Overview: physical disease associated with mental disorders may be because, although the primary different diseases, psychiatric symptoms vary, but all have common characteristics: non-specific psychiatric symptoms. Were generally more acute onset, with acute organic mental disorders (disturbance of consciousness syndrome) mainly occurred in the peak of physical disease; chronic disease of early onset and recovery, and often debilitating syndrome, brain-based; in disease can occur late chronic organic mental disorders, personality changes or mental disorders in their characteristics. mental disorders and primary physical disease often has a parallel relationship in extent, its clinical manifestations with the physical changes in the severity of the disease changes, by one state into another state. Various types of mental disorders often repeated, there interwoven and complex. Symptoms with day and night, light weight characteristics.[Cause]
leukemia associated with causes of mental disorders is not clear, which is a mental disorder leukemia major risk factors, but not the only reason. Bio-psycho-social factors and quality factors such as personality characteristics, age, genetic predisposition and individual differences in nervous system function and response of the body and so with the occurrence of mental disorders. leukemia associated with the emergence of psychiatric symptoms and the severity of leukemia is not always proportional. leukemia caused by mental disorders may be factors:
1. central nervous system bleeding leukemia leukemia complicated by cerebral hemorrhage in the nervous system, the most common type of injury, gradually increasing in recent years the tendency of some statistics about nerve damage caused leukemia in 32%. This may be the main cause neuropsychiatric disorders.
2. leukemic cell proliferation and infiltration of anti-leukemia drugs have largely failed because the blood-brain barrier, the leukemia cells to multiply within the central nervous system and neurological disorders.
3. central nervous system leukemia in patients infected with neutropenia due to normal maturity and quality defects, while the anti-leukemia drug can promote neutropenia, inhibition of the cellular and humoral immunity, At the same time a large number of applications adrenocorticotropic hormone, can make the body resistant to decline in the fight against infection often are applied to a large number of antibiotics, some bacteria is inhibited, but also led to the large population of other bacteria, the bacteria constitute the central nervous system , viruses, fungal infections, increased incidence of neuropsychiatric disorders.
4. energy supply shortage of leukemia associated with common mental disorders in the pathophysiology of diffuse brain changes in energy demand change. Because leukemia causes the body metabolism, resulting in energy supply. The brain is very sensitive to the energy requirements, as leukemia, brain growth in demand for energy, then the body from energy supply and demand, resulting in normal physiological function of the brain disorder. This is such a major mechanism for the occurrence of mental disorders.
5. brain hypoxia leukemia, particularly cardiovascular, lung and brain involvement, can lead to lack of oxygen-carrying capacity, or the body under the influence of harmful factors in the microcirculation etc., can lead to cerebral blood supply, lack of oxygen to cerebral dysfunction, which is an important mechanism for the occurrence of mental disorders.
6. biotoxins role in leukemia, where exogenous substances such as bacteria, viruses, parasites, chemicals, toxic gases, and other invasive organism, its toxins or intermediary metabolism product directly on brain cells, causing brain cell damage and lead to cerebral dysfunction mental disorders.
7. body metabolism leukemia, the body fluid metabolism and acid-base balance disorders, and certain vitamin deficiencies and other disorders can lead to metabolic activity, thereby affecting the metabolism, and energy supply, is bound to affect brain function and neurological disorders.
8. stress response of leukemia, the exogenous harmful factors, including biological stressors and psychological stressors acting on the body, through the nerve physiology, neurological and biochemical, neuroendocrine and immune mechanisms, resulting in a series of physiological and biochemical reactions. In these reactions, the brain or directly involved or indirectly involved, leading to its normal physiological functions are affected, leading to the occurrence of mental disorders.
9. individual susceptibility to clinical can also see the fact that only a minority of the population suffering from leukemia patients with leukemia associated with mental disorders, suggesting that this may be related to genetic factors and individual quality or character defects, mental disorders due to physical illness, such as family history accounted for 2% to 8%, higher than the general population; introverted, irritable, stubborn, headstrong person prone to physical illness mental disorders; poor stability of brain function persons, such as the elderly and children prone to physical illness such as delirium.
(B) the pathogenesis
1. refers to physical disability resulting from disease, psychological reactions, such as leukemia after suffering anxiety, depression, irritability, paranoia, loneliness and other mental disorders caused by .
2. mental disorders resulting from leukemia caused by biological factors directly. Such as central nervous system hemorrhage, leukemia cell proliferation and infiltration, central nervous system infections, and energy supply (cerebral insufficiency, cerebral hypoxia, etc.), toxin, water, electrolyte imbalance, stress response, neurotransmitter changes, and so on. Directly or indirectly affect brain function, resulting in neuropsychiatric symptoms.
3. In most cases, is often the result of the role of these two.[Sign]
clinical manifestations of this disease:
(1) disturbance of consciousness: the most common, accounting for 77% of acute leukemia, brain damage is mainly an initial period of sleepiness that can later be developed into a lethargy, delirium resulting in coma.
(2) excited state: patients restless.
(4) depression: In addition to feeling pessimistic, sometimes suicidal tendencies.
mental disorders have the following characteristics: ① acute leukemia, myeloid leukemia in the mental disorders associated with the most common, severe symptoms, psychiatric symptoms to disturbance of consciousness based; ② chronic leukemia lower incidence of mental disorders, mild symptoms, mainly to other mental disorders; ③ mental disorders and blood relations are not parallel, and even some patients with psychiatric symptoms only appear in the blood better, but it closely associated with brain damage; ④ most cases of neurological symptoms associated with mental disorders.
2. neurological symptoms of nerve damage when leukemia variety of clinical manifestations, from the meninges into the brain, from brain to the spinal cord. The pathological damage to leukocyte infiltration and major bleeding, the former similar to encephalitis, meningitis, brain tumor, is the earliest and most common symptoms of increased intracranial pressure, such as headache, vomiting, optic disc edema. The latter (bleeding) can occur in any part of the nervous system. Thus the clinical symptoms include almost all the symptoms of nervous system diseases, while others tend to appear before the leukemia diagnosis, which clinicians need to be vigilant.
clinical manifestations of consciousness, intelligence diminished or forgotten syndrome, should take into account the possibility of organic mental disorders, but alone can not serve as organic mental disorders qualitative or diagnosis, must be made to the etiology, diagnosis taxonomy, diagnosis, the establishment must have the following points:
1. a change of diagnosis of leukemia.
4. psychotic symptoms can not be attributed to other psychiatric disorders.
leukemia patients because the body metabolism in hyperthyroidism, the need to give high-calorie, high protein, rich in vitamins, minerals and digestible diet, to supplement the body heat and the consumption of various nutrients. Especially for chemotherapy patients often have loss of appetite, bloating, diarrhea, nausea, vomiting and other gastrointestinal reactions, dishes should be noted that the color, smell, taste, type, in order to cause the patient's appetite.
mental disorders should pay attention to nutrition diet and fasting. Nutritional supplementation can eat foods rich in vitamin b complex, calcium and magnesium, L-tyrosine, vitamin c, fiber, lecithin and other substances in food.
eating disorder care
1, dominated by the paranoid suspicion of toxic and refused to eat food, you can enable patients to participate in sub rice can also be allowed to share meals with other patients, and allow him to optional meals, but also in front of the patient's face to taste a few mouthfuls of the patient's meals, to increase their sense of security.
2, patients with delusions of a crime can disrupt the food, so he thought it was food and eat food disability. Should strengthen the management, oil barrels should be placed beyond the reach of the patient, to prevent the patient eat leftovers, dirty water and the occurrence of physical disease.
3, for depression, poor diet, patients should be persuasion, to understand the patient's state of mind, give compassionate, to talk about the good life, improve life interest in trying to persuade patients to eat automatically. Should be selected easily digestible foods, pay attention to food color, smell, taste, to stimulate appetite, and enhance induction, the language used to promote appetite, eating with others, and feeding and other methods to increase patient interest in eating.
5, excessive drinking can not take care of patients, should someone manage to avoid the use of barbed, bone food. food should be soft, easily digestible, suitable temperature, to persuade patients slowly, anti-food stems choke. Never give patients excellent food and fruit. Patients to the appropriate restraint for their binge eating, to control the amount of food for catering to prevent patients beg for food to other people.
6, hypochondriasis or hypochondriacal delusions in patients that their risk of gastrointestinal illness or an incurable disease, have ulcers or gastrointestinal tract and can not eat, can be implied The disease has been gradually improved, and adjust the diet of the color, variety, such as milk, soft rice, so easily accepted by patients.
information for reference, please consult a doctor.[Prevent]
(1) must first have confidence and perseverance. leukemia patients adhere to long-term treatment should be established to overcome the disease be cured of confidence, to feel comfortable, confident to overcome the pessimistic despair, active treatment. Although it is incurable leukemia, but that is intractable disease. Therefore, each patient's resistance to fully mobilize their potential to fight with, so that ultimately the strong recovery.
(2) must adhere to the correct and reasonable long-term treatment: "leukemia is an incurable disease" has become the past. Admitted to our department in recent years, leukemia, for example, as long as adhere to the formal system in combination therapy can make the most of the long-term disease-free survival in patients with leukemia and achieved good effect, so that survival gradually extended. Recommend that patients adhere to treatment, detect the disease when repeated or increased, the time to the regular hospital or specialty hospital. Outside the hospital during treatment, using drugs in strict accordance with doctor's orders, the timely review of the appropriate checks, regular referral to the hospital.
(3) daily self-nursing can not be ignored: leukemia patients should maintain good personal hygiene, frequently changes underwear, bed sheets often wash, bathe, scrub the body. bleeding in situ pressure and tamponade. Daily with salt water, nitrofurazone gargle, wound healing in patients with leukemia, to minimize unnecessary surgical operation. Self-poor blood clotting mechanism of leukemia, should try to reduce accidents.
high temperature, the mixture of leukemia should eat fresh vegetables, food rich in fiber, vitamins, protein-based: such as fruits, celery, animal liver, lean meat, Tremella, soybeans; should Changyin bean soup to prevent heat stroke, do not eat cold food (freezer food), etc., patients in mental status, loss of appetite, sleep, toilet, etc. to maintain a normal, if necessary, hospitalization.
strengthening exercise, tai chi, qigong, and enhance physical fitness, prevent colds and various infections; attention to food hygiene, flirting Chi, to feel comfortable, work and rest, to participate in outdoor activities, exposure to adequate sunlight, fresh air, quit alcohol, enhance the body resistance, to avoid the application of bone marrow suppression drugs.
(1) not too much exposure to x-ray and other harmful radiation. Personnel engaged in radiation work to do personal protection, to strengthen prevention measures. Infants and pregnant women more sensitive to radiation, vulnerable, women during pregnancy to avoid exposure to excessive radiation, or a higher incidence of fetal leukemia. But occasionally, the medical x-ray examination, the smaller the dose, basically no impact on the body.
(3) to reduce benzene exposure, benzene poisoning, chronic major damage to the body's blood system, causing human leukocyte, platelet count reduction induced leukemia. Engaged in the production of raw materials for the chemical benzene workers must pay attention to strengthening labor protection.
prevention of complications related to leukemia, once diagnosed with leukemia, it should actively prevent its complications, is very difficult to treat complications of leukemia, and higher cost, but if From prevention is much easier to start, not only can reduce the pain on the patient's body, but also reduce the financial burden of patients.
remedies: (The following information is only for reference, details need to consult a doctor)
[side 1] Rehmannia, Digupi, Codonopsis, 15 grams of Huang Jing, wolfberry, habitat of 20 grams, anemarrhena , Cork, Dan, cornus 10 grams each, rhizoma imperatae 30 grams barbata 40 grams. Shuijianbi day one.
[side 3] wide horns, Dan, indigo, 9 grams of licorice, gypsum, habitat, Hedyotis diffusa, 30 grams, dandelion, silver Flower, turtle The 24 grams, aloe vera, bupleurum of 6 grams, chine 18 grams, barbata 15 grams, 21 grams turtle version, Digupi, Huaihua, each with 12 grams. Decoction.
[side 4] Angelica, Gentiana, Dan, digupi of 6 grams, habitat, white peony root, turtle shell, Lugushuang, Rhizoma Imperatae, keel, oysters, silver flower of 9 grams, Lithospermum, loofah of 4.5 grams, 2.4 grams Chuanxiong. Decoction.
[square 5] 30 grams astragalus, codonopsis 20 grams of rhizome, wolfberry fruit, Asparagus, per reference, angelica 15 grams each. Shuijianbi 1-2 agents. bleeding obvious, add Radix, eclipta prostrata, Agrimony, 15 grams; with infection, plus Scutellaria, Coptis, Phellodendron 15 grams each.
[square 6] geckos, centipedes of 30, Han thirty-seven 30 grams, cinnabar, saponins, 15 grams, 40 grams of dry alum; indigo, black snakes, 50 grams, white silkworm 25 grams. Total research and go, each serving 2 g, 2 times a day. And with oral administration of decoction: diffusa 30 grams, barbata, Codonopsis, Radix, Salvia, dioscorea bulbifera, re-building, Lithospermum, 20 grams of refined yellow 40 grams, white peony root, 15 grams of gelatin , purslane 50 grams a day.
[square 7] astragalus, Ruddle, red peony, scutellaria barbata, 15 grams, heterophylla, white peony root, Inula, bergamot, hawthorn each 12 grams of carbon , gallus gallus domesticus, radish Seed, citrus aurantium, Chuan Dong Son, 9 grams of licorice, triangular, coix 8 grams, 20 grams of yam, hedyotis diffusa 30 grams of soil poria 18 grams. Shuijianbi day one.
[square 9] zokor 1. Drying into powder. 10 grams per serving, 1-2 times daily.
[side 11] astragalus, raw yam, diffusa, Eclipta, 30 grams, Ophiopogon, Asparagus, tonkinensis, Burnet, multiple intersecting , 15 grams per reference, ligustrum lucidum 12 grams. Decoction. 1 day, 2 pm service.
[side 12] wild clover 15 grams. Decoction.
(1) There is no precise and effective treatment, early diagnosis, early treatment is important.
(2) anti-leukemia drug applications, such as methotrexate, asparaginase enzymes, pay attention to the relationship between the blood-brain barrier, especially in the spirit of suspected nerve damage should intrathecal medication. Pay attention to side effects of the drug itself, such as epilepsy and so on.
(4) To prevent infection, radiation exposure and other predisposing factors.
(5) severe infection in the rational use of antibiotics, if necessary, intrathecal injection.
2. symptomatic treatment: Because the presence of mental disorders may affect the treatment of physical diseases, physical diseases also need to improve a process, it is the start of treatment should also apply the appropriate mental drugs for symptomatic treatment is necessary. mental principles of drug treatment of mental illness with different functional, ① dose should be small. Hallucinations, delusions, excitement, agitation can choose the appropriate antipsychotic drugs, but the dose should be small. ② full consideration of drug side effects and contraindications, choice of side effects similar drugs in the lesser. consciousness when the antipsychotic to be used with caution. ③ mental symptoms after the drug should be discontinued.
3. supportive therapy: as in the main disturbance of consciousness, it would take the simultaneous implementation of supportive therapy, including energy supply, maintenance of water and electrolyte balance and vitamin supplement.
4. psychotherapy: on the basis of the above treatment should be carried out simultaneously, but generally need to ease after the acute phase or other disturbance of consciousness is restored, the patient can be accepted in the implementation. Psychological treatment as on the type of mental disorders such as depression, anxiety, fear, etc. to the individual, language interpretation, the main guarantee; for patients with symptoms of paranoid hallucinations take the interpretation of the trial, they often need to wait after the onset of drug, or patients in a little under acceptable conditions, otherwise objectionable or conflict and to refuse treatment, the results will be counterproductive; psychomotor inhibition or silence, stupor, loneliness, withdrawal, and they should strengthen the behavioral training; dementia for those left behind , personality changes psychological treatment is often with little success. However, combined application of psychotherapy in the early mental retardation and may reduce the incidence of personality change, in the Qing Han (1995) reported a controlled study, the combined therapy group, the remission rate of mental disorders 75.9%, and the remaining personality changes were 5.1%, 6.9% mental retardation, rather than combined therapy in the control group, remission rates were 69%, 10.6%, 9.8%.
Prognosis: prognosis depends on the body and severity of the disease course, the spirit left over after the resumption of most non-defective. A small number of long-term coma who may be left even personality changes or mental decline. intensive care good care of the body is directly related to the prognosis and outcome of mental disorders. Care should not only pay attention to the care of physical disease, but also make a special psychiatric care. Environmental and psychological care to help eliminate the patient's fear, anxiety, disturbance of consciousness of a patient care with particular attention to safety, to prevent its self-injury, accidental death, fall, impulsive, destruction of property, etc., for patients with depression should be guard their suicide attempts.[Examine]
with other diseases associated with mental disorders and other functional mental illness such as schizophrenia, hysteria and depression differentiated. Mainly rely on doctors obtain comprehensive medical history (including history of physical and mental illness), careful physical examination and appropriate biochemical and endocrine laboratory data for a comprehensive determination.[Disease]
mental age is less than the physiological age may be caused by the diseases?
mental age is less than the physiological age-related diseases
more other symptoms
"frozen" phenomenon "three fears" (water, sound, light 21 - hydroxy enzyme deficiency in the amount of igm antibodies increased belching SM physical scars accumulate excessive daytime sleepiness, insomnia at night to reduce the white blood cell white blood cell infiltration of leukemic cells increased signs of sepsis, galactosemia failure to keep hold of sleep disorders rage addiction overeating or passive position paranoia stolen hypochondriacal delusions
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