Neurosis associated with epilepsy

Introduction Neuroses associated with epilepsy are common symptoms of clinical manifestations of mental disorders associated with epilepsy. Mental disorders associated with epileptic seizures can occur before, during, and after seizures, and can present persistent mental disorders during seizures. People with epilepsy not only endure physical pain, but also endure mental torture. A survey of outpatients with epilepsy found that 25% of people had depressive symptoms. There are many reasons for causing or affecting epilepsy patients with mental depression.

Cause

There are many reasons for causing or affecting epilepsy patients with mental depression:

(1) One-sided understanding of epilepsy, lack of relevant knowledge. It is considered to be an incurable disease and requires long-term medication. Patients with epilepsy suffer from long-term lingering disease, long-term unhealed, lose confidence in treatment, lose fun in life, think that the symptoms of seizures are embarrassing, and they feel that they are unacceptable and inferior.

(2) Employment and difficulty in finding objects. The family is not harmonious and interpersonal relationships are tense.

(3) The economic burden is too heavy. In order to seek radical cure, patients seek medical attention and try a variety of methods to bring a serious financial burden to the family.

(4) Not enough attention to psychotherapy. Doctors only pay attention to the therapeutic effect of drugs on patients with epilepsy, ignoring the adverse effects of psychosocial factors on the disease.

(5) Personal psychological quality. Generally, the introverted personality and the patients who are not open-minded are more concurrent.

an examination

Related inspection

Cerebrospinal fluid lactic acid nervous system examination

symptom

Before seizures, some patients may experience general malaise, irritability, irritability, mood depression, bad mood, frequent picky or complaining about others, etc., which may be expressed as various short-lived abnormal experiences, such as various simple to complex Illusion, visual distortion or somatosensory illusions and hallucinations, followed by seizures. It is also known as a spiritual harbinger. Some patients may suddenly have disturbances of consciousness, dull eyes, chewing lips without purpose, unbuttoning buttons, pulling clothes or squeaking, clumsy movements, repeated lack of purpose, called mental autosis, the above symptoms are also Can appear separately.

After seizures, they often show confusion, disorientation, and sometimes emotional outbursts, such as panic, irritability, and violent behaviors such as incitement, attack, and destruction. The brain wave examination can be performed on the diffuse slow wave of the dominant side of the frontal lobe or the spike or spike of the temporal lobe.

A small number of patients with epilepsy have symptoms of paranoid schizophrenia, such as chronic epilepsy schizophrenia, after a long-term episode, in the case of conscious consciousness, such as association disorder, mandatory thinking, victim delusion and auditory hallucinations. At this point, most of the patient's seizures have been reduced or stopped. Psychiatric symptoms can often last for months or years and still maintain a good emotional response. Most scholars believe that such episodes are patients with temporal lobe epilepsy. It is also thought to be associated with long-term use of anti-epileptic drugs for folate metabolism disorders.

In some patients with epilepsy, after a long-term episode, personality changes gradually occur, which is characterized by thinking stagnation and emotional outbreaks. Patients are self-centered, controversial, constrained in trivial matters, difficult to convert ideas, lack of creativity, and pathological narratives. When an emotional outbreak occurs, it is impulsive and aggressive, and it can not be self-made by self-injury. A small number of patients may have cognitive and intelligent changes due to frequent epileptic seizures, especially the younger the initial age, the greater the impact on intelligence, called epilepsy dementia. These conditions, in addition to secondary brain damage caused by seizures, are also related to genetic, anti-epileptic drug adverse effects, psychosocial factors and cultural education.

diagnosis

In the past, there was a history of seizures, and the mental symptoms were episodes. The situation of each episode was basically the same. With varying degrees of disturbance of consciousness, it has important reference value for diagnosis. If the course of the disease lasts for a long time and the symptoms are not typical, the electroencephalogram examination should be repeated several times. It is necessary to give anti-epileptic drugs for diagnostic treatment. If mental symptoms and EEG are improved after administration, it can be used as an important basis for diagnosis. The diagnosis should also distinguish between mental disorders before or after seizures, which is of value for treatment.

Differential diagnosis

1. Pre-seizure mental disorder

Behaves as aura or prodromal symptoms. Aura is a partial seizure that occurs before seizures, usually only a few seconds, rarely more than a minute. Seizures in different parts will behave differently, but the same patient will have the same aura before each episode. Prodromal symptoms occur several hours to several days before seizures, especially in children. It is characterized by irritability, nervousness, insomnia, restlessness, and even extreme depression. Symptoms usually end with seizures.

2, mental disorder at the time of attack

(1) Automatic symptoms: refers to the turbid state of consciousness that occurs at the time of attack or just after the attack. At this time, the patient can still maintain a certain posture and muscle tension, and complete simple or complicated actions and behaviors in the unconscious. 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. 80% of patients have an automatic syndrome of less than 5 minutes and a few can last up to 1 hour. There are often auras before the onset of autopsy, such as dizziness, salivation, chewing movements, somatosensory abnormalities and strangeness. Suddenly become stunned, confused, unconsciously repeating actions such as chewing, pouting, etc., can even complete more complex technical work. After the event, the patient completely forgot what happened during this time.

(2) Shenyou disease: rarer than automatic disease, which lasts for several hours, summer 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 manifested as roaming without a destination, patients can travel far, and can also engage in coordinated activities, such as shopping, simple conversation. Forgotten or difficult after the attack.

(3) state: sudden onset, usually lasts for 1 to several hours, sometimes as long as more than 1 week. The patient presented with a disturbance of consciousness. Accompanied by emotional and sensory impairments, such as horror, anger, etc. can also express emotional apathy, thinking and slow movements.

3, post-onset mental disorders

Patients may develop autopsy, paralysis, or transient paranoia, hallucinations, etc., usually ranging from a few minutes to several hours.

4, interictal mental disorders

Personality changes are more common, mainly in patients with left temporal lobe lesions and major seizures, and are related to factors such as brain organic damage, psychosocial factors, type of seizures, long-term use of antiepileptic drugs, and patient's original personality characteristics. For interpersonal relationships, sensitivity, and thinking, and sticky thinking. A small number of patients with epilepsy may experience memory loss, difficulty in attention, and judgment can be reduced, which may be accompanied by behavioral disorders. These symptoms are more common in patients with secondary epilepsy and long-term, severe epilepsy. Clinically, schizophrenia-like symptoms and emotional symptoms such as anxiety are also seen. It is worth noting that the suicide rate of patients with epilepsy is 4-5 times that of ordinary people, so care should be taken to prevent suicide.

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