Mental disorders associated with systemic lupus erythematosus
Introduction
Introduction to mental disorders associated with systemic lupus erythematosus Systemic lupus erythematosus is an autoimmune disease involving multiple systems, multiple organs and multiple autoantibodies. It is the most common disease in connective tissue diseases. It is clinically characterized by facial and skin erythema, and involves multiple connective tissues. Lesions are characteristic and more common in young women. The ratio of male to female is 1:7 to 1:9. The age of onset is mostly 15 to 35 years old, and can also be seen in the elderly and children. The mental disorder associated with systemic lupus erythematosus (SLE) may be due to the involvement of autoantibodies in cerebral vascular injury through immune mediated, which in turn affects brain function, resulting in neuropsychiatric symptoms. basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious Complications: vascular injury
Cause
Causes of mental disorders associated with systemic lupus erythematosus
(1) Causes of the disease
Systemic lupus erythematosus (SLE) is a disease characterized by a variety of immune-regulatory dysfunctions. The etiology of mental disorders is not well understood. It is generally believed that autoantibodies interact with cerebral vascular injury and affect brain function. Related, possible factors are as follows:
1. Genetics This disease has obvious genetic predisposition. The same disease rate in the same twins is 69%, which is much higher than 3% of fraternal twins. Molecular genetics found that HLA-D sites may be related to this disease.
2. Infection It is generally believed that this disease may be related to type C virus infection. There are many anti-viral antibodies in the blood of patients, and some people think that it is related to streptococcus or tuberculosis infection.
3. Hormones The disease is mostly caused by women, and it is mostly in the growth period. Therefore, it is believed that the occurrence of this disease may be related to estrogen. When oral contraceptives can promote the occurrence of this disease.
4. 40% of patients in the environment are allergic to sunlight, cold, strong electro-optic light, trauma or mental stress can also induce or aggravate the disease.
(two) pathogenesis
The main pathogenesis of systemic lupus erythematosus is immunoregulatory disorder. A person with genetic quality causes the immune function of the body to be disordered under the action of one or more of the above factors, resulting in disorder of immune regulation, and the spirit associated with the disease. There are many obstacles, and the mechanism that causes mental disorders is still unclear. There are some following theories:
1. Immune complex said that in the case of mental disorders associated with this disease, it was found that the choroid plexus in the brain has immunoglobulin IgM deposition, and the immunoglobulin IgG in the cerebrospinal fluid is increased. Some authors have two cases of lupus erythematosus with or without mental disorders. In contrast, antibodies to cerebrospinal fluid were found to be elevated, with 20/27 (74%) in the group with mental disorders and only 1/18 (5.6%) in the control group.
2. Cerebrovascular disease said that from the pathological anatomy of the disease, there are cell infiltration, swelling, hyperplasia and necrosis of the cerebral vascular wall, but in fact there are pathological changes without psychotic symptoms, but no pathological changes are also Mental disorders can occur, so this pathological change is difficult to explain.
3. Lymphocyte toxicity has been reported to have a positive rate of 79.8% for serum lymphotoxicosis and 100% for people with mental disorders. William (1981) believes that brain-reactive lymphocyte antibodies play an important role in neuropsychiatric disorders. It is because the immune complex is deposited on the blood-brain barrier, allowing lymphocyte poisoning to enter the brain.
4. The promotion of severe complications said that the disease often complicated by multiple organ lesions, such as uremia, hepatitis, cardiovascular disease, anemia, sepsis and high fever, these complications can cause secondary damage to brain cells, especially In the case of toxic encephalopathy caused by uremia.
5. Inducing factors Systemic infections, anticonvulsants, antimalarials, chloroquine, antipsychotics, sulfonamides, phenylbutazone, pregnancy and sun exposure are often predisposed factors.
Prevention
Prevention of mental disorders associated with systemic lupus erythematosus
The prevention of this disease is to remove various predisposing factors, such as clearing chronic infections, avoiding drugs that may induce or aggravate the disease, avoiding sun exposure and ultraviolet radiation (especially during active periods), avoiding pregnancy, etc., effectively preventing the body. The key to the disease is accompanied by the prevention of mental illness. At the same time, the cultivation of good personality and the maintenance of mental health after illness are related to the degree of occurrence and occurrence of mental disorders.
Complication
Complications of mental disorders associated with systemic lupus erythematosus Complications, vascular injury
See the relevant section on systemic lupus erythematosus.
Symptom
Symptoms of mental disorders associated with systemic lupus erythematosus Common symptoms Responsive dullness, medullary palsy, tension, stagnation, madness, consciousness, obsessive-compulsive disorder, anxiety illusion
Mental disorder
It is one of the most common symptoms of systemic lupus erythematosus. It can involve mental activities such as consciousness, cognition, emotion, intention and behavior. The incidence rate is about 17% to 50%, and the mental symptoms are diverse and complex. Can be roughly classified into 4 categories:
(1) Neurosis: It often occurs in the early stage of recovery or recovery, with headache, insomnia, weakness, memory loss, anxiety, emotional instability, obsessive attitudes, etc.
(2) Affective disorders: more common, can express emotional apathy, slow response or emotional instability, anxiety, depression or psychomotor excitement, strange action and other manic symptoms.
(3) Chronic prolonged cases can be seen in the symptoms of schizophrenia, hallucinations or delusions, hallucinations, monotonous content, more common in auditory hallucinations, most of the delusions are victimized, related, embarrassed, exaggerated, controlled, and sensed Non-blood reverie, etc., can also be similar to schizophrenia, youthful excitement, more words, sloppy thinking, hallucinations, impulsiveness, behavioral disorders, and childish movements.
(4) Affective mental disorder: a state of manic state, at this time should pay attention to the identification of the response in the treatment of adrenal cortex hormones, mostly mild mania, accompanied by mild disturbance of consciousness, depression, decreased words, depression , fear, etc.
(5) organic mental disorder: severe cases, in the acute phase may appear all kinds of disorientation disorders, disturbance of consciousness, disease often appear drowsiness in the early stage, gradually shift to the sputum, and finally can enter the coma, at this time the mortality rate is higher.
(6) Intelligent barriers and personality changes: more often in the late stage of the disease, chronic brain organic mental disorders, memory loss, personality changes, intelligent defects and dementia, most of the above-mentioned mental symptoms often overlap or staggered, It is heterogeneous, volatility and transitional. In the case of the above-mentioned psychiatric symptoms, it is sometimes difficult to distinguish whether the disease directly invades the brain, or is caused by drug-induced or organ dysfunction. It is generally considered to be the combination of the above-mentioned complex factors. the result of.
2. Neurological symptoms
About 50% to 60% of patients develop neurological symptoms and signs, which may be caused by direct damage to the central nervous system, or may be caused by damage to other organs. Hair is the most common, and other eyeball tremors, eyes Muscle paralysis, optic atrophy, facial paralysis, bulbar palsy, hemiplegia, myasthenia gravis, dance-like movement, subarachnoid hemorrhage, transverse myelopathy.
(1) sputum episode: It is one of the common neurological symptoms of this disease. Sometimes epileptic seizures may occur. In the past, this was considered to be a late manifestation of this disease. In recent years, 2% to 5% of patients have also been found in the early stages of the disease. Some even exist in the first 10 years before other symptoms appear. Therefore, the seizure of this disease can occur in the early stage of the disease. During the development process, it can also be in the advanced stage. Most of the former two are caused by the direct invasion of the brain parenchyma.
(2) increased intracranial pressure: clinical manifestations of headache, vomiting, optic disc edema, the mechanism is unknown, central nervous system infection is not the main reason, moderate dose of adrenal cortex hormone can make it quickly relieve.
(3) Hemiplegia, aphasia: caused by cerebral hemorrhage caused by invasion of small arteries and brain softening.
(4) Involuntary movements such as dance samples or hand and foot movements: the incidence rate is about 25%, which usually occurs in the early stage of the disease, due to vascular damage in the basal ganglia.
(5) peripheral nerve damage: often manifested as multiple neuropathy, accompanied by cranial nerve damage.
(6) Muscle symptoms: About 50% have muscle weakness, pain, and pathological changes consistent with interstitial polymyositis.
3. Physical symptoms
Recurrent fever, joint pain and skin erythema, and typical butterfly erythema on the face.
Examine
Examination of mental disorders associated with systemic lupus erythematosus
Meet the results of laboratory tests for systemic lupus erythematosus.
Electroencephalogram abnormalities are very common, the abnormal rate is 60% to 90%, and the changes of EEG are parallel with the growth and decline of central nervous system symptoms. EEG changes mostly manifest as bilateral diffuse non-specific slow waves. The rhythm is irregular.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with systemic lupus erythematosus
diagnosis
1. Basis for systemic lupus erythematosus
(1) Meet the symptoms and signs of lupus erythematosus.
(2) ESR is accelerated.
(3) Lupus cells can be found in the blood, and so on.
2. Psychotic symptoms occur after systemic lupus erythematosus. On the basis of the diagnosis of systemic lupus erythematosus, symptoms such as lethargy or visual hallucinations, excitement, etc. can be found. Consider the possibility of mental disorder, euphoria, speech or auditory hallucinations. Aggravation, excitement to drowsiness, slumbering to sputum, can be considered as a sign of mental disorders, the emergence of mental symptoms and the progress of systemic lupus erythematosus.
3. Psychiatric symptoms often improve with the relief of systemic lupus erythematosus, or worsen as it worsens.
4. Psychiatric symptoms cannot be attributed to other mental illnesses, ie mental disorders caused by other factors.
Differential diagnosis
1. First diagnosed as systemic lupus erythematosus.
2. Determine neuropsychiatric symptoms secondary to lupus erythematosus.
3. According to its characteristics and signs, it is further differentiated from other physical diseases associated with mental disorders and functional psychosis such as schizophrenia and affective disorders.
