Mental disorders associated with anemia
Introduction
Introduction to mental disorders associated with anemia Anemia can be divided into many types according to etiology and morphology, and their pathological mechanisms are also different. In summary, there are three major categories: poor hematopoiesis (iron deficiency anemia, aplastic anemia, etc.), excessive destruction of red blood cells (various hemolytic anemia) and acute, chronic blood loss anemia. All kinds of anemia can be reduced due to the oxygen carrying capacity of the blood. The lack of blood supply to the brain cells causes brain cells to be ischemia and hypoxia and produce some common clinical symptoms. However, due to the nature of the primary disease, the speed of onset and the age of the patients, clinical Performance is also different. However, the mental disorders associated with various types of anemia are all kinds of mental disorders that affect brain function. Iron deficiency anemia affects the synthesis of hemoglobin due to the lack of iron stored in the body. The neuropsychiatric symptoms associated with it are related to cerebral edema or cerebral hypoxia caused by anemia. In addition, the activity of many clinically important metabolic enzymes in the body is reduced due to iron deficiency. Decreased cell function, lack of iron-containing enzymes in the body, can produce cell mitochondrial swelling, and can also produce neuropsychiatric symptoms. The severity of mental disorders generally has a parallel relationship with the degree of anemia. In addition, the occurrence of mental disorders and the overall functional status of patients related. basic knowledge Proportion of disease: 1%-3% of special population Susceptible people: no special people Mode of infection: non-infectious Complications: insomnia, anemia, consciousness disorder, mental disorder associated with anemia
Cause
Causes of mental disorders associated with anemia
Iron deficiency anemia (20%):
Iron deficiency anemia is a common type of anemia, mostly young women, usually due to inadequate intake, malabsorption, digestive tract, uterine bleeding, malnutrition and hookworm infection.
Aplastic anemia (10%):
Aplastic anemia is anemia caused by bone marrow hematopoietic dysfunction. The cause of aplastic anemia is called primary aplastic anemia. The cause of damage to bone marrow hematopoietic function caused by clear chemical, physical or biological toxic factors is called secondary. Sexual aplastic anemia, usually caused by nitrobenzene (plastic, paint), mercury, lead, chloramphenicol, sulfonamides, antipsychotics and radioactive substances.
Hemolytic anemia (15%):
Hemolytic anemia refers to the type of anemia that occurs when red blood cells are destroyed in the body and the bone marrow hematopoietic function is insufficient. The causes are red blood cell internal defects (mostly hereditary such as thalassemia), and acquired acquiredness (such as paroxysmal). Sleep hemoglobinuria, external factors that promote red blood cell destruction: infection, poisoning, autoimmune hemolytic disease, mechanical physics, chemistry, biology (such as edible broad beans) and other factors.
Megaloblastic anemia (15%):
Juvenile cell anemia (formerly known as malignant anemia) mainly refers to an anemia caused by folic acid, vitamin B12 deficiency or other factors that cause cell nuclear glucose synthesis disorders. Clinically, there are gastrointestinal symptoms in addition to anemia, vitamin B12 deficiency. The neurological symptoms are more prominent.
The causes of all kinds of anemia associated with psychiatric symptoms are not clear, but it is certain that various types of anemia are the main factors in the onset of such mental disorders. Anemia causes brain disorders to lead to mental disorders, but anemia is not such a spirit. The only cause of the disorder, because not all patients with anemia develop mental disorders, so there are other factors related to the occurrence of mental disorders, such as other biological factors, including the patient's gender, age, genetic factors, personality traits, and The history of neuropsychiatric diseases, etc., psychological factors include stress state, long-term psychological contradiction. Environmental factors, such as overcrowding, noisy environment, humidity, air pollution, etc., can also be a trigger for anemia associated with mental disorders.
Pathogenesis
Iron deficiency anemia affects the synthesis of hemoglobin due to the lack of iron stored in the body. The neuropsychiatric symptoms associated with it are related to cerebral edema or cerebral hypoxia caused by anemia. In addition, the activity of many clinically important metabolic enzymes in the body is reduced due to iron deficiency. Decreased cell function, lack of iron-containing enzymes in the body, can produce cell mitochondrial swelling, and can also produce neuropsychiatric symptoms. The severity of mental disorders generally has a parallel relationship with the degree of anemia. In addition, the occurrence of mental disorders and the overall functional status of patients related.
The pathogenesis of aplastic anemia is not fully understood, mainly due to the lack of hematopoietic stem cells, hematopoietic microenvironmental defects and immune dysfunction. These factors can exist in a patient at the same time.
Hemolytic anemia refers to the type of anemia that occurs when red blood cells are destroyed in the body and the bone marrow hematopoietic function is insufficient. The average life span of normal red blood cells in the body is 120 days, and the metabolic capacity of adult bone marrow can reach 6-8 times. Anemia can only occur when the life span of red blood cells is significantly shortened. According to the onset of the disease, hemolytic anemia can be divided into acute and chronic. If the bone marrow and cardiovascular compensatory function is good, the symptoms may not occur. Compensatory hemolytic disease.
Causes of folic acid deficiency associated with megaloblastic anemia: Insufficient intake is the main cause, mostly related to malnutrition, improper feeding, partial eclipse and excessive cooking; when pregnancy, breastfeeding, hyperthyroidism, malignant tumors, etc. are increased, When intestinal inflammation, chronic diarrhea and other malabsorption, when applying drugs that affect folic acid metabolism or absorption (such as methotrexate), the main cause of vitamin B12 deficiency is gastrointestinal dysfunction, malabsorption; Insufficient, folic acid and vitamin B12 are important coenzymes in the process of nucleic acid metabolism, which can cause DNA synthesis disorders. Due to DNA deficiency, it affects the metabolism of the long axis of the nerve and undergoes neurodegeneration. Vitamin B12 participates in methyltransfer reaction and folic acid interaction. In the process of transformation, it has been suggested that the conversion disorder of methylmalonate-CoA increases the amount of methylmalonate in the blood, causing degeneration of the nervous system caused by the deposition of nerve tissue. It is also believed that vitamin B12 is involved in cyanide metabolism in the body, and the accumulation of cyanide is also It can damage brain tissue and cause mental disorders.
In short, the pathogenesis of various types of anemia associated with mental disorders can be considered from the following aspects.
1. Insufficient energy supply The common pathophysiological changes of various types of anemia accompanied by mental disorders are changes in diffuse brain energy demand. Due to insufficient energy supply due to various types of anemia, the body's metabolic disorders cause disorders in the normal physiological functions of the brain. The main mechanism by which such mental disorders occur.
2. Cerebral hypoxic anemia leads to insufficient oxygen carrying capacity, causing circulatory disorders in the body and brain, and even microcirculatory disorders, leading to brain blood supply, insufficient oxygen supply and impaired brain function, which is also an important mechanism for mental disorders. .
3. Biotoxins are anxious to be invaded by exogenous substances such as bacteria, viruses, parasites, chemicals, harmful gases, etc. These toxins or intermediate metabolites can directly act on brain cells, causing brain cells to damage and brain Dysfunction leads to mental disorders.
4. When the body's metabolic disorder is anemia, the metabolic disorder of the body can cause metabolic enzyme activity disorder, which in turn affects metabolism, and the energy supply is insufficient, which will inevitably affect brain function and cause neuropsychiatric disorders.
5. When the stress responds to anemia, the biological stressor and the psychological stressor act on the body simultaneously, and through the neurophysiological, neurobiochemical, neuroendocrine and immune mechanisms, a series of physiological and biochemical reactions are generated. In these reactions, the brain All of them are directly or indirectly involved, causing their normal physiological functions to be affected, leading to the occurrence of mental disorders.
6. Individual susceptibility can also be seen in the clinical fact that the probability of suffering from various types of anemia in the population is not uncommon, but only a very small number of patients have anemia associated with anemia; this may be related to genetic factors and individual quality or personality defects Related to, such as physical illness caused by family history of mental disorders accounted for 2% to 8%, higher than the general group; personality introverted, impatience, stubborn, willful to suffer from physical disorders when suffering from physical illness; poor brain function stability, such as Older people and children are prone to convulsions when suffering from physical illnesses.
Prevention
Prevention of mental disorders associated with anemia
The incidence of anemia is extremely high. The most common is iron deficiency anemia, which is more common in children. The incidence of anemia in children under 7 years old in China is 40%. The key is to adjust the daily life and diet, and to provide sufficient hematopoietic substances for the bone marrow. It is the main raw material for the manufacture of hemoglobin. Under normal circumstances, adult males need about 1mg of iron per day, women in growing period need 1.5~2mg of iron per day, and need more iron during pregnancy and lactation. Therefore, you should eat more iron-rich Food, such as lean meat, pork liver, egg yolk and kelp, hair dish, seaweed, fungus, mushrooms, beans, etc., should pay attention to the reasonable combination of diet, such as eating some fruits after a meal, the fruit is rich in vitamin C and fruit Acid can promote the absorption of iron, and drinking strong tea after a meal is caused by the combination of iron and tannic acid in tea to form a precipitate, which affects the absorption of iron. In addition, cooking food in a wok is beneficial to prevent anemia, folic acid and Vitamin B12 is also essential for hematopoiesis. Fresh green vegetables, fruits, melons, beans and meat are rich in folic acid. Meat and liver, kidney, heart and other internal organs are rich. Vitamin B12, but after cooking at high temperature, more than 50% of folic acid and 10% to 30% of vitamin B12 are destroyed. Therefore, it is necessary to pay attention to diet diversification in life, but also pay attention to cooking techniques and try to avoid overcooking. food.
To protect the "hematopoietic plant", many chemical and physical factors can damage the bone marrow, chemical factors such as benzene organic arsenic, anti-tumor drugs, certain antibiotics (such as chloramphenicol, streptomycin), sulfonamides, anti- Epilepsy drugs, anti-rheumatic drugs [such as Baotaisong, indomethacin (indomethacin)], physical factors such as X-ray, B12, -ray, neutron, etc., can damage the bone marrow, is the enemy of hematopoiesis Therefore, protective measures should be strictly implemented, and the operating procedures should be followed. In particular, drugs that are harmful to hematopoiesis should not be abused, and unnecessary X-rays should be avoided.
Blood loss is also an important cause of anemia. Therefore, various blood-threatening diseases such as hookworm disease, hemorrhoids, and functional uterine bleeding should be actively treated.
Another characteristic of senile anemia is that the elderly are not easy to be found due to skin pigmentation anemia. Some clinical manifestations are dizziness, some show pain in the precordial area, some show mental confusion, laziness, indifference, depression, irritability, hallucinations, etc. These are special manifestations of anemia in the elderly, so about 30% of elderly anemia patients visit other departments, and these mental symptoms disappear when the anemia is corrected.
The elderly have many years of drinking tea habits. Long-term drinking of strong tea can cause iron precipitation in foods to affect gastrointestinal absorption, which may cause iron deficiency anemia. In addition, the elderly have ulcers, sputum, cirrhosis, atrophic gastritis and other chronic bleeding. It can also cause iron deficiency anemia, so the elderly to prevent anemia, advocate drinking light tea, patients with digestive tract disease should be treated early, is an important means to prevent iron deficiency anemia, due to lack of teeth, dentures and overcooking lead to folic acid, vitamins B12 is lacking. The elderly must not cook too badly because of bad teeth. They can be cut into pieces. Usually, they eat green leafy vegetables and fruits to prevent megaloblastic anemia. There are many secondary causes of aplastic anemia. It is a disorderly use of drugs, contact with gasoline, benzene and other toxic substances. At the same time, it is necessary to urge drugs for the elderly anemia. The elderly are forgotten. Super senior citizens (greater than 80 years old) often forget to take medicine, and family members should always remind them.
Complication
Complications of mental disorders associated with anemia Complications, insomnia, anemia, dysfunction, anemia associated with mental disorders
Dizziness, palpitations, insomnia, fatigue, shortness of breath, laziness, numbness or numbness, pale or sallow, pale lips, fatigue, pale complexion, less bloating, loose stools, dizziness, women's menstrual flow Less, pale tongue, thin white fur, weak pulse. At the same time, due to the onset of mental illness, cognitive decline may occur, and accidental injury may occur.
Symptom
Symptoms of mental disorders associated with anemia Common symptoms Disorders of consciousness Dizziness Insomnia, neurasthenia syndrome, irritability, mania, suspicion, anxiety, ear illusion
Usually, the mental disorders associated with various types of anemia have the following clinical features: they originate from various types of anemia, and generally occur in the acute or most severe period of various types of anemia; they are often parallel to the extent of the primary anemia. Relationships, symptoms are characterized by phlegm and light weight; cerebral weakness syndrome often occurs in the early stage of the disease and recovery, acute encephalopathy syndrome often occurs in the acute phase, and chronic symptoms may occur after severe physical illness or improper treatment of brain function Encephalopathy syndrome; the course of disease and prognosis often depend on the length of the primary physical disease and the severity of the disease, and the prognosis is generally reversible.
1. Mental disorders associated with iron deficiency anemia
(1) Mental disorders:
1 early symptoms of neurosis: such as dizziness, headache, insomnia, emotional instability, memory loss, mental dysfunction.
2 affective disorder: more common in depressed state, patients with less movement, sadness, negative, ignorance and so on.
3 hallucinations or delusions: auditory hallucinations can occur in severe anemia, which is a common symptom in mental disorders associated with iron deficiency anemia. Among them, true, verbal, and commentary auditory hallucinations are common, and illusions are rare. , often accompanied by relationships, self-blame and so on.
4 heterophagia: patients with iron deficiency anemia often have a heterosexual disorder, it is believed that due to iron deficiency anemia, especially in starvation, citrate and adenosine triphosphate (ATP) moved to the feeding center, resulting in increased acetylcholine formation It stimulates the appetite center and causes abnormal excitement.
(2) Neurological symptoms: headache, tinnitus, loss of absence or syncope, decreased muscle tone, etc.
2. Aplastic anemia (Aplastic anemia) associated with mental disorders
(1) Mental disorders:
Symptoms of type 1 neurosis: including neurasthenia syndrome, snoring-like episodes, etc.
2 affective disorders: depression, manic state, etc. can occur.
3 Illusion delusion state: illusion, auditory hallucinations, can be accompanied by sinister delusions.
4 disturbance of consciousness: mostly in the advanced stage and accompanied by central nervous system bleeding, can appear paralyzed or disordered, and even coma.
(2) Neurological symptoms: tinnitus, loss of mind, or seizures, meningeal irritation, increased intracranial pressure, sputum, fundus hemorrhage, cerebral hemorrhage, etc.
3. Psychiatric disorders associated with hemolytic anemia
(1) Mental disorders: mental retardation and mental retardation are more prominent, and acute cases may also have disturbances of consciousness.
(2) Neurological symptoms: If it occurs in children, it is mainly characterized by extrapyramidal system, such as muscle rigidity, dance-like movement, speech growth retardation, quadriplegia and other central nervous system symptoms.
4. Psychiatric disorders associated with megaloblastic anemia
(1) Mental disorders: rare, but diverse include disturbance of consciousness, lethargy, paralysis, paralysis, etc.; acute hallucinations, hallucinations and delusions; amnesia syndrome; affective disorders are emotionally unstable, changeable, Irritability, or depression, anxiety, euphoria, manic state, etc.; dementia can occur in the later stage, psychiatric symptoms can occur simultaneously with anemia, but also before anemia, also after anemia, and the severity of anemia is not parallel.
(2) Neurological symptoms: The incidence of neurological symptoms is very high, accounting for 70% to 90%, of which 25% are neurological symptoms, which can cause peripheral nerve degeneration, subacute combined degeneration of the spinal cord and damage of brain tissue.
The diagnosis of all physical illnesses associated with mental disorders must first determine that mental symptoms are caused by physical illnesses, so a comprehensive understanding of the medical history including a complete history of physical and mental disorders, detailed physical examinations and laboratory tests, and some necessary psychological tests. And the identification of the nature, characteristics and symptom of the psychiatric symptoms is the premise of making a correct diagnosis. Based on the comprehensive evaluation and comprehensive analysis of the results of the above-mentioned aspects, the diagnosis of mental disorders caused by physical diseases can be made or excluded.
Examine
Examination of mental disorders associated with anemia
1 bone marrow analysis.
2 protein electrophoresis.
3 urine routine.
4 hemoglobin.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with anemia
Diagnostic criteria
1. Determine the presence and diagnosis of anemia, that is, evidence of anemia, and evidence to determine the classification of anemia.
2. Determine the nature, characteristics and diagnosis of mental symptoms, and carefully identify the following mental symptoms and the existence of symptom groups and their relationship with anemia: 1 Intelligent damage syndrome. 2 amnesia syndrome. 3 personality changes. 4 disturbance of consciousness. 5 psychotic symptoms (such as hallucinations, delusions, nervous syndrome, etc.). 6 affective disorder syndrome (such as mania syndrome, depression syndrome, etc.). 7 dissociation (conversion) syndrome. 8 neurosis-like syndrome (such as anxiety syndrome, emotional vulnerability syndrome, etc.), mental symptoms can not be attributed to other mental illness.
3. Determine the relationship between anemia and psychiatric symptoms. If anemia is present first, psychiatric symptoms occur, psychiatric symptoms improve with the relief of anemia, or worsen as it worsens, it can be determined that psychiatric symptoms are associated with anemia.
Differential diagnosis
1. Functional psychosis induced or accompanied by physical illness When a mental disorder caused by physical illness is similar to a schizophrenia-like state, a depressed state, a manic state or a brain-debilitating syndrome, it is sometimes difficult to obtain clinical symptoms and physical illnesses. Accompanied or induced schizophrenia, affective disorder, neurasthenia and other functional mental disorders are identified, but it is not difficult to identify the disease process, positive physical signs and laboratory findings.
2. Mental disorders caused by brain organic diseases 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.
