Mental disorders associated with hypertension
Introduction
Introduction to mental disorders associated with hypertension Psychiatric disorders associated with essential hypertension (psychonosemacaused byhypertension) is the most common type of mental disorder associated with vascular disease, and refers to the mental disorder accompanied by the occurrence of essential hypertension. The mental disorder associated with essential hypertension is mainly manifested as neurosis-like syndrome, depression syndrome, hallucinations, delusional state, etc. When the blood pressure rises sharply and there is a hypertensive crisis, it often shows a disturbance of consciousness. The cause of hypertension is still unclear, and emotional instability, mental stress and other factors often make patients' blood pressure continue to rise. This sensitivity of hypertensive patients to mental factors, clinically believed that it is likely to be the cause of mental disorders in patients with hypertension. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: coronary heart disease, diabetes, heart failure, high blood lipids
Cause
Causes of mental disorders associated with hypertension
(1) Causes of the disease
The current cause of essential hypertension is still unknown, and may be related to age, psychosocial factors, genetic factors, high-calorie diet, etc., mostly occurring in 40 to 50 years old, without gender differences, in cerebrovascular wall lesions and blood components, blood On the basis of changes in flow dynamics, coupled with long-term emotional instability, persistent mental stress and other factors, can cause blood pressure to continue to rise, causing small arteriospasm and small arteriosclerosis, and thus resulting in insufficient blood supply or even ischemia of brain tissue. As a result, neuronal cells develop dystrophies, produce transient cerebrovascular crisis or cause mental disorders. Generally, the disease is acute, the progress is slow, the course of disease fluctuates step by step, and the clinical manifestations are various, but eventually develop into dementia.
(two) pathogenesis
On the basis of vascular wall disease of hypertension, plus sleep disorders, dehydration, shock, heart failure, arrhythmia, erythrocytosis and other factors, can cause blood pressure to drop, slow blood flow, increased blood viscosity or abnormal blood coagulation Other factors, often cerebral infarction, leading to brain dysfunction, data show that the degree of cerebral blood flow reduction is positively correlated with the severity of dementia, the number of infarcts in multiple infarction plays an important role in the occurrence of dementia, dementia according to intracranial vascular lesions Range, pathology is classified as:
1. Dementia caused by diffuse lesions: multiple cerebral plexus infarction is more common, pathological anatomy often has multiple lacunar infarcts at different stages, and extensive atherosclerosis can be seen in the vessels.
2. Dementia caused by localized lesions: related to the size and location of the lesions, the main pathological findings are cerebral arteriosclerosis, in addition to brain parenchyma and cerebrovascular disease, but also involving the retina and heart and kidney organs, with cerebral arteriosclerosis The serious development can produce diffuse brain atrophy.
Prevention
Prevention of mental disorders associated with hypertension
The key to mental disorders associated with hypertension is to prevent the occurrence and development of essential hypertension. Primary prevention of hypertension refers to the effective presence of people who have risk factors for hypertension but have not yet developed hypertension. Preventive measures to control or reduce the risk factors for developing hypertension to reduce the incidence of morbidity. Secondary prevention refers to the effective treatment of people who already have high blood pressure to prevent further development of hypertension and the occurrence or recurrence of complications. Third-level prevention refers to the rescue of severe hypertension to prevent the occurrence of complications and death of patients. The third-level prevention includes rehabilitation treatment. The purpose of primary prevention is twofold: 1 to find out that high may occur in the future. People with high blood pressure, ie high-risk groups, prevent before the blood pressure rises; 2 prevent the whole social population, those who have a family history of hypertension, and the blood pressure is high in children and adolescents. People who have a tendency to develop high blood pressure, such as obese people.
1. Primary prevention measures
(1) Reasonable adjustment of diet:
1 Limit excessive intake of sodium salts.
2 increase the intake of potassium.
3 high calcium intake, low calcium intake can raise blood pressure, if the daily calcium intake increases by 100 mg, the systolic blood pressure can be reduced by 0.33 kPa (2.5 mmHg), and the diastolic blood pressure is reduced by 0.17 kPa (1.3 mmHg). People's daily calcium intake is 800mg. By drinking milk, adding beans and fresh vegetables and fungus, mushrooms, shrimp skin, seaweed, etc., can increase the intake of calcium. In addition, vegetables also contain a lot of vitamin C, which is reduced. Blood cholesterol, reduce the role of atherosclerosis, some vegetables such as celery, sputum and so on have a blood pressure lowering effect.
4 reduce fat intake, especially animal fat.
5 increase the intake of high-quality protein, such as animal protein (such as fish) and legume protein, Chinese nutritionists recommend that adults consume 14kg of cereal per person per month, 3kg of potato, 1kg of egg, 1.5kg of meat and 0.5kg fish.
(2) Quit smoking and abstaining from alcohol.
(3) Lose weight.
(4) Conduct physical exercise.
(5) Prevent the occurrence of high blood pressure from childhood, develop good living habits, actively carry out physical education, and educate on prevention of hypertension.
2. Secondary preventive measures
(1) It is necessary to implement measures for primary prevention.
(2) Conduct regular systemic antihypertensive treatment.
1 The blood pressure is reduced to the normal range by antihypertensive treatment, and the blood pressure of the hypertensive patients is controlled to a reasonable extent. It is generally believed that for patients with existing cardiac and brain complications, the blood pressure should not be lowered too low, and the diastolic blood pressure is 11.47~ 12.0kPa (86 ~ 90mmHg) is appropriate, the systolic pressure is about 18.67kPa (140mmHg), otherwise the condition may be aggravated, for those without heart and brain complications, can be lowered a little lower.
2 to protect the target organs from damage, although different antihypertensive drugs can reduce blood pressure to the same level, but their effects on target organs are different, such as angiotensin converting enzyme inhibitors and beta blockers Etc., can reduce the left ventricular hypertrophy while reducing blood pressure, other antihypertensive drugs do not have this function, at the same time, the calcium antagonist nifedipine can improve the recurrence rate of myocardial infarction in the treatment of coronary heart disease, and verapamil It is reduced; thiazide diuretics, which cause hypokalemia and hyponatremia and low-density lipoprotein, elevated levels of triglycerides and high-density lipoproteins during hypotension, all of which are to the heart unfavorable.
3 to take into account the treatment of other risk factors, secondary prevention of hypertension itself is atherosclerosis, stroke, primary prevention of coronary heart disease, and the coexistence of many other risk factors can make the incidence of coronary heart disease multiply, Therefore, the best effect can be achieved by taking into account the combination of smoking control, drinking, weight control, proper exercise, and psychological balance.
(3) Use a better method of pressure measurement, that is, pressure measurement at the peak of blood pressure to ensure that the blood pressure is truly reduced to normal.
In short, we must attach great importance to the prevention and treatment of hypertension, develop a good lifestyle, pay attention to the combination of work and rest, prevent excessive mental stress, and carry out physical activities within our ability. No smoking, no drinking, pay attention to work and rest, control diet, eat less animals. Fat, lower blood fat, prevent obesity, eat more fruits, vegetables and foods rich in iodine and vitamins, ensure adequate sleep, and actively treat diseases related to this disease such as hyperlipidemia, diabetes, etc., to learn this knowledge, Regular inspections at the hospital to understand the changes in the development of the disease, establish and adhere to the concept of lifelong treatment and lifelong prevention, will certainly be able to control the development of the disease, prevent the occurrence of complications, at the same time, promote the cultivation of good character, actively maintain health psychology, to prevent There is a positive effect of mental disorders associated with primary hypertension.
Complication
Complications of mental disorders associated with hypertension Complications, coronary heart disease, diabetes, heart failure, hyperlipidemia
Common complications include coronary heart disease, diabetes, heart failure, hyperlipidemia, kidney disease, peripheral arterial disease, stroke, and left ventricular hypertrophy.
Symptom
Symptoms of mental disorders associated with hypertension Common symptoms Intelligent disorder mental disorders dementia hypertension hypertension cognitive impairment consciousness disorder attention deficit illusion lack of self-control ability
First-grade hypertension (mild): refers to adult systolic blood pressure sustained 18.7 ~ 21.1kPa (140 ~ 159mmHg), diastolic blood pressure 12.0 ~ 13.2kPa (90 ~ 99mmHg), the patient has only systemic and small arteriolar spasm, Some patients have brain weakness syndrome, manifested as head discomfort, emotional irritability, autonomic symptoms such as rapid heartbeat or pre-cardiac discomfort, and sleep disorders, patients are prone to fatigue, weakness, inattention, poor memory , work ability is reduced, and so on.
Secondary hypertension (moderate): refers to systolic blood pressure continued to be 21.3 ~ 23.8kPa (160 ~ 179mmHg), diastolic blood pressure is more than 13.3 ~ 14.5kPa (100 ~ 109mmHg), patients with small arterial spasm, hardening, so that There are dystrophic changes in brain cells. Clinically, episodes of anxiety and depression can occur, accompanied by excitement. A small number of patients may have hallucinations and delusions, but their emotions are coordinated and contact is good.
Grade III hypertension (severe): refers to systolic blood pressure continuously 24.0kPa (180mmHg), diastolic blood pressure 14.7kPa (110mmHg), patients may present with hypertensive encephalopathy or crisis, may have obvious cerebral edema, appear different Degree of consciousness disorder, accompanied by headache, vomiting, optic disc edema, temporary hemiplegia aphasia, pseudo-cerebral tumor-like syndrome and symptoms and signs of heart and kidney dysfunction.
The course and prognosis of the disease often depend on the severity of the hypertension itself. The appearance of mental symptoms can aggravate the hypertension, and the disturbance of consciousness appears in multiple episodes. If the disturbance of consciousness persists, the prognosis is not good.
Mental disorders are often manifested in the following:
1. Early symptoms: early symptoms of mental disorders are mainly brain weakness syndrome, manifesting head discomfort, emotional instability, sleep disorders, inattention, poor memory, decreased working ability, autonomic dysfunction and so on.
2. Localized symptoms and signs of the nervous system: Localized symptoms of neurological symptoms are more common with pseudobulbaric palsy, difficulty in dysarthria, difficulty in swallowing, central facial paralysis, hemiplegia with different degrees, aphasia, misuse or loss of recognition, epilepsy Attacks, urinary incontinence, etc., different parts of cerebral hemorrhage or cerebral infarction caused by different local symptoms, such as the cerebral artery supply area of the obstacle, there may be ipsilateral hemianopia, spatial loss of recognition and lack of insight.
3. Intelligent damage (dementia): Early limitation is cognitive function damage, although there are memory impairments, intelligent damage, but self-knowledge and judgment remain good, anxiety and depression only show excessive attention to their own diseases. In the future, fears, worries, depressions, and suspected illnesses often arise, and they often start to fall apart. In the later process, some patients develop perceptual disorders and thinking disorders, producing various hallucinations, delusional states, such as Relationships, murder, suspicion, paralysis, shackles, etc., are often the manifestations of mid-stage hypertension, but there are no disturbances of consciousness. Some patients gradually develop from emotional vulnerability to emotional retardation, compulsory crying, and a few emotional outbursts. As the disease progresses, if there is physical complications, trauma, and rapid environmental changes, especially in the case of an acute cerebrovascular accident, the symptoms of dementia will increase in a stepwise manner, and in the advanced stage, it becomes a comprehensive dementia.
In the case of hypertensive crisis, when the brain disease occurs, the patient may have disturbance of consciousness, which may be accompanied by a horror hallucination or piece of delusion, excitement, impulsivity, verbal inconsistency or pseudo-brain tumor-like syndrome (increased intracranial pressure). After the patient's consciousness is restored, there is still a similar mania or depression in the short term.
4. Psychiatric disorders associated with cerebrovascular disease: mental disorders associated with cerebrovascular disease may have memory, intelligent disorders and localized neurological symptoms. Most patients have a gradual, volatility, and some strokes. Deterioration, only a small number of patients can be relieved, the short course of disease is about 2 months, the elderly are more than 20 years, the average is about 5 years, half of the patients are accompanied by hypertension, and some are accompanied by coronary heart disease, diabetes, hyperlipidemia, etc. Patients with high blood pressure, carotid murmur, emotional instability with transient depression, crying or bursting laughter, transient turbidity or convulsions are often exacerbated by further infarction, and personality remains relatively intact, but can also occur Obvious personality changes, such as apathy, lack of self-control, or original personality characteristics, such as egocentric, paranoid or irritability, most patients died of repeated episodes of acute cerebrovascular disease or coronary heart disease or secondary infection.
5. Somatic symptoms: often have headache, vomiting, dizziness, elevated blood pressure, transient stenosis or hardening of the fundus artery, X-ray see heart changes, laboratory tests for renal function changes.
Examine
Examination of mental disorders associated with hypertension
The results of laboratory tests for mental disorders associated with hypertension must be consistent with changes in laboratory tests for hypertension, and no specific laboratory tests for mental disorders.
Uncharacteristic auxiliary examination of mental disorders, such as the third phase of hypertension, there is evidence of positive examination of the affected target organs.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with hypertension
Diagnostic criteria
1. According to the recommendations of the World Health Organization (WHO), the blood pressure standard is: normal adult systolic blood pressure should be less than or equal to 140mmHg (18.6kPa), diastolic blood pressure is less than or equal to 90mmHg (12kPa), if adult systolic blood pressure is greater than or equal to 160mmHg ( 21.3 kPa), diastolic blood pressure greater than or equal to 95 mmHg (12.6 kPa) for hypertension; blood pressure value between the two, that is, systolic blood pressure between 141 ~ 159mmHg (18.9 ~ 21.2kPa), diastolic blood pressure between 91 ~ 94mmHg (12.112.5kPa) is the critical hypertension. When diagnosing high blood pressure, blood pressure must be measured multiple times. At least two consecutive diastolic blood pressures with an average value of 90mmHg (12.0kPa) or above can be diagnosed as hypertension. 1 case of elevated blood pressure can not be diagnosed, but need to follow-up observation, WHO's new standard: ideal blood pressure: <120/80mmHg; normal blood pressure: <130/85mmHg; normal high value: 130 ~ 139 / 85 ~ 89mmHg; Pressure 140mmHg and/or diastolic blood pressure 90mmHg is high blood pressure (should be repeated 2 times or more).
2. Before the onset of mental symptoms, there is a clear history of hypertension, that is, on the basis of essential hypertension, the patient has a brain weakness syndrome, or anxiety, depression, hallucinations, delusional state and disturbance of consciousness, and Psychiatric symptoms fluctuate with blood pressure and physical symptoms, that is, the ups and downs of symptoms are closely related to fluctuations in blood pressure.
3. In the early stage, it is mainly caused by brain weakness syndrome, and there are often disturbances of consciousness in the late stage.
4. When the patient has unconsciousness, the emotion is clear, the contact is good, but the judgment is lacking.
Differential diagnosis
1. Identification of mental disorders associated with cerebral arteriosclerosis: Since essential hypertension and cerebral arteriosclerosis often exist simultaneously, and late-stage mental disorders are sometimes very similar, identification is more difficult, and essential hypertension is in the spirit. Before the onset of symptoms, there have been many years of history of hypertension. Mental factors are often the cause of mental disorders, and mental disorders occur more rapidly. People with cerebral arteriosclerosis often experience overwork, heavy tasks or infectious diseases. Hypertensive seizure disorder is more common, cerebral arteriosclerosis, if not accompanied by essential hypertension, rarely occurs in such symptoms. When hypertensive symptoms of dementia occur, the performance of "pseudo-paralytic dementia" Mainly, cerebral arteriosclerosis is characterized by localized dementia, and autonomic symptoms are more common in patients with hypertension than those with cerebral arteriosclerosis.
2. Identification with functional psychosis: a history of mental disorders associated with hypertension, physical symptoms with psychiatric symptoms, and conscious disturbances.
3. Identification of mental disorders associated with infection and poisoning: it can be identified by medical history (with or without infection, history of poisoning) and the characteristics of disturbance of consciousness.
4. There is a pseudo-cerebral tumor-like syndrome, and intracranial tumors should be excluded by CT and MRI.
5. neurasthenia: neurasthenia patients generally have low blood pressure, mostly due to excessive mental stress or stress factors, and the early cerebral weakness syndrome of this disease is caused by essential hypertension, not necessarily causing mental Tension factor.
