Deterioration of psychomotor activity

Introduction Psychomotor activity deteriorates: There are two subtypes based on changes in psychomotor activity. The low-activity subtype is characterized by slow mental movement and awakening of the patient's sleepiness. Overactive subtypes are often overly alert and agitated, and have excessive activity of autonomic nervous outreach. In addition, overactive subtypes most often have delusions and sensory disturbances such as hallucinations. About half of the patients are mixed, with two subtypes of ingredients or fluctuating between types 2.

Cause

Common causes classification:

1. Metabolic disorders: the most common cause of convulsions. Fortunately, most of the acquired metabolic disorders can be screened out by physical examinations and laboratory tests. Some conditions (especially hypoxia and hypoglycemia) must be considered immediately because they can be life-threatening and leave a lasting sequela. Also pay attention to dehydration, water and electrolyte disorders. Calcium and magnesium disorders, rapid changes in electrolyte levels, are also an important factor in the development of earthworms compared to their absolute values. For example, some people can tolerate a chronic sodium level of 115 mmol/L or less, but if it falls to this level quickly, it can contribute to sputum, seizures, or central medullary myelin. Low perfusion caused by cardiac output or heart failure is another common cause of delirium. Also pay attention to the failure of other major organs, such as liver and kidney failure, including the possibility of some uncommon causes; such as undetected portal vein short circuit, acute pancreatitis that releases fatty acids, and sputum caused by endocrine dysfunction Common prominent emotional symptoms such as hyperthyroidism and Cushing syndrome. The sputum is caused by toxins, including industrial agents, pollutants, heavy metals such as lead, mercury, antimony, arsenic, gold, antimony and zinc. Other things to note are congenital metabolic abnormalities such as acute intermittent porphyria. Finally, it is particularly important to pay attention to the lack of thiamine (vitamin B1). For patients with alcoholism and other suspected thiamine deficiency, thiamine injection must be given immediately to avoid the induction of Wernicke encephalopathy due to the use of glucose.

2. Drug poisoning and withdrawal: it is also the most common cause of convulsions. In particular, it can occur in drugs with anticholinergic properties, including many drugs that can be purchased without a doctor's prescription, antihistamines, antidepressants, antipsychotics, and anticholinergic drugs. Pupil enlargement, dry mouth, flushing and confusion. Other drugs related to sputum, especially in the elderly, are sedative sleeping pills, narcotic analgesics and histamine-2 blockers.

3. Infection: Infection and fever often cause paralysis. The main cause is urinary tract infection, pneumonia and sepsis. The important pathogen of sporadic encephalitis and meningoencephalitis is herpes simplex virus. People with AIDS can develop paralysis, and HIV itself and opportunistic infections can be the cause of the disease, and the risk of infection in immunocompromised patients is greatest. Any infection suspected should be promptly urinary, sputum, blood and cerebrospinal fluid culture.

an examination

Related inspection

Brain evoked potential brain CT examination

Laboratory tests include whole blood routine, blood glucose, liver function, renal function, blood ammonia, blood gas analysis, urine analysis, and urine drug screening.

A series of EEGS follow-up observations can be seen with a substantial change in EEGs. Structural damage and general slowing of brain wave rhythms are the most common changes. The degree of rhythm reduction is related to the degree of paralysis. There are two subtypes of sputum activity and overactivity, which have similar EEG slowing down. However, low voltage fast activity predominates in sedatives and alcohol withdrawal patients.

Intracranial causes cause other EEG changes, including focal slow waves, asymmetric activity, and paroxysmal release (spine, spike, spine-slow wave synthesis). Periodical integrated waves such as three-phase waves and periodic lateralizing epileptiform discharges (PLEDs) contribute to the diagnosis of sputum caused by focal brain injury such as liver failure, encephalitis, cerebral infarction, and cerebral hemorrhage.

In conclusion, EEGs are valuable for the identification of paralysis caused by intracranial causes, for the evaluation of deafness in patients with dementia, and for the identification of delirium and schizophrenia and other primary psychosis.

The evoked potential shows a prolonged incubation period, but it is non-specific. Lumbar puncture is only considered when the cause is unknown. If the brain is suspected of having focal brain lesions, space-occupying lesions, or increased intracranial pressure, CT or MRI should be performed before the lumbar puncture. Lumbar puncture with signs of meningitis can help diagnose the cause. Other auxiliary examinations include chest radiographs, electrocardiograms, and the like.

Differential diagnosis

can be caused by many physical diseases, including the following various obstacles, which are described as follows:

(1) Acute onset with fluctuations in the course of the disease: develops in a few hours or days, rarely more than 1 week, and the condition fluctuates throughout the day. Attention, awakening, or large fluctuations in both occur unpredictably and irregularly, especially at night. Because of the clear interval, attention and arousal improvement, medical staff may be misled unless the patient is observed and evaluated at any time.

(2) Attention disorder: Attention disorder is the primary symptom of sputum. Patients pay attention to distraction. Any stimuli may get the patient's attention without distinction. The insignificant stimuli are more noticeable than the important stimuli. All components of attention are turbulent, including selection performance, long-lasting performance, processing capability, mobilization performance, environmental monitoring, and the ability to divert attention when necessary. The degree of disturbance of consciousness caused by the same disease can range from mild inattention to coma, and the symptoms of convulsions due to arousal disorders are also different.

(3) Disintegration of thinking: There is a disorder in the flow of thought. Breaking into the interfering thinking of the patient's consciousness, the patient can not rationalize the various symbols, perform sequential activities and organize the target-oriented sexual behavior. Ambiguity means that this kind of thinking flow that cannot be kept with habit, clarity, coherence and speed. The patient's words reflect this messy thinking activity. Words shift from one subject to another, manifesting as sloppy, digressive, cumbersome, hesitant, repetitive, and continuous speech. The reduction of verbal content and the impediment to reading comprehension are the characteristics of embarrassment. Ambiguous speech is characterized by abnormal rates, dysarthria, and non-aphasia naming errors, especially those related to disease and stress, such as hospitalization days, bed numbers, and so on.

(4) The level of consciousness deteriorates: the clarity of consciousness or attention can be disordered. Most patients are lethargic and have a reduced degree of arousal. Other patients, such as tremors, can be overly alert and easy to wake up. In an over-alert patient, extreme arousal does not eliminate the attention deficit, because the patient's alertness is disorganized and easily distracted by irrelevant stimuli and cannot be noticed. The two extremes of consciousness can overlap or alternate in the same patient and can be caused by the same pathogenic factors.

(5) Perceptual disorder: The most common perceptual disorder is a decrease in perception per unit time, and the patient is not aware of the events that occur around him. Illusions and other misperceptions are caused by abnormal sensory discrimination. Perception can be multiple, variable, or abnormal in size and positioning. Hallucinations can also occur, especially in young patients and subtypes of patients. Visual hallucinations are the most common, more vivid and vivid, three-dimensional and full-color, the patient can see animals or people in the country of small people are active. The hallucinations are mostly unpleasant, and many patients fight or flee because of fear. Some illusion experiences come from the intrusion of dreams or visual imaginations, and psychotic auditory hallucinations, accompanied by comments on patient behavior, are also common.

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