acute delusional episode
Introduction
Introduction to acute delusional episodes Acute delusional episode (acutedelusional episode) is a paroxysmal disorder, also known as delusional paroxysm. The disease belongs to the category of transient mental disorders. It is a short-acting psychotic disorder with rapid onset and complete relief. Generally, there is no cause of morbidity, even if there are psychological factors that can be found, it is insignificant. Often a sudden onset (mostly within a week), with a transient reverie as the main performance, but also accompanied by emotional and behavioral abnormalities. The disease is more common in young adults, does not occur in children, and is rare in people over 50 years old. It does not include diseases such as periodic psychosis and rapid-circulating affective disorder. basic knowledge The proportion of illness: 0.0025% Susceptible people: more common in young adults Mode of infection: non-infectious complication:
Cause
Cause of acute delusional attack
(1) Causes of the disease
Acute delusional seizures generally have no cause of morbidity. Even if there are psychological factors that can be found, it is insignificant. Often sudden acute onset (mostly within 1 week), manifesting symptoms of transient delusion, diversification of delusions , fragmented, but also emotional and behavioral disorders, each attack onset, rapid relief, duration of no more than 3 months, good prognosis, but also accompanied by emotional and behavioral abnormalities.
(two) pathogenesis
So far, the current pathogenesis of acute delusional seizures is still unclear.
Prevention
Acute delusional attack prevention
So far, the prevention of mental illness has been carried out in the areas of synergy, society, education, and the existing level of medicine. As for the prevention of mental illness, it is awaiting psychiatry and related sciences. The development of the disease, as well as the full clarification of the etiology and pathogenesis of various mental illnesses, is an arduous and noble mission given to human medical science by human history.
At present, it is almost universally recognized that many of the problems discussed in the etiology and epidemiology of mental illness have multiple sources, that is, the development and prognosis of some mental diseases, the genetic factors of patients, and the susceptibility The pre-existing personality characteristics, the state of the body at the time of onset, the trauma, the triggering factors in the environment, and the social and cultural background all have extensive links. Therefore, when the patient's symptoms are relieved, follow-up observations should be carried out for a certain period of time to prevent recurrence. Psychotherapy can not only improve the curative effect, but also has a preventive effect, aiming at eliminating the misunderstanding and psychological burden of the patient on mental disorders.
Complication
Acute delusional complications Complication
Depressed, victimized
Symptom
Acute delusional symptoms common symptoms depression personality disintegration mental disorder memory impairment anxiety hallucination
I want to experience
The delusion appears more and more rapidly, and it develops rapidly and becomes a unique clinical manifestation of the disease. The delusions are diverse, such as murder, exaggeration, poisoning, relationship, embarrassment, control, religious or mysterious delusion, etc. The patient is completely immersed in this vivid paranoia. Attraction, delusion structure is loose, and it is not continuous and change. Sometimes patients are convinced that delusion is a fact. These delusions can be mixed, that is, there are two or three kinds of delusions at the same time, and one of them may be the main central content, which is delusional. In the background, various hallucinations can occur, and the content is more vivid, sometimes causing the patient to indulge in an immersive feeling.
2. Emotional disorders
Emotional variability is also one of the important symptoms of this disease. With the ups and downs of delusions, patients can express high or low mood, or from fear to stun, but also have anxiety or agitation. Emotional disorders can alternate, duration is not Long, usually a few hours or 1-2 days, compared with delusions, emotional disorders do not occupy prominent positions, and the duration is not long, usually from a few hours to a week, and the longest is no more than one week.
3. Behavior and awareness
Patients may have abnormal behavior or loud shouting, which is related to delusions and emotional changes. There is no obvious obstacle in consciousness. The patient's appearance seems clear, orientation exists, and can talk better, but sometimes the patient suddenly feels like entering a new one. The environment is confusing, at this time there may be illusions or hallucinations, personality disintegration symptoms, and thus increased activity or silence, after the patient has a feeling of dreams, some patients have near memory impairment, often It may lead to the possibility of organic lesions (Kaplan HI, 1994), but the actual test results are negative.
Case: Male 28 years old, married, temporary worker, junior high school education level, the patient came from a foreign city to work as a temporary worker. Recently, due to excessive construction, he also suffered from a cold. After symptomatic treatment, his condition improved after a break. Suddenly yelling and yelling, "The doctor in the outpatient department gave the wrong medicine." This is poison, and he is going to be responsible for him. When other workers come to comfort him, he thinks that he has to send him to the clinic for injection. Kindly, and using tools to injure his workers, he was immediately forced to go to the psychiatric hospital for emergency treatment, and after giving injections, he fell asleep. After two days, his mental state returned to normal. He could basically recall the morbidity at the time and apologized for what he did. Forgive, past physical health, denied a history of mental illness, no history of drinking.
Diagnostic points:
1. Desperate predominance, no signs before the onset, suddenly produce a variety of structures and systems, and loose and volatility, such as murder, exaggeration, embarrassment, religious delusions, etc., can be accompanied by embarrassment, illusion, short-lived illusion Personality disintegrates, or exercise increases or decreases.
2. Have emotional disorders that last for hours or days (not more than 1 week), such as emotional ups and depressions, or anxiety, or irritating emotional disorders, although common, but not the main symptoms, short duration, but not the main Highlight symptoms and last for a short time.
3. There are no obvious obstacles to consciousness and attention, but it can be a little confused.
The above 3 can be used as the main basis for diagnosis; the following symptoms can be used as a reference, but non-essential symptoms: 1 misrecognition or confusion; 2 illusion, hallucination or personality disintegration; 3 increased activity or behavioral inhibition.
4. The severity should have the following two
1 Social functions (including study, work, daily life and social activities) are significantly affected;
2 lack of self-knowledge or incomplete.
5. Course standard: Both the appearance and disappearance of mental symptoms are sudden. This is the meaning of "acute attack". The longest course of disease is no more than 3 months. Otherwise, the diagnosis of other mental diseases should be considered according to clinical manifestations.
6. Exclude reactive psychosis, mental disorders caused by psychoactive substances and non-addictive substances, or schizophrenic psychosis with persistent hallucinations and characteristic thinking disorders.
Examine
Examination of acute delusional attacks
There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.
There is currently no specific laboratory support for this disease.
Diagnosis
Diagnosis of acute delusional seizure
Differential diagnosis
1. Psychogenic mental disorders and neurosis
Some types of reactive mental disorders can be acutely ill, have a transient delusional experience, have a good prognosis, and need to be differentiated from acute delusional seizures. The difference is that patients with reactive mental disorders experience significant and intense trauma before onset. The content of delusions is closely related to the traumatic experience and changes little. In addition, different levels of consciousness disorder can be seen.
Acute delusional seizures may have certain psychosocial factors before onset, but this is only a coincidence, and the degree of psychosis is generally mild, sometimes differentiated from factitious disorder, which is an adulthood The obstacles in personality development and behavior are manifested in the fact that individuals repeatedly disguise symptoms and give people a deliberate feeling. If you ask the medical history carefully, it will be helpful for differential diagnosis.
2. Schizophrenic psychosis
Although the disease is acute, its clinical manifestations mainly predominate over the symptoms of schizophrenia, that is, the disharmony between thinking, emotion and behavior, and often accompanied by mild disturbance of consciousness; sometimes accompanied by sputum-like manifestations, Sometimes there are certain difficulties in early identification, and it takes a period of observation to confirm the diagnosis. The course of schizophrenic psychosis may be longer than that of acute delusion, but it usually does not exceed 6 months.
3. Periodic psychosis
The disease is mostly caused by puberty, and it is more common in women. Symptoms occur periodically and are closely related to the menstrual cycle. In the same patient, the symptoms are basically similar, so there is a "copy sign". The clinical manifestations can be seen in the symptoms of emotion, behavior and disturbance of consciousness, but there is no dominant symptom. The course lasts for 1 to 2 weeks and relieves itself.
4. Splitting emotional psychosis
The disease can also be acutely ill, and the clinical manifestations are mainly schizophrenic symptoms and affective symptoms. The symptoms of the two groups can exist at the same time, and they are also prominent, and can also alternately appear. The mental state is good during the remission period, although there are many recurrences, no personality. Defect performance.
