Mental disorders associated with leukemia
Introduction
Introduction to mental disorders associated with leukemia Leukemia is a malignant tumor of the hematopoietic system characterized by uncontrolled abnormal proliferation of a series of blood cells of the bone marrow, and infiltration into the whole body tissue by blood. When the lesion invades the nervous system or is affected by the invasion and function of the organ, it can cause neuropsychiatric disorders. Leukemia is one of the top ten malignant tumors in China, and it is also the malignant tumor with the highest incidence and mortality rate under 35 years old. The progress of leukemia treatment, the remission rate of this disease has been greatly improved, and the clinical manifestations of neuropsychiatric symptoms have become increasingly prominent. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific population Mode of infection: non-infectious Complications: cerebral hemorrhage, nausea and vomiting
Cause
Causes of mental disorders associated with leukemia
Central nervous system bleeding (20%):
Leukemia-induced cerebral hemorrhage is the most common type of leukemia complicated by neurological damage. In recent years, there has been a tendency to increase gradually. Some people account for about 32% of the neurological damage caused by leukemia, which may be the main cause of mental disorders.
Leukemia cell proliferation and infiltration (15%):
Because most anti-leukemia drugs can not pass the blood-brain barrier, leukemia cells can be multiplied in the central nervous system and neuropsychiatric disorders occur.
Central nervous system infection (15%):
Leukemia patients due to normal mature granulocyte reduction and quality defects, and anti-leukemia drugs can promote neutropenia, inhibit cell and humoral immunity, while the application of adrenocortical hormone can reduce the body's resistance, in the prevention and treatment of infection At times, a large number of antibiotics are often applied to inhibit certain flora, and other bacteria are allowed to multiply, which constitutes a central nervous system of bacteria, viruses, fungal infections, and increases the chance of neuropsychiatric disorders.
Insufficient energy supply (15%):
The common pathophysiological change of leukemia with mental disorders is the change of diffuse brain energy demand. Because leukemia causes metabolic disorders, the energy supply is insufficient, and the brain is very sensitive to energy requirements. When leukemia, the brain's demand for energy increases. At this time, the contradiction between energy supply and demand occurs in the body, causing the normal physiological function of the brain to be disordered. This is the main mechanism for the occurrence of such mental disorders.
Brain hypoxia (10%):
Leukemia, especially cardiovascular, lung and brain involvement, can lead to insufficient oxygen carrying capacity, or microcirculatory disorders caused by harmful factors in the body, can lead to blood supply to the brain, lack of oxygen and brain damage, this It is also an important mechanism for mental disorders.
When a biotoxin acts on leukemia, if exogenous substances such as bacteria, viruses, parasites, chemicals, and harmful gases invade the body, its toxins or intermediate metabolites directly act on brain cells, causing damage to brain cells and brain function. Disorders lead to mental disorders.
When the body is metabolically disordered, leukemia, body fluid metabolism and acid-base balance disorders and certain vitamin deficiency can lead to metabolic enzyme activity disorder, which in turn affects metabolism, resulting in insufficient energy supply, which will inevitably affect brain function and neuropsychiatric disorders.
In the case of stress-responsive leukemia, 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 the middle, the brain either directly participates in or receives tiredness, causing its normal physiological function to be affected, leading to the occurrence of mental disorders.
Individual susceptibility clinically can also be seen in the fact that only a small number of patients with leukemia have leukemia with mental disorders, suggesting that this may be related to genetic factors and individual quality or personality defects, such as family history of mental disorders caused by physical illness Those accounted for 2% to 8%, higher than the general group; introverted, impatience, stubborn, willingness to cause mental disorders when the physical disease of the incumbent; poor brain function, such as the elderly and children with physical diseases are prone to paralysis.
The cause of leukemia associated with mental disorders is still unclear. Leukemia is the main cause of mental disorders, but it is not the only cause. The differences between biopsychosocial factors and quality factors such as personality characteristics, age, genetic predisposition and individual nervous system function. And the reactivity of the body is related to the occurrence of mental disorders. The appearance of leukemia with psychiatric symptoms is not always proportional to the severity of leukemia.
Pathogenesis
The mechanism of leukemia with mental symptoms associated with mental disorders is not clear and may be related to the following factors.
1. Physical and mental disorders refer to the psychological reactions to physical illnesses, such as anxiety, depression, irritability, suspiciousness, loneliness and other mental disorders caused by leukemia.
2, mental disorders caused by biological factors directly caused by leukemia, such as central nervous system hemorrhage, leukemia cell proliferation and infiltration, central nervous system infection and insufficient energy supply (brain deficiency, brain hypoxia, etc.), toxins, water, Electrolyte disorders, stress reactions, neurotransmitter changes, etc., directly or indirectly affect brain function and produce neuropsychiatric symptoms.
3. In most cases, it is often the result of the combination of the two.
Prevention
Prevention of mental disorders associated with leukemia
Prevention of leukemia associated with mental disorders, first of all for the prevention of leukemia, although it is not currently possible to completely prevent leukemia, but for some factors, can also achieve relative prevention.
1, cause prevention
(1) Do not touch X-rays and other harmful radiation too much. Persons engaged in radiation work should do personal protection and strengthen preventive measures. Infants and pregnant women are more sensitive to radiation and vulnerable to injury. Women should be pregnant during pregnancy. Avoid contact with excessive radiation, otherwise the incidence of leukemia in the fetus is higher, but occasionally, medical X-ray examination, the dose is small, basically does not affect the body.
(2) Do not abuse drugs. Use caution when using chloramphenicol, cytotoxic anticancer drugs, immunosuppressive drugs, etc., and must be guided by a doctor. Do not use or abuse them for a long time.
(3) To reduce the exposure of benzene, chronic benzene poisoning mainly damages the human hematopoietic system, causing human leukocytes, and the decrease in the number of platelets induces leukemia. Workers engaged in the production of benzene as chemical raw materials must pay attention to strengthening labor protection.
2, prevention of leukemia-related complications Once diagnosed with leukemia, it should actively prevent its complications, leukemia complications are difficult to treat, and the cost is higher, but it is relatively easier to prevent and control, not only can Reducing the physical pain of the patient can also reduce the financial burden on the patient.
3, the maintenance of leukemia patients is also very important
(1) First of all, we must have confidence and perseverance. Leukemia patients should establish the confidence to persist in long-term treatment to overcome the disease and get better, maintain a good mood, overcome pessimistic despair, have confidence, and actively treat. Although leukemia is not an incurable disease, it is refractory after all. Disease, therefore, each patient should fully mobilize their own resistance to disease and fight against it, so as to achieve the ultimate recovery.
(2) Must adhere to long-term correct and reasonable treatment: "Leukemia is an incurable disease" has become a thing of the past, taking the leukemia admitted to our department in recent years as an example, as long as it can adhere to the formal system of integrated Chinese and Western medicine treatment can make most leukemia patients Long-term disease-free survival, better results, and prolonged survival, it is recommended that patients adhere to treatment, when it is found that the condition is repeated or aggravated, go to a regular hospital or a specialist hospital in time, and strictly follow the doctor's advice during the out-of-hospital treatment. , timely review the corresponding inspections, and return to the hospital on a regular basis.
(3) can not ignore the daily self-care: leukemia patients should maintain personal hygiene, change underwear frequently, often change the sheets, take a bath, scrub the body, press and fill the bleeding when bleeding, daily use of light salt water, nitrofurazone containing sputum, The wounds of leukemia patients are not easy to heal, and unnecessary surgical operations are minimized. The coagulation mechanism of leukemia itself is poor, and accidents should be minimized.
When the temperature is high, people with leukemia should eat more mixed vegetables. The food is mainly rich in fiber, vitamins and high protein: such as fruit, celery, animal liver, lean meat, white fungus, soybean; should always drink mung bean soup to prevent heat stroke, no Eat cold food (refrigerator frozen food), etc., patients in the mental state, appetite, sleep, urine and so on should be kept normal, if necessary, hospitalized.
Complication
Complications of mental disorders associated with leukemia Complications Cerebral hemorrhage nausea and vomiting
1. Leukemia cerebral hemorrhage When a leukemia patient has headache, nausea, vomiting, lethargy, irritability, he or she should immediately consider the possibility of cerebral hemorrhage. When the sleepiness develops further to coma or hemiplegia and other localized neurological features, brain CT Hemorrhagic lesions are often found in the examination.
2, leukemia central nervous system infection when leukemia patients with fever, respiratory infections, such as headache, nausea, vomiting, neck stiffness, or excitement or high intracranial pressure, should consider the possibility of central nervous system infection; Agitation or disturbance of consciousness is aggravated, and when it is disordered, it may be considered a mental disorder accompanied by leukemia central nervous system infection.
3. Proliferation and infiltration of leukemia cells When leukemia patients have the above symptoms and no signs of bleeding, they should be considered for leukemia hyperplasia and infiltration, but exclude encephalitis, meningitis, brain tumors and other diseases. If the above-mentioned neuropsychiatric symptoms appear in leukemia, it means that the disease has advanced to a late stage, and the mortality rate is very high. Those with combined cerebral hemorrhage often die within 5 days, and those with mental disorders usually only maintain for 1 to 3 months.
Symptom
Symptoms of mental disorders associated with leukemia Common symptoms Consciousness disorder Personality changes Mental disorders Drowsiness Coma Increased intracranial pressure Uncoordinated excitement
Although the mental disorders associated with physical diseases may differ depending on the primary disease and mental symptoms, they all have the same characteristics: non-specific psychiatric symptoms, generally acute onset, acute acute mental disorder ( The main disorder of consciousness disorder occurs mostly at the peak of physical illness; the chronic onset and early and recovery stages of the disease are often dominated by brain-debilitating syndrome; in the late stage of the disease, chronic organic mental disorders may occur, with personality changes or The characteristic of intelligent disorder is that the mental disorder is often parallel with the degree of primary physical disease. The clinical manifestation also changes with the severity of physical illness, and can change from one state to another. Often repeated, interlaced, intricate, and the symptoms are characterized by light and heavy nights.
Clinical manifestations of the disease:
1, mental disorders
(1) disturbance of consciousness: the most common, accounting for 77% of the acute phase of leukemia, is the main manifestation of brain damage, the initial stage of drowsiness, and later can develop into drowsiness, sputum state and coma.
(2) Excited state: The patient can be restless.
(3) Illusion or delusion state: There are obvious auditory hallucinations, illusions, delusions to be victimized, and relationships are mostly.
(4) Depressive state: In addition to emotional pessimism, there are sometimes suicidal tendencies.
Mental disorders have the following characteristics:
1 In acute leukemia, mental disorders associated with neutrophilic leukemia are the most common, and the symptoms are also severe. The mental symptoms are mainly disturbance of consciousness.
2 The incidence of mental disorders in chronic leukemia is low, the symptoms are mild, and other mental disorders are dominant.
3 The relationship between mental disorders and blood is not parallel. Some patients' mental symptoms appear even when the blood is improved, but it is closely related to brain damage.
4 Most cases with neurological symptoms are accompanied by mental disorders.
2. Neurological symptoms The clinical manifestations of neurological damage are various. From the meninges to the brain, from the brain to the spinal cord, the pathological damage is mainly leukocyte infiltration and hemorrhage. The former is similar to encephalitis, meningitis, brain tumor, the earliest and most common. Symptoms of increased intracranial pressure, such as headache, vomiting, optic disc edema, etc., the latter (bleeding) can occur in any part of the nervous system, so its clinical symptoms almost all symptoms of nervous system diseases, and some often appear in Before the diagnosis of leukemia, clinicians need to be highly vigilant.
Examine
Examination of mental disorders associated with leukemia
Meet the leukemia laboratory positive test results.
Conforms to leukemia-assisted examination changes.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with leukemia
Diagnostic criteria
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, and the etiology must be made. For the diagnosis of taxonomy, the diagnosis must be established with the following points:
1, the diagnosis of leukemia changes.
2, the emergence of mental symptoms and the progress of leukemia have a time link, general leukemia in the first, mental symptoms occur after it.
3. Mental symptoms often improve with the relief of leukemia, or worsen as it worsens.
4. Mental symptoms cannot be attributed to other mental illnesses.
5, the severity reaches 1 reality test ability decline; 2 social function decline.
Differential diagnosis
It should be differentiated from other mental illnesses and other functional mental illnesses such as schizophrenia, snoring and depression. It relies mainly on doctors to master a comprehensive medical history (including physical and mental illness), careful physical examination and corresponding Laboratory data such as biochemistry and endocrine are comprehensively judged.
