Mental disorders associated with abnormal thyroid function
Introduction
Introduction to mental disorders associated with thyroid dysfunction Mental disorder associated with hyperthyroidism refers to excessive secretion of thyroxine, which directly causes or causes mental disorders and neurological symptoms caused by metabolic changes in the brain. According to statistics, about half of patients with hyperthyroidism will have personality changes, mania, depression, hallucinations. I want to wait for mental disorders. Hypothyroidism is caused by thyroxine synthesis, decreased secretion, or abnormal brain metabolism caused by biological effects. This is the biological basis for hypothyroidism with mental disorders. Thyroxine is an indispensable substance in the central nervous system and an important component in maintaining normal human behavior and stress response. It has been reported that the incidence of depression in patients with severe hypothyroidism is almost 100%. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: alcoholic dementia
Cause
Causes of mental disorders associated with thyroid dysfunction
(1) Causes of the disease
1. The etiology of hyperthyroidism is not fully understood. The research in recent decades proves that the disease is mainly caused by genetic defects and the autoimmune reaction induced by mental stimulation. It is widely believed that hyperthyroidism is present. The occurrence is related to immunity. In recent years, radioimmunoassay analysis has shown that more than 90% of patients with hyperthyroidism have thyroid stimulating hormone (TSH) receptor autoantibodies in their serum, and this antibody may be considered to be the cause of hyperthyroidism.
The disease has a certain genetic predisposition. There are often multiple patients in the same family. Some people have a single-five twins with a same morbidity rate of 30% to 60%, and twins have a same morbidity rate of only 3% to 9%. Negative stress such as stress, depression, and excessive grief is often the cause of this disease, because the above negative stimuli can affect the function of T cells.
2. Mental disorders associated with hypothyroidism refer to mental disorders and neurological symptoms caused by cerebral metabolism changes caused by insufficient or lack of thyroxine secretion. Hypothyroidism can be divided into primary, secondary, and primary. %, mostly acquired, common reasons:
1 After treatment or surgical resection, the thyroid tissue structure is destroyed, causing thyroxine synthesis and insufficient secretion;
2 thyroid inflammation;
3 application of thyroid drug overdose inhibits thyroxine synthesis;
4 genetic defects caused by thyroxine synthetase system dysfunction, secondary hypothyroidism due to hypothalamic-pituitary lesions, such as tumors, inflammation, surgery, radiotherapy and postpartum pituitary ischemia, necrosis, etc., making TRH or TSH secretion less than T3, T4 has also been reduced, local endilopathy, mostly due to maternal iodine deficiency, resulting in hypothyroidism in the fetal thyroid hormone synthesis.
(two) pathogenesis
Hyperthyroidism associated with the development of mental symptoms (35%):
There are several the following theories:
1 Endocrine Disorder: Endo (1988): pointed out that the occurrence of mental disorders is related to the hypersensitivity of -adrenergic receptors, metabolic disorders and toxic substances: Takahashi Saburo (1976) believes that hyperthyroidism is due to metabolism Hyperactivity leads to hypoxia and undernutrition, and toxic substances produced by the thyroid gland can cause paralysis or disorder.
2 psychological factors: Brom reported 2342 cases of patients with fire, earthquake, car accident and other stress factors, long-term mental stress, depression, excessive sorrow is often the cause of this disease.
3 Personality characteristics: Many scholars believe that the mental disorder of hyperthyroidism is the result of pre-existing personality, psychological factors and hyperthyroidism. There are also many studies on the personality characteristics of patients with hyperthyroidism. Li Qiuxiang (1982) applied Ai The Senke Adult Personality Questionnaire (EPQ) surveyed 100 patients with hyperthyroidism and found that the N score was increased. Cai Xiongxin et al (1985) also obtained similar results in 81 patients with hyperthyroidism, and found that the patient's E scale was significantly lower. For healthy people, all of the above indicate that the personality characteristics of patients with hyperthyroidism are introverted, emotionally unstable, clinical manifestations are irritable, irritable, nervous, suspicious, easy to anxiety, depression and so on.
Mechanism of mental disorders associated with hypothyroidism (27%):
Have the following explanation:
1 cerebral circulatory disorder said: Lisman proposed hypothyroidism with mental disorders due to thyroxine deficiency leading to changes in brain metabolism, which is not only a direct impact on brain tissue, but also due to cardiac involvement affecting circulatory disorders, brain tissue hypoxia, Raymond Etc. (1978) also holds the same view.
2 Some people think that the mental disorder associated with mucous edema is due to cerebral edema, or accumulation of neurofibrin substances in the brain or circulatory function caused by arteriosclerosis.
3 thyroid system activity is an important component to maintain normal behavior and stress response, thyroxine treatment of depression has a positive effect, so the relationship between thyroxine depression and depression is very close.
Prevention
Prevention of mental disorders associated with thyroid dysfunction
Improve the vigilance of the primary thyroid disease and pay attention to find the cause, the incidence of this disease can be greatly reduced, to avoid the various factors that induce disturbance of consciousness, especially coma, such as cold, infection, surgery, etc., be careful in winter Actively treat the primary disease.
At present, there is no method to prevent the occurrence of hyperthyroidism. Patients with exophthalmia goiter must take medication for a long time to achieve permanent remission, so the cooperation of patients is very important. On the other hand, the lack of iodine in the diet and hyperthyroidism, development Slow and mentally retarded, in areas with insufficient iodine intake, the incidence of toxic multinodular goiter increases in older women. Therefore, daily life needs to pay attention to iodine intake, especially in pregnant women and children, thyroxine is growing. Indispensable substances, good living habits, balanced diet, and maintaining health can not prevent the occurrence of hyperthyroidism, but can prevent or reduce the symptoms of hyperthyroidism.
Complication
Mental disorders associated with thyroid dysfunction Complications, alcoholic dementia
1. Memory weakening (hypomnesia) The overall dysfunction of memory is most common in brain organic disorders, such as dementia patients can also be seen in normal elderly.
2. Forgotten (amnesia) can not recall a certain event or a certain period of experience, called the memory blank can retain the recognition function is divided into antegrade amnesia retrograde amnesia, progressive forgetting, pre-existing, forgotten, two types are more common in brain damage Progressive forgetting is mainly seen in the selective forgetting of dementia due to obscurity. The things that are forgotten are selectively limited to painful experiences or things that may cause psychological pain. Most of the major psychological problems occur after stress. Acute stress disorder and the like.
Symptom
Symptoms of mental disorders associated with thyroid dysfunction Common symptoms Nausea constipation Loss of appetite Demention Aversion to auditory hallucinations Anxiety Dizziness Susceptibility to myasthenia gravis
1. Hyperthyroidism accompanied by psychiatric symptoms
The onset is generally slow, and a few can be acutely affected by heavier mental stimulation, trauma, infection, etc. The physical symptoms are mainly prone to heat, sweating, eating more but losing weight, palpitations, and arrhythmia can also occur. Chest tightness, shortness of breath; elevated blood pressure, low menstrual flow or amenorrhea, impotence, goiter, some patients may have symptoms of exophthalmos, usually tired, weak, and work efficiency decreased significantly.
(1) Mental disorders:
1 neurasthenia syndrome: occurs mostly in the early stage of the disease, almost all patients in the early or the course of the disease will appear insomnia, forgetfulness, fatigue, temperament, poor self-control, irritability, emotional instability, lack of concentration, ability to work Decreased, sensitive, weak, fatigue, poor adaptability and other symptoms, this time is easily misdiagnosed as neurasthenia or anxiety, it has been reported that 36 of a group of hyperthyroidism patients were diagnosed after 1 to 2 years.
2 Personality change: the incidence rate can reach 50%, manifested as different levels of impatience, irritability, fighting, fear, depression, sadness or joy, sensitive and suspicious, increased irritability, emotional instability or nervousness, etc. There are nervous, allergic, suspicious, impulsive or aggressive behaviors. Some people have raised the triad of emotional instability, nervousness, allergic hyperthyroidism, and often accompanied by loss of libido, abnormal appetite, sleep disorders, menstrual disorders and other endocrine mental syndromes. A small number of elderly patients show that they are slow-moving, slow-moving, and ignorant, called "indifferent" hyperthyroidism. Patients with hyperthyroidism are often accompanied by loss of libido, abnormal appetite, and sleep disorders.
3 manic or depressed state: some patients may have emotional ups and downs, hyperactivity, increased excitement, euphoria, busy, nosy, good advice, Lenovo runaway, but the infection is not clear, individual patients can There are fragmentary delusions and hallucinations and other similar manic states, sometimes with fear, anxiety, pessimism, depression, etc., easy to be mixed with emotional psychosis mania, more common in young women, in elderly patients, clinical appearance often indifferent, reaction Slow, drowsiness, fatigue, anorexia, weight loss, etc., sometimes only gastrointestinal symptoms such as anorexia, diarrhea, weight loss, clinically known as apathetic hyperthyroidism, easily misdiagnosed as depression, can also be manifested as depression, depression, Anxiety, less movement, ignorance, etc., often accompanied by inferiority, self-esteem, anxiety, depression, nervousness, fear, irritability or depression, easy to hurt, reduced interest, more discomfort.
4 Illusion delusion state: auditory hallucinations are mostly verbal, commentary, delusions are often more systematic, continuous victimization, sin and other content, auditory hallucinations are consistent with delusions, have a sloppy mind, similar to schizophrenia, multiple chronic hyperthyroidism patient.
5 disturbance of consciousness: more often occurs in the occurrence of thyroid crisis, with a state of paralysis, accompanied by severe psychomotor excitement, and then quickly into a coma, more common in sputum or disorder, which is caused by inflammation, infection, trauma, surgery, body Induced by disease or psychological factors, it begins to show drowsiness or lethargy, and later develops into sputum and even coma, often accompanied by symptoms of thyroid poisoning such as high fever, sweating, and tremor. These serious symptoms of poisoning have been improved due to advances in diagnosis and treatment. rare.
6 long-term severe hyperthyroidism patients may also have memory loss and mental retardation, according to Qing Han et al (1978) in the two groups of controlled studies with and without mental disorders found in the size of mental disorders and goiter, The basal metabolic rate has a certain relationship with the radioactive iodine absorption rate. In the group with mental disorders, the basal metabolic rate is more than +40%; the goiter is more than II; the incidence of thyroid enlargement is lower. The higher, on the contrary, in the group without mental disorders, the basal metabolic rate was below +40%; the goiter was below II; the iodine absorption rate was also associated with the mental disorder group compared with the non-mental disorder group. high.
(2) neurological symptoms: can be manifested as myasthenia gravis, limb tremor, periodic paralysis, ophthalmoplegia, dance-like exercise, Parkinson's syndrome, a small number of patients may have epileptic seizures, active knee or knee reflexes, etc. And often have a variety of autonomic dysfunction symptoms such as sweating, chills, heart rate, heart palpitations, hyperthyroidism, intractable diarrhea, hand tremor, skin erythema, chronic urticaria, skin scratches and weight loss There may also be loss of libido, impotence, decreased menstrual flow, post-cycle delay or amenorrhea.
2. Hypothyroidism, referred to as hypothyroidism, is caused by a variety of causes of thyroid hormone synthesis, insufficient secretion or biological effects caused by changes in brain metabolism caused by mental disorders, divided into three types due to the age of onset:
1 dying disease (cretin disease): dysfunction begins in the fetal period or newborn, can be divided into local and loose hair;
2 juvenile hypothyroidism: dysfunction begins in pre-sex developmental children, also known as juvenile mucous edema;
3 adult type hypothyroidism: adulthood, the most typical and serious manifestations of this disease is mucous edema, physical symptoms mainly mucinous edema, amenorrhea, hypotension, chills, fatigue, lack of desire, apathy, low body temperature.
(1) Mental disorders:
13 different types of mental disorders:
A. Mental disorders of minor illness: characterized by low mental development and short body.
a. Mental retardation: dysplasia, depression, volitional disorder: psychomotor inhibition, loneliness, coldness.
b. Affective Disorder: Responsive and indifferent, do not care about the surroundings.
B. Mental disorders of juvenile mucous edema: depending on the age of onset, younger people are similar to the symptoms of small illnesses, showing mucous edema in adulthood.
C. Mental disorders in adult hypothyroidism:
a. Mental retardation: comprehension is mildly retarded, inattention is not concentrated, memory is poor, and thinking is poor.
b. Inhibition state: slow, less moving, less talk, lack of will, fatigue or lethargy and other mental activities decline, depression occurs mostly in the early and middle stages of the disease, manifested as low mood, reduced interest, less language, less movement, dull, Lazy, passive contact, loss of intention, sleepiness and fatigue.
c. Manic or depressed state: depression is more common than mania.
d. Illusion delusion state: The hallucination feature is characterized by the illusion of human face and small animal image. The delusion is often systematic, persistent victimization, and the symptoms are similar to schizophrenia.
e. Disorder of consciousness: coma is more common. It is seen in elderly patients and elderly patients. It often occurs in winter. Before coma, chills, drowsiness and dry and rough skin and hoarseness are severe symptoms. A short disorder may occur first. The state gradually shifts to a coma. If not treated in time, the mortality rate can reach 50%.
2 Intelligent decline: can be expressed as poor thinking, slow, lack of understanding and judgment, difficulty in concentration, computational power and memory loss.
3 Illusion delusion state: Illusion is more common in illusion, often as a character or animal image, and delusion is more common in the paranoia of the piece.
4 disturbance of consciousness: short-term confusion can occur in the hypothyroidism crisis, coma can occur in cold environment and season, called mucous edema coma.
(2) neurological symptoms: dysplasia is more common in hearing and dysarthria, visual field reduction, optic atrophy, retrobulbar optic neuritis, etc., adults can be seen with facial paralysis, ataxia, gait instability, tremor, seizures, neuritis Wait.
Examine
Examination of mental disorders associated with thyroid dysfunction
1. Examination of serum thyroid hormone (T4) and triiodothyronine (T3).
2. Thyroid stimulating hormone releasing hormone stimulation test After intravenous injection of 200 g, thyroid stimulating hormone does not increase or increase very little.
3. Serum cholesterol check.
4. Blood sugar Because thyroid hormone promotes gluconeogenesis, some patients with hyperthyroidism may have secondary diabetes or impaired glucose tolerance.
5. Examination of serum electrolytes.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with thyroid dysfunction
1. According to symptoms and signs and laboratory tests, diagnosed as thyroid dysfunction (hyperthyroidism, hypothyroidism), such as serum thyroid stimulating hormone releasing hormone (TRH), T3, T4 changes.
2. Mental symptoms are often closely related to thyroid dysfunction.
Exclude mental disorders associated with other causes, and pay attention to distinguishing from functional psychosis, such as schizophrenia, affective disorder, and neurosis.
