Mental disorders associated with epilepsy

Introduction to mental disorders associated with epilepsy People with epilepsy mental disorders have found through long-term observation that people with epilepsy are prone to various types of mental problems, affective disorders, psychosocial adaptation disorders, and personality changes. The symptoms of epileptic disorder are different and can be roughly divided into paroxysmal and non-iconic. Paroxysmal disorder manifests as feeling, perception, memory, thinking, psychomotor seizures, emotional changes, and so on. Non-onset mental disorders are manifested as psychotic disorders, affective disorders, personality changes or dementia. The etiology and pathogenesis of epilepsy mental disorders are not completely clear. Organic or structural lesions in the brain of patients with epilepsy can be the cause of epilepsy or the cause of epilepsy. In addition, at the time of seizures, the brain is hypoxic and hypoxic for a certain period of time, and abnormal discharge of certain parts causes increased excitability of brain neurons, which may affect mental behavior and lead to mental disorders. In addition, social and psychological factors also have a certain impact, patients may have a feeling of stigma, or feel isolated and helpless. basic knowledge The proportion of illness: 0.024% Susceptible people: no specific people Mode of infection: non-infectious Complications: acute renal failure schizophrenia

Causes of mental disorders associated with epilepsy

Causes of epilepsy complicated with depression

Epilepsy patients not only endure physical pain, but also endure mental torture. This article, through a survey of outpatients with epilepsy, found that 25% of people have depressive symptoms, causing or affecting epileptic patients with many causes of depression.

(1) One-sided understanding of epilepsy, lack of relevant knowledge, is considered to be incurable disease, long-term medication, epilepsy patients due to disease for many years, long-term unhealed, loss of confidence in treatment, loss of fun in life, think of seizures The symptoms are embarrassing, and the feeling is that it is unacceptable and inferior.

(2) Difficulties in finding employment and finding objects, family disharmony, and interpersonal relationships are tense.

(3) The economic burden is too heavy. Patients seek cure, seek medical attention everywhere, and try various methods to bring serious economic burden to the family.

(4) Insufficient attention to psychotherapy, doctors only pay attention to the therapeutic effect of drugs on patients with epilepsy, ignoring the adverse effects of social psychological factors on the disease. ;

(5) Individual psychological quality, general introversion, and more open-minded patients.

Prevention of mental disorders associated with epilepsy

General care

Place the patient in the intensive care unit and check the patient's oral cavity for active dentures. If the denture should be removed, the patient should avoid wearing glasses to prevent falls and cause trauma, strengthen the inspection, and discover the seizures in time.

Take necessary measures to avoid predisposing factors, including induced excessive drinking, eating, drinking, constipation, poor sleep, emotional excitement, air sultry, strong sound and light stimulation, sudden stop taking anti-epileptic drugs.

Pay attention to the observation of the condition. When the patient complains of chest tightness, numbness of the limbs, smell of unpleasant smell, emotional changes and illusion, immediately slumber the patient and prepare the patient for sudden loss of consciousness.

Encourage patients to develop good habits, regular work and rest, defecation, avoid constipation, overwork and fatigue, diet should be light, reduce glare.

Carefully implement the drug treatment requirements and nursing routines, observe the drug response, follow the doctor's advice, and dose according to the dosage, to ensure that the patient will take the drug, and observe the side effects of the drug after medication, including the presence or absence of ataxia, lethargy, dizziness, and avoid sudden Stop the drug and change the dressing to avoid the onset of epilepsy.

Family support, patients should be visited frequently during hospitalization so that patients can enjoy the warmth of the family. The patient's home care should pay attention to urge the patient to take the medicine, care about the patient's condition change, and reduce the irritability of the patient to prevent the disease from repeating.

Symptomatic care:

Care for epileptic seizures:

1. Place the patient in the same place and quickly place the dental pad between the upper and lower molars to prevent biting the tongue. In case of emergency, use the corner and towel instead, but do not fill the entire mouth to avoid breathing.

2, loosen the collar, belt, protect the jaw and limbs.

3. Turn the patient's head to one side after stopping the convulsion to prevent the saliva from being inhaled into the trachea.

4, observe the recovery of breathing, if the respiratory recovery is not smooth, face cyanosis, should immediately take artificial respiration, give oxygen, if necessary, use respiratory stimulants.

5, check the patient for fracture and dislocation, the patient rests in bed, guardian guard, protect the patient to prevent falls, continue to observe whether the patient has signs of sustained attacks, and change the underwear for patients with incontinence.

Care for status epilepticus :

If convulsions continue to cause circulatory failure, respiratory disorders, electrolyte disturbances, and life-threatening, immediate rescue should be terminated. In the process of coping with the rescue, the nurse should:

1, special care, close observation of the condition, detailed record of the frequency of seizures, the duration of each episode and intermittent time, pay attention to changes in vital signs.

2, keep the airway unobstructed, prevent hypoxia, the patient's head turns to one side, the oral secretions are discharged, sucking at any time, and finding that breathing is difficult to do artificial respiration in time.

3, high fever patients give physical cooling.

4. Ensure the implementation of various treatments.

5, protect the limbs to do basic care.

6. After 24 hours of seizure control, nasal feeding mixed milk can be given according to the patient's consciousness.

Care for epileptic seizures :

Pay attention to frequent episodes of frequent episodes, pay attention to service attitudes and words and deeds, listen patiently to the patient's narrative, and do not argue with them. Don't expose ignorance and boredom, don't force patients to do things they don't want to do, pay attention to the patient's unreasonable demands. Ways, patient interpretation so that patients can accept as much as possible, care about their work and life, appropriate arrangements for recreational activities, find that patients with low mood must be closely observed to prevent suicide, do all basic care, prevent various complications.

Main nursing problems of mental disorders caused by epilepsy :

1. The possibility of suffocation may be related to apnea caused by forced contraction of the respiratory muscles.

2, there may be a fall or bite the tongue muscle may be related to sudden loss of consciousness loss; associated with the sudden closure of the masticatory muscle contraction.

3, there is a serious destruction, attacking the wounded may be related to psychomotor excitement awareness, illusory delusions or long-term seizures leading to personality changes.

4. There is a possibility of accidental danger.

5. The possibility of suicide is related to the sudden depression and pessimism of patients with epilepsy.

Complications of mental disorders associated with epilepsy Complications acute renal failure schizophrenia

Often complicated by acute renal failure, a variety of mental illness.

Symptoms of mental disorders associated with epilepsy Common symptoms organic mental disorders mental disorders eating autopsy irritability after seizures mental disorders paroxysmal sorrows caused by somatic diseases... seizures between mental disorders, mental disorders, frontal lobe epilepsy "hit...

Pre-existing mental disorder

Mainly refers to the aura and prodromal symptoms of seizures.

(1) Aura refers to the occurrence of epilepsy a few seconds or minutes before the onset of tonic-clonic seizure. It is of great value in determining the localization diagnosis of epileptogenic focus. The aura is often the beginning of epileptic discharge, and the origin of the dominant hemisphere language center may have Aphasia; parietal lobe episodes may have numbness, tingling or hot and cold sensation; the posterior occipital lobe may have a body image disorder, a heavy or small limb, a sense of separation, occasional limb contraction or phantom limbs; There may be visual disturbances in the onset. The temporal lobe episodes may have a variety of complex auras. The above abdominal discomfort is the most common. The typical manifestations are stomach discomfort and even pain. There may be symptoms of autonomic nervous function changes, symptoms of perceptual disorder, and emotions. Cognitive symptoms. The typical aura of the onset of the temporal temporal lobe is illusory scent, illusion, and can be accompanied by pouting, chewing, and swallowing.

(2) Prodromal symptoms refer to mental abnormalities that occur several days to several hours before the onset, mainly characterized by irritability, nervousness, irritability, depression, frequent pick-up or complaining about others. These symptoms often indicate that seizures will occur soon.

2. Mental disorder at the time of attack

Mainly refers to psychomotor seizures. Some people think that its hair is caused by temporal lobe lesions, also known as temporal lobe epilepsy. include:

(1) Epilepsy is a state of confusion that occurs during or after a seizure, during which the patient can perform simple or complex actions and behaviors, but is unaware of what he or she is doing. There are often auras before the onset of autopsy, such as dizziness, salivation, chewing movements, somatosensory abnormalities and strangeness. Automated behaviors are diverse, some of which are characterized by sluggish expressions, such as stereotypes or groping actions such as continually pouting and pulling an object, and more complex behaviors such as pacing in the room, moving items, etc. You can even engage in complex technical work that you are used to. Automated symptoms last from a few seconds to a few minutes, and occasionally more than an hour. Each time the symptoms are similar, the patient is completely forgotten about what happened during this time. Automated disease is mainly related to the spontaneous electrical activity of the temporal lobe. Sometimes the discharge of the frontal lobe, the cingulate gyrus and the cortex can also produce an automatic disease.

(2) The phenomenon of safari is rarer than automatic disease, which can last for hours, days or even weeks. The degree of disturbance of consciousness is relatively light, the abnormal behavior is more complicated, and it has a certain ability to perceive the surrounding environment, and can also respond accordingly. It is characterized by no-destination roaming, patients can travel far, and can also engage in coordinated activities, such as shopping, simple conversation. Forgotten or recalled after the attack.

(3) The seizure state suddenly occurs, usually lasting for 1 to several hours, sometimes for up to 1 week. Patients present with disturbances of consciousness, accompanied by emotional and sensory impairments, such as horror, anger, etc., can also be expressed as apathy, thinking and slow movements.

(4) Special sensory seizures, which are hallucinations and illusions. Odor hallucinations are often unpleasant and unpleasant smells; taste hallucinators taste bitter; visual hallucinators can have simple flashes or complex videos. You can also see things become bigger, smaller, etc.; you can hear noise, voice or music when you hear the hallucinations.

(5) visceral sensory seizures, the most common is abdominal or chest gas rise, but also palpitations, abdominal pain, bowel and so on.

(6) Memory disorders, usually like a sense of familiarity, strangeness or environmental distortion.

(7) Attacks of thinking disorders, such as forced thinking.

(8) Emotional disorders, fear, anger, depression, etc. during the attack.

3. Post-onset mental disorders

After seizures, they often present with confusion, disorientation, and unresponsiveness. They can also have vivid hallucinations and various autonomic symptoms. There are also emotional outbursts, such as panic, irritability, and incitement to violent behavior, which usually lasts from several minutes to several hours.

4. Interictal mental disorder

It refers to a group of mental disorders that occur during the episodes of epileptic seizures. Mental disorders that occur during the epileptic seizure may be the result of brain damage caused by psychosocial factors, abnormal EEG activity, and seizures. In patients with complex partial seizures (temporal lobe epilepsy), the incidence of mental disorders is high. The more common intermittent mental disorders are personality changes, schizophrenic symptom groups and affective disorders.

(1) Epileptic personality change is the result of multi-factor combination. It is generally considered to be related to the effects of psychosocial factors, brain organic damage, type of seizures, long-term use of anti-epileptic drugs, and pre-existing personality characteristics. Expressed as stubborn, self-centered, entangled, thinking stagnation, pathological narrative, good controversy and temper. Excited, impulsive, self-inflicted, and self-inflicted when the emotions erupt. Some can have a variety of personality disorders and antisocial behavior. Personality changes are more common in patients with temporal lobe epilepsy. About 50% of patients with temporal lobe epilepsy can develop severe personality disorder. Left temporal lobe lesions are more likely to have personality disorder and aggressive behavior than right temporal lobe lesions.

(2) Acute schizophrenic psychosis is also known as transient schizophrenia. The clinical symptoms are often nervous, uncooperative, psychomotor excitement, hallucinations, delusions, and normal orientation. Psychiatric symptoms can last for days or weeks, during which seizures mostly stop. Most patients can recall the situation at the time of onset after the relief of mental symptoms, and a small part of the performance is forgotten.

(3) Chronic schizophrenic psychosis, part of epilepsy patients after repeated episodes of seizures, under the clear consciousness, associative obstacles, compulsory thinking, scams and auditory hallucinations, and other similar paranoid schizophrenia symptoms, known as chronic epileptic schizophrenic psychosis (chronic epileptic schzophteniform psychosis). At this point, the patient's seizure has been reduced or stopped, and the mental symptoms can last for months or years. It is thought that it may be related to folic acid metabolism disorder caused by long-term anti-epileptic drugs.

(4) Epileptic affective disorder

1 pathological mood is bad. For periodic emotional changes, such as irritability, depression, nervousness, hostility, irritability, or aggressive behavior. Severe episodes resemble affective mental disorders, but lack the joy and appeal of mania, and there are no symptoms such as association increase, thinking and running.

2 manic depression-like mental disorders. Epilepsy with manic state is rare, with depression is more common, bipolar disorder is more common in right temporal lobe epilepsy, electroconvulsive treatment is good or terminated after a major episode. The occurrence of depression is related to social psychological factors and abnormal electrical activities. The suicide rate of epilepsy patients with depression is significantly higher than that of ordinary people. The risk of suicide is about 5 times that of normal people, and most of them are temporal lobe epilepsy.

(5) epileptic dementia

A small number of patients with epilepsy can experience significant mental decline. It is more common in patients with epilepsy, temporal lobe epilepsy and severe epilepsy secondary to brain damage. Among the different types of epilepsy, the authors of frequent hair loss had the most serious intelligence damage, and the incidence of dementia and mental disability rate were the highest.

(6) Epileptic neuropathy syndrome

The most common are depression and anxiety states, as well as snoring-like reactions.

Examination of mental disorders associated with epilepsy

In addition to detailed medical history, physical and electroencephalographic examinations and EEG are very important. If necessary, CT, MRI and SPECT examinations can be performed, and dilated brain atrophy can be found by gas cerebral angiography or CT and MRI.

Diagnosis and diagnosis of mental disorders associated with epilepsy

diagnosis

CCMD-3 ("China Mental Disorders Classification and Diagnostic Criteria 3rd Edition") Diagnostic Criteria for Organic Disorders:

Symptom standard

1. Have evidence of body, nervous system and laboratory tests;

2. There are encephalopathy, brain damage, or physical illnesses that can cause dysfunction, and one of the following items is rare:

(1) Intelligent damage syndrome,

(2) Forgetting syndrome,

(3) Personality changes,

(4) disturbance of consciousness,

(5) psychotic symptoms (such as hallucinations, delusions, nervousness 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.).

Serious standard

Daily life or social function is impaired.

Disease standard

The occurrence, development, and course of mental disorders are associated with primary organic diseases.

Exclusion criteria

Lack of sufficient evidence that mental disorders are caused by other causes, such as psychoactive substances.

Diagnostic criteria for CCMD3 epilepsy-induced mental disorders:

Symptom standard

1. Comply with the diagnostic criteria for organic mental disorders,

2. Evidence in primary epilepsy,

3. The occurrence of mental disorders and their course of disease are related to epilepsy.

Serious standard social function is impaired.

The course of disease is divided into two types of disease: seizure and persistence. The former has the characteristics of suddenness, transientness, and recurrent episodes. The latter (such as schizophrenia-like disorder, personality change, or intelligent damage) is a protracted course.

Exclusion criteria

1, to rule out mental disorders caused by infection or poisoning, need to pay attention to them can produce secondary epilepsy.

2, exclude snoring, sleepwalking, schizophrenia, affective disorder.

Differential diagnosis

1. Syncope, loss of consciousness and fall caused by transient ischemia of the whole brain, slow onset and recovery, most of them have certain organic causes, may have dizziness, black eyes, nausea or cold sweat at first. . After waking up, there are often cold limbs and fatigue.

2. The onset of snoring, often have certain emotional factors, often there are others present, exaggerated color, crying, kicking and kicking, gradually falling without injury, normal face, no bite tongue, blood foam, long attack time, After comforting or suggesting, you can recall the attack.

3. Migraine, which can be differentiated from partial seizures in visual aura, hemiplegic or aphasia in migraine patients. The neurological symptoms of migraine develop more slowly, often lasting for a few minutes or more.

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