep the nasal mucosa moist in the spring, drink plenty of water, antibacterial effect, can effectively resist the invasion of the virus, drink more water, and also enhance the metabolic function of the body, reduce the stimulation as much as possible, do not smoke, do not drink, Do not eat spicy food, by reducing the stimulation of the respiratory tract, to achieve the protection of natural immune function, enhance the ability to eliminate the invasion of external bacteria into the respiratory tract.
4. The law of work and rest: the combination of work and rest, to maintain adequate sleep and life routine, to avoid excessive fatigue, not to get through, to achieve entertainment.
5. Balanced diet: Eat more fruits and vegetables containing vitamin C and high-calorie, high-protein foods, which can enhance the resistance to viral and bacterial infections.
6. Insist on exercise: exercise and enhance physical fitness can effectively improve the vitality of the immune system.
7. Pay attention to keep warm: clothing should increase or decrease with temperature changes.
8. Keep the room hygiene: the living environment is clean, the bedding is regularly exposed to the sun for 2 hours, which is not conducive to the survival of bacteria. Indoor smoked moxa, incense, spray perfume, plug-in air cleaning tablets can help eliminate germs, vaccination related vaccine baby The body's immunity is relatively low, and you can plan to immunize on time to prevent the corresponding infectious diseases.
9. Avoid contact: There are similar symptoms of cold and fever, especially fever, headache, joint pain, cough, and more timely medical treatment, try to avoid visiting infected patients, the patient's family can take preventive drugs under the guidance of a doctor.
10. If there are respiratory infections in the family, patients who should be able to recuperate at home should be restricted to a certain range of activities during the segregation period, not to go to public places; keep indoor air fresh, often open windows for ventilation, ventilation can The number of pathogens and pathogenic microorganisms should decrease; when the family members are in contact with the patient, they should wear a mask. The mask should not be used continuously for more than 4 hours. Do not forget to change clothes after taking the patient. The patient's food and daily necessities should be used exclusively, and be kept clean. Disinfect after the isolation period. , ceramic, glass catering utensils boiled disinfection, water surface immersed in the sterilized items, the water starts to count, usually 15 ~ 30min; sputum with bleach powder mixed disinfection, the ratio is 5:1, disinfection time is 2h, cup, After every use, soak it with strong sterilizing solution for 30min, then wash it with clean water; after the patient is released from isolation, disinfect the air, floor and furniture in the living room, close the doors and windows when spraying disinfectant, and open the window after 1h; After disinfecting the furniture, wipe it off with water.
At the same time, improving mental health, treating diseases correctly, and developing cheerful, optimistic, and open-minded personality can keep us away from respiratory diseases.
Complication
Complications of mental disorders associated with respiratory diseases Complications, shock arrhythmia, diarrhea, upper gastrointestinal bleeding
Complications include shock, arrhythmia, multiple organ damage, such as liver failure, electrolyte imbalance, gastrointestinal symptoms such as vomiting, diarrhea, upper gastrointestinal bleeding and so on.
Hypercapnia acidosis can cause cerebral vasodilation, resulting in cerebral edema, increased intracranial pressure, severe cases can lead to shock; at the same time can reduce myocardial contractility, vasodilating tension, can also increase the activity of sympathetic nerves, causing Arrhythmia. Multiple organ damage is an important cause of death from mental disorders associated with respiratory diseases.
Symptom
Symptoms of mental disorders associated with respiratory diseases Common symptoms Anxiety, dyspnea, confusion, lethargy, intelligent decline, suspicion, slow response, depression, auditory hallucinations
The clinical occurrence of all respiratory diseases with mental disorders is highly correlated with pulmonary dysfunction.
1. Mental disorders associated with bronchial asthma
(1) Emotional disorder type, patients often have fears, anxiety, irritability, depression and other negative emotions during the attack.
(2) Depression- delusion type, there may be delusions, content is mainly victimized, relationship, sin, etc., may be accompanied by auditory hallucinations, often accompanied by mild confusion.
(3) Epilepty-like disturbance of consciousness, mostly short-term loss of consciousness, similar to epileptic seizures, patients with epileptic seizures in asthma attacks, asthma and consciousness disorders are parallel, the prognosis is generally good, there are observations Asthma attacks and some functional psychosis may have antagonistic effects. For example, some scholars have suggested that patients with manic depression have fewer bronchial asthma, but there are also two diseases at the same time.
2. Pulmonary encephalopathy
The psychiatric symptoms of pulmonary encephalopathy are most common in consciousness disorders. They begin to manifest as conscious turbidity, lethargy, often occur during meals, conversations, and intermittent. When the drowsiness is awake, the sputum state may occur, and if the condition is further aggravated Entering drowsiness, from drowsiness to sputum, confusion, serious coma, or from the beginning as a state of paralysis or insanity, the condition can be repeated fluctuations, several states can alternately appear, or suddenly into a coma Some patients have no obvious disturbance of consciousness, or only mild changes, highlighting suspicion, anxiety, disillusionment, auditory hallucinations and victimization delusions. A small number of patients may experience depression or euphoria. These symptoms are often transient or paroxysmal, and some patients may have partial insight.
(1) disturbance of consciousness: more common in pulmonary heart disease, the patient is transferred from sleepiness to confusion, and if there is a lung infection, he may have a paralyzed state. In severe cases, coma may occur. When the patient is confused or in a semi-conscious state, There may be excitement, irritability, lack of purpose, lack of purpose, hand grasping, disorientation, verbal disorder, horror visual hallucinations, fragmentary delusions, etc., the degree of patient's disturbance of consciousness often fluctuates, sometimes intermittently awake, with physical illness improved, Consciousness has gradually turned clear.
(2) schizophrenic appearance: more often after the disappearance of consciousness disorder or early stage of the disease, manifested as euphoric words, excitement, sloppy thinking, often accompanied by mild disturbance of consciousness, illusory delusion state, only short-lived, fragments Phantom, auditory hallucinations and murderous delusions, others are characterized by stereotypes and stupor, and a small number of patients have sputum-like episodes.
(3) Anxiety and depression: such as anxiety, nervousness, fear, low mood, self-blame and pessimism, similar anxiety, depression, should be carefully identified.
(4) In the elderly or those with arteriosclerosis, when the disturbance of consciousness is eliminated, there may be euphoria, more words, near forgotten, fictional, misconstructed and other Kosakov syndrome or dementia state.
(5) Symptoms and signs of the nervous system are common flapping tremor, sputum attack, myoclonus, pyramidal tract sign, eye movement disorder, fundus vein dilatation, optic disc edema, retinal hemorrhage, etc., may have epileptic seizures in the later stage.
(6) Symptom staging: Stage 1: psychomotor inhibition, sleepiness, paralysis or lethargy, mild manic performance, occasional flapping tremor, etc.; Phase 2: lethargy, hallucinations, delusions, convulsions, flapping tremors Etc.; 3: disorder, optic disc edema, pyramidal tract disease, seizures, myoclonus and so on.
Examine
Examination of mental disorders associated with respiratory diseases
There are currently no laboratory-specific test indicators for mental disorders. The primary respiratory disease routine, biochemical, and immunological laboratory tests are found in the relevant sections of the respiratory system.
Respiratory diseases associated with mental disorders, especially pulmonary heart disease, EEG examination generally shows that the background activity is extensive slow wave, accompanied by high amplitude delta waves.
1. A small amount of low amplitude wave.
2. Alpha waves are slowed or irregular.
3. On the background of the slow rhythm, there are waves of medium to high amplitude of 2 to 3 times/s.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with respiratory diseases
Diagnostic criteria
Diagnostic principles for patients with clinical manifestations of disturbance of consciousness, mental retardation or amnesia syndrome should take into account the possibility of organic mental disorders, but mental disorders alone cannot be used as a qualitative or localized diagnosis of organic psychosis. The etiology, the diagnosis of taxonomy, and the establishment of a diagnosis must have the following points:
1. The basis of physical illness, diagnosed as chronic pulmonary disease caused by pulmonary insufficiency or severe respiratory failure, with symptoms of difficulty breathing, cyanosis and edema.
2. Identify the existence of mental symptoms, such as reduced mental activity, such as comprehension difficulties, slow response, insufficiency and sleepiness, paralysis, excitement, etc.; drowsiness and paralysis to slumber or coma, if necessary, can be combined with experiments Room examinations, such as decreased blood oxygen partial pressure, elevated carbon dioxide partial pressure, and EEG diffuse high amplitude slow waves.
3. The appearance of mental symptoms is related to the progress of physical illness. Generally, physical illness is first, and mental symptoms occur later. However, some early physical illnesses are difficult to find, relatively concealed or fail to attract attention, resulting in Psychiatric symptoms appear in the first illusion.
4. Psychiatric symptoms often improve with the relief of underlying diseases, or worsen as they worsen.
Differential diagnosis
It is mainly the differential diagnosis of mental disorders. It is very important to distinguish between organic and non-organic mental disorders. Otherwise, it will delay the diagnosis and treatment. Sometimes it is difficult to identify cases with insignificant causes, such as the body described above. Diseases sometimes have some symptoms of functional mental illness, such as anxiety, depression, schizophrenia, mania, etc. At this time, it is necessary to distinguish between organic mental disorders associated with physical diseases, or mental illnesses induced by them; When physical illness is accompanied by symptoms such as insomnia, anxiety, depression, etc., it is caused by biological factors or psychological stress caused by physical diseases; both schizophrenic manifestations need to be differentiated from schizophrenia, and clinical often It is difficult to distinguish, and the two often coexist. The symptomatic mental disorder refers to the former. The identification of the two depends mainly on the doctor's comprehensive medical history (including the history of physical and mental illness). According to the history of chronic lung disease, lung function Incomplete and paroxysmal mental disorders, possible disturbances in the course of the disease, careful physical examination and corresponding biochemical and endocrine laboratory Sexual discovery, comprehensive judgment to identify.
