Mental disorders caused by medical drug poisoning

Introduction to mental disorders caused by medical drug poisoning Among the mental disorders caused by medical drug poisoning, emphasis is placed on adrenal cortex hormones, anticholinergic drugs, snake root grass preparations, anti-tuberculosis drugs, oxytetracycline and chloramphenicol, mipirin (Apipine), bromine preparations, and barbie. Mental disorders when properly poisoned. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: mental disorders

Causes of mental disorders caused by medical drug poisoning

(1) Causes of the disease

1. Mental disorders caused by adrenocortical hormone poisoning: The literature reports that mental disorders often occur when the duration of treatment is short, such as within a few days or within 2 months, there have been reports of the onset after the first injection, Most authors believe that the severity of mental symptoms is not related to the total amount and duration of treatment, but that individual differences in pre-existing personality characteristics, past mental history and physical function status are important factors.

2. Mental disorders caused by anticholinergic drugs: anticholinergic drugs such as atropine, belladonna, scopolamine, anisodamine, 654-2, etc., folk treatment of rheumatic fever, bronchial asthma, joint disease, etc. The windflower flower, the mandala flower) also belongs to this kind of medicine, and the cause of poisoning is multi-service or mis-service.

3. Mental disorders caused by poisoning of snake root grass preparation: snake root grass is a colorless crystalline alkaloid, which has the function of inhibiting sympathetic nerves. It is used clinically to treat hypertension and mental illness. ), antihypertensive, compound antihypertensive, compound antihypertensive tablets, indapamide (Shoubishan) and other antihypertensive drugs all contain snake root alkaloids, some people think that the elderly, hypertension, arteries Sclerotherapy and those who have had depression in the past are prone to mental disorders, and the dose of mental disorders varies from person to person. It has been reported that when taking a total amount of 8 mg (0.75 mg per day), it can cause obvious mental disorders; At the time, the total amount reached several hundred milligrams (3 to 8 mg per day), but did not cause toxic mental symptoms.

4. Mental disorders caused by anti-tuberculosis drug poisoning: Among various anti-tuberculosis drugs: isoniazid, cycloserine and ethionamide can cause central nervous system toxicity and significant mental abnormalities. Isoniazid is a commonly used anti-tuberculosis drug. Domestic and foreign scholars believe that the occurrence of central nervous system poisoning symptoms does not have much to do with drug dosage. It is also suggested that psychiatric symptoms are more likely to occur when using larger doses or intraspinal injections. It is generally believed that there are epilepsy, mental illness, apparently unstable personality, genetic quality, chronic alcoholism and advanced arteriosclerosis, and severe neurological complications are likely to occur after administration.

5. Mental disorders caused by mipalin (Azepine) poisoning: Mipalin is generally used to treat malaria, amebiasis, ascariasis, etc. This medicine absorbs quickly, but discharges slowly, about 90% of which is accumulated in In the organization, it will still cause poisoning after stopping the drug. The mental disorder is only one kind of toxic reaction. The dosage varies from person to person. It is reported to be generally 0.6-4.0g. The injection has more mental disorders than oral administration. In the course of taking the drug or within 1 or 2 weeks after stopping the drug.

6. Mental disorders caused by bromine poisoning: bromine preparations are widely used as sedative drugs. In recent years, due to the increase of anti-anxiety drugs, the application of bromine agents has decreased, so bromine poisoning is also rare. The inhibition of bromine is bromide ion. The role of the clinical use of simple bromine salts such as sodium bromide, bromine absorption in the stomach is very fast, but the kidney is very slow, long-term use can cause accumulation, bromide ions and ammonia ions are often balanced in the body, Heart, kidney disease patients with long-term consumption of salt or salt-free diet, bromine is more likely to accumulate, the possibility of poisoning is greater, because long-term use of larger doses of bromide, especially in the diet of insufficient sodium chloride or kidney In dysfunction, bromine poisoning is more likely to occur. According to the literature, bromine poisoning and advanced neurological activity status and physical health status, such as arteriosclerosis, menopause, and frail age, are reported in foreign literature. 6 cases of mental disorders caused by bromine poisoning Three of them were members of a family of doctors who accidentally took sodium bromide (NaBr) as salt (NaCl) and died of poisoning for 3 months. The doctor died in a severe state of paralysis. His wife After a serious sputum, he was discharged completely and healthily. His son had a serious paranoid state, but his consciousness was clear and he recovered his health within a few weeks. This case shows that the age and body reaction are different due to differences in individual qualities. It is also different, so 3 people have experienced different clinical phases and the outcomes are different.

It is generally believed that when the blood bromine content reaches 100-150mg% or more, early poisoning can occur. When the blood bromine content reaches 200mg% or more, the mental disorder is more significant. According to Zhang Jizhi (1958), nearly 2000 mental patients in 3 years. In the middle, the psychiatric symptoms appeared within 5 to 9 weeks after taking the drug, and 4 cases of bromine-poisoning psychosis were diagnosed. The blood bromine content was above 200 mg%, and one case was as high as 500 mg%.

7. Mental disorders caused by barbiturate poisoning: Barbiturates are used in clinical sedative and hypnotic drugs. They have been widely used. Barbital has many derivatives, and its hypnotic effect is strong. The rate of excretion and toxicity are different, and it is poisoned due to overdose or other reasons.

(two) pathogenesis

1. Mental disorders caused by adrenocortical hormone poisoning: The pathogenesis is still unclear. It has been observed that the symptoms of this mental illness are similar to those caused by Cushing disease. Therefore, it is believed that taking corticosteroids can cause excessive body fluids, resulting in changes in brain function. However, some people think that it is related to corticosteroid-induced electrolyte disorder or metabolic disorder. According to laboratory data, some patients taking ACTH or cortisone have 5-7 times/s mild slow wave EEG activity. Prove that hormones have a certain effect on brain function.

2. Mental disorders caused by poisoning of snake root grass preparations: the common dosage form of saponin is risperidone. These drugs can lower the central nervous system norepinephrine, dopamine and serotonin levels, and the serotonin makes the central nervous system The system's monoamine neuromedity storage capacity is reduced, which is the biochemical pathological basis for the development of depression.

3. Mental disorders caused by anti-tuberculosis drug poisoning: Isoniazid caused by anti-tuberculosis drugs caused by mental symptoms. The direct cause is due to the deficiency of B vitamins caused by isoniazid, especially tobacco acid and vitamin B6. Most scholars have The process is considered to be the result of "competitive inhibition" because isoniazid is chemically similar to tobacco acid, and tocopherol is a raw material that constitutes coenzymes I and II in the body. Therefore, isoniazid competes with tobacco acid in the body. When the amount of isoniazid increases and the amount of tobacco acid decreases, isoniazid inhibits tobacco acid; instead, it becomes a component of coenzymes I and II. This coenzyme I and II are not true coenzymes and cannot assist cells to complete. Redox reaction, thus producing tobacco acid deficiency, such as Lagra disease, neuritis, psychosis, etc. At the same time, it also inhibits the coenzyme necessary for tobacco acid to complete cell metabolism in the body and causes mental symptoms, the chemical structure of vitamin B6 Similar to isoniazid, it also produced competitive inhibition. Isoniazid inhibited the normal metabolism of vitamin B6 in the body, causing 6 deficiency targe t=_blank> Vitamin B6 deficiency, which causes mental symptoms, and some scholars believe that the inhibition of catecholamine metabolism is caused by the inhibition of monoamine oxidase by drugs.

Cycloserine is commonly used in tuberculosis patients who are resistant to tuberculosis drugs. Some people think that because of the strong decomposition of tuberculin by cycloserine drugs, the patient's skin tuberculosis reaction is extremely positive after using a certain amount of drugs. It is an allergic reaction, and some people think that it is caused by drug toxicity. Some people reported that 1 g per day of cycloserine was used, and toxic reaction accounted for 44%. If 0.5 g was used as 15% per day, most of the toxic reactions appeared 10 to 12 days after administration. Reported within 34 days, the mechanism of toxicity is not yet certain.

Prevention of mental disorders caused by medical drug poisoning

This class of drugs should be protected against abuse and strengthen drug management. When using drugs, pay attention to doses should not be too large, prevent excessive, pay attention to prevent iatrogenic abuse, and at the same time popularize drug knowledge to prevent accidental eating.

Barbiturate poisoning

(1) The dose should be strictly controlled. If intravenous bolus administration is required, the dosage should not be too large, and the speed should not be too fast.

(2) When adults and children take this class of drugs for a long time, they should pay attention to the accumulation of poisoning caused by such drugs.

(3) Patients with liver and renal insufficiency are advised not to use this type of medicine; if necessary, it should also be used with caution.

(4) For mentally ill patients, do not let them take their own medicine; family members or medical staff give it according to each dose, see it under the service, in the case of depression, sensitive to barbiturates, the dosage should be reduced.

(5) This class of drugs should be used together with other central inhibitors, and the dose should be reduced.

(6) After drinking alcohol, especially those who are suffering from alcoholism, this type of medicine is prohibited.

2. Phenytoin sodium

(1) long-term application of phenytoin, must be prescribed according to the prescribed dose, if necessary with other anti-epileptic drugs, but it must be noted that if phenytoin is initially administered, if phenobarbital is suddenly removed, seizures may be more frequent; It is necessary to gradually eliminate phenobarbital after phenytoin has formed an appropriate concentration in the brain.

(2) The starting dose should not be too large, the dose increase should not be too fast, and the intravenous injection speed should be slow.

(3) In the application process, if there are more important side effects, the dose can be reduced. If the seizure cannot be controlled, the dose will be gradually increased after several days, and the poisoning reaction does not necessarily reappear.

(4) Liver disease, sensitive patients for this drug, etc., must be used with caution.

(5) methylphenidate (Ritalin), high-dose aspirin can enhance the effect of phenytoin, the same dose should be reduced.

3. Chloral hydrate

(1) The medication should be prescribed according to the prescribed dose.

(2) Some patients who need to apply sedative or hypnotic drugs for a long time should preferably alternate with other sedative drugs.

(3) Alcohol and chloral hydrate have synergistic effects and cannot be applied at the same time.

(4) When a monoamine oxidase inhibitor is applied, the chloral hydrate effect can be increased, so that the latter dose should be reduced as appropriate.

(5) At the same time oral anticoagulant, it should be noted that chloral hydrate has weakened anticoagulant effect.

4. Chlorpromazine prevention

(1) Master the indications and do not abuse them.

(2) Applying such drugs to mental patients, so they are in control of their families.

(3) For long-term use, the blood must be closely observed and regularly checked.

(4) When applying this medicine, it should be lying for more than a few hours, and pay attention to the following items:

1 such drugs such as general anesthesia (including alcohol), anticholinergic drugs such as atropine, antipyretic analgesics, antihypertensive drugs, anti-shock drugs such as levodopa should be used with caution, and should control the dose.

2 Do not use these drugs at the same time when using insulin, phenformin (hypoglycemic) or sulfonylurea, as it may cause jaundice and abnormal liver function.

3 This class of drugs is used with caution with piperazine (exterminus), because of the appearance of extra-cone symptoms.

4 due to the hypotension caused by this class of drugs, banned epinephrine, metobutylamine (recovery pressure) as a booster.

5. Stabilizing poisoning

The chemical name of diazepam is benzodiazepine:

(1) Strictly control the indications, dosage and duration of medication.

(2) Infants, with a history of glaucoma and patients with myasthenia gravis abstained.

(3) This product can enhance the action of chlorpromazine and monoamine oxidase inhibitors (such as pargilin), so it should not be used together.

Complications of mental disorders caused by medical drug poisoning Complications

Mental disorder.

Symptoms of mental disorders caused by medical drug poisoning Common symptoms Anesthetic poisoning Suspicious manic sensation disorder Irritability Irritability Excitement Nightmare ataxia response Slow and sorrowful

1. Mental disorders caused by adrenocortical hormone poisoning

Psychotic disorders caused by adrenocortical hormones are rare in clinical practice. After taking adrenal cortex hormones, patients generally have more onset of illness and a shorter course of disease. The main clinical manifestations are:

(1) Mental symptoms:

1 affective disorder, is a more prominent symptom, such as euphoria, irritability, nervousness, emotional instability, etc., the patient actively describes the pathological experience, the emotional response is clear, showing a state of light mania, many authors believe that euphoria is due to the cortex The direct effect of hormones is also one of the characteristics of this disease, and there are fewer clinical manifestations of depression.

2 disturbance of consciousness, manifested as mild disturbance of consciousness, the patient's time orientation is incomplete, the response to the outside world is slow, and there are rich hallucinations. Some patients have no consciousness disorder at the time of mental symptoms, and some are forgotten after the condition improves. .

3 delusional state or illusion delusion state, mostly the illusion of a piece, the content is mostly persecution, and some patients have hallucinations, which are regarded as common. If you see the body, there are many bugs on the bed, some have magical touches, such as feeling Someone stabbed his body, sucked his blood, and expressed fear and anxiety.

4 Excited state, the patient can be expressed as speech excitement, content disorder, noisy, fear or anger.

The characteristics of the above mental symptoms are one. The symptoms are fluctuating. If some patients have relationship suspicion and suspicion, emotional, often self-injury, loss of self-knowledge, symptoms can rise and fall several times within a few days. Self-knowledge is sometimes restored, sometimes lost; second, the symptoms are easy to change, such as the patient's transition from delusional state to slow thinking, followed by euphoria, and some patients begin to change from a paradoxical relationship to a slow response, followed by performance Rich illusion of delusion, accompanied by speech excitement, rapid changes in symptoms, and suddenly, can be differentiated from schizophrenia.

(2) Somatic symptoms:

Visible full moon face, increased hair, purple skin and centripetal obesity.

2. Anti-cholinergic poisoning caused by mental disorders, the most common disturbances, such as lethargy, convulsions, coma and other levels of consciousness, illusions, hallucinations, such as confessing people, seeing vivid and vivid objects, caused by such drugs Sympathetic excitation, parasympathetic inhibition, manifested as inhibition of secretion, dry mouth, thirst, dilated pupils, blurred vision, headache, facial flushing, respiratory pulse acceleration, elevated blood pressure and fever, etc., severe cases may have convulsions, coma .

3. Clinical manifestations of mental disorders caused by poisoning of snake root grass preparations

(1) Psychiatric symptoms: mainly anxiety and depression, patients with low mood, frowning, anxiety, reduced movement, some irritability, fear; some self-blame and even attempted suicide, most patients are aware.

(2) physical symptoms: the patient feels headache, dizziness, fatigue and weakness, individual patients may have diarrhea, angioedema.

4. Mental disorders caused by anti-tuberculosis drug poisoning

(1) Isoniazid poisoning:

1 mental symptoms:

A. Disorder of consciousness: more common, with different levels of consciousness disorder, can be mildly blurred, turbid, stunned and even coma, accompanied by rich and horrific illusions, such as seeing viper, beast, dead Image; hearing the threat or filthy auditory hallucinations, the patient is afraid of it.

B. Illusion delusion state: the patient has clear consciousness, obvious auditory hallucinations, self-intentional delusions and victimization delusions.

C. Kosakov syndrome: memory loss, fiction, disorientation, and misjudgment.

D. Stupor state, manic state, depression state and brain weakness state.

2 nervous system symptoms and signs:

A. Peripheral nerve: peripheral nerve changes mainly caused by sensory disturbances, often manifested at the extremities of the limbs, such as allergies, numbness, burning of the soles of the feet, paresthesia, etc., knee reflexes are reduced or disappeared, and in severe cases, muscle paralysis , tremors and even muscle atrophy.

B. Most seizures are big seizures.

C. Autonomic dysfunction: dry mouth, constipation, impotence, dysuria and skin discoloration, nutrition, temperature and sweating and other obstacles.

3 vitamin deficiency dermatitis, increased glossitis of the tongue and capillaries, leukopenia and so on.

(2) Cyclic serine poisoning:

1 mental symptoms:

A. Brain weakness syndrome, such as memory loss, inattention, insomnia, vertigo, dizziness.

B. Disorder of consciousness, sleepiness, confusion, and embarrassment.

C. Desperate state, the patient is suspicious, self-incriminating and victimized.

D. Manic state, the patient's performance is more exciting, especially with sexual function hyperactivity.

2 neurological symptoms and signs: convulsions, convulsions, etc. on the fingers, sputum reflexes during examination.

5. Mental disorders caused by poisoning of oxytetracycline and chloramphenicol In recent years, psychiatric symptoms caused by oxytetracycline poisoning are rare, and poisoning caused by chloramphenicol is sometimes seen.

(1) Psychiatric symptoms: The general incidence is more acute, the following are common:

1 brain weakness syndrome: early patients may have dizziness, insomnia, upset, emotional excitement, fear, anxiety and so on.

2 Illusion state: It occurs more often when the condition is aggravated. Phantom is more common. For example, you can see small animals or insects on the ground crawling on the body, or see the scene with more horror.

Three types of manic state: increased patient activity, more exciting.

4 disturbance of consciousness: in severe cases, it can produce paralysis and coma.

(2) Neurological symptoms and signs: visible tongue, lips, finger tremors.

6. Mental disorders caused by mipalin poisoning

(1) Psychiatric symptoms: occur more urgently, the following performance is common:

1 brain weakness syndrome: Some patients may have some pioneer symptoms such as headache, fatigue, insomnia and emotional instability.

2 types of manic state: the most common characteristic symptoms when the symptoms are obvious. Most patients have increased speech, clear content, and are associated with the environment, with increased emotions, increased movements, nosy, interference with others' actions or Unreasonable quarrels, sometimes incitement, destruction, etc., similar to the manic state of bipolar disorder, the difference is that the amount of speech is increased, but the content is not rich, Lenovo is not fast, sometimes self-talk, and often tired When you have been in contact with the patient for a long time, you may find irritability. The above words, movements, and emotional increase are not closely coordinated, and there may be intermittent periods. At this time, the symptoms may be relieved for tens of minutes to several hours. The early days were most obvious.

Three types of depression: Sometimes the patient shows less movement and the mood is low.

4 disturbance of consciousness: there may be disturbances of consciousness ranging from mild to severe, and in severe cases, paralysis and coma.

5 schizophrenia-like symptoms: hallucinations, delusions, content is not fixed.

(2) The body includes symptoms and signs of the nervous system: there may be headache, dizziness; the skin is yellow but the sclera is not yellow; the pulse is accelerated; it may be accompanied by fever and hepatosplenomegaly, and there may be increased white blood cells and urine in the urine. Palin.

7. Mental disorders caused by bromine poisoning

(1) Mental symptoms:

1 brain weakness syndrome: When early poisoning is light, dizziness, insomnia, nightmares, inattention, memory loss, fatigue, weakness, understanding, obscurity, indigestion, dry skin and impotence are common.

2 disturbance of consciousness: When the poisoning is heavier, there is confusion, and in severe cases, paralysis or coma occurs.

3 Illusion delusion state: mostly unfixed delusions, mainly based on victimization, and more closely related to hallucinations. Illusion is more common in auditory hallucinations and illusions.

4 Some people have reported cases of manic depressive psychosis.

(2) Neurological symptoms and signs: tremors of the tongue, lips, hands, etc., unclear articulation, ataxia, gait instability, hyperreflexia, dilated pupils, weakened response to light, etc.

In addition, there is a rash on the forehead, face and chest and back, especially acne-like rash, swollen salivary glands, sweet smell in exhalation, yellow-brown thick moss on the tongue, constipation, or urination retention, increased bromine content in blood and urine. .

8. Mental disorders caused by barbiturate poisoning

(1) Psychiatric symptoms: Acute poisoning is mostly caused by misuse or suicide. It is mainly caused by disturbance of consciousness. It can be comatose by turbidity. If it is not rescued in time, it can die. A large amount of continuous taking of accumulated poisoning causes mental disorders, such as In the process of drug sleep therapy, obvious mental symptoms can often occur. When the poisoning is light, the excitability is increased, the speech is increased, the movement is increased, the ataxia is unclear, the articulation is unclear, and the expression is euphoric, similar to the drunkenness. " state", when heavier, he can be ambiguous, and have illusions, hallucinations (illusion, hallucination, magical touch), which can cause toxic stuns and even coma in severe cases.

(2) Neurological symptoms and signs: nystagmus, tremors of the hands and lips, decreased muscle tone, decreased or absent sputum reflexes, and positive urinary barbiturate.

Examination of mental disorders caused by medical drug poisoning

According to the psychiatric symptoms caused by different drugs, the positive detection result of the drug can be seen in the blood and urine of the patient.

Diagnosis and diagnosis of mental disorders caused by medical drug poisoning

diagnosis

The diagnosis of mental disorders caused by all drug poisoning must first have a history of the use of related drugs, followed by the time of use of the drug, the generation of psychiatric symptoms related to the dose, as follows:

1. Mental disorders caused by adrenocortical hormone poisoning

(1) There is a clear history of the application of adrenocortical hormones, and it can be determined that mental disorders are caused.

(2) Physical or psychological symptoms such as poisoning, psychotic symptoms, affective disorders, neurological symptoms, intellectual disorders, amnesia syndrome, and personality changes.

(3) Impaired or lost social function.

2. Mental disorders caused by anticholinergic poisoning

After the application of anticholinergic drugs, mental disorders occur, and the mental disorder can be determined, and the diagnosis can be confirmed.

3. Mental disorders caused by poisoning of snake root preparations

Due to the lack of prominent specific signs of poisoning, the reserpine poisoning should pay attention to the medication and the history of mental illness.

4. Mental disorders caused by poisoning of oxytetracycline and chloramphenicol

Mental distress occurs after the application of the combination of oxytetracycline and chloramphenicol, and the mental disorder can be determined, and the diagnosis can be confirmed.

5. Mental disorders caused by mipalin poisoning

A mental disorder occurs after excessive application of mepacrine, and a mental disorder can be determined, and a diagnosis can be determined.

6. Mental disorders caused by bromine poisoning

A mental disorder occurs after excessive application of the bromine agent, and the mental disorder can be determined, and the diagnosis can be confirmed.

Differential diagnosis

1. Psychological disorders caused by adrenal cortical hormone poisoning: According to the characteristics of psychotic symptoms caused by adrenocortical hormone poisoning, the symptoms are fluctuating and the symptoms are easy to change and can be differentiated from schizophrenia.

2. Mental disorders caused by poisoning of snake root grass preparations: should be differentiated from bipolar disorder, reactive psychosis and menopausal depression.

3. Mental disorders caused by anti-tuberculosis drug poisoning: all are caused by the application of anti-tuberculosis drugs: isoniazid, cycloserine, and mental disorders can be determined, and the diagnosis can be confirmed.

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