Thinking rush

Introduction Subjective experience is a form of thinking disorder that is forced by thinking, usually accompanied by mania or madness. The characteristics are that the speech speed is fast, the endlessness is fast, the association is fast, and the sound union and the Italian association often appear. The verbal expression may not keep up with the trend of thought, resulting in the incoherence of speech connection. It is easy to divert attention due to accidental factors or no obvious reason, and the transfer of the environment is one of the prominent features.

Cause

First, genetic factors

Based on the prevalence of first-degree relatives of patients, the same-sex rate of twins, and the same rate of twins, it is speculated from the available data that manic depressive psychosis may be passed to the next generation through X chromosome. It may also be inherited through other means.

Second, physical factors

Kretschmer and Sheldon et al. believe that the incidence of short-skinned people with circulating personality is significantly higher. The main characteristics of circular personality are good communication, cheerful, wide-ranging, active, optimistic, and easy to become worried. Patients with mesodermal leaf type bones, muscular muscles, and connective tissue are more ill than those with delicate and delicate ectoderm.

Third, the central nervous system function and metabolic abnormalities

In the past decade or so, the application of neurobiochemistry has done a lot of research on manic depressive psychosis. The results are very helpful in understanding the pathogenesis of this disease, and can guide clinical work to a certain extent.

(a) central noradrenergic system dysfunction Schildkraudt and Davis et al. (1965) found that patients with manic depressive psychosis have central norepinephrine (NE) systemic dysfunction. The medium of NE receptors in manic patients increased accordingly, causing the function of NE energy system to be hyperactive. Laboratory tests found that mandarin-type patients had more urinary 3-methoxy-4-hydroxy-phenylene glycol (MHPG) excretion than normal. The final metabolites of NE are MHPG and 3-methoxy-4-hydroxylamarinic acid (VMA), and 80% of MHPG is derived from the central nervous system. Therefore, the above laboratory shows that mania may be functioned by the central nervous system. Caused by an imbalance.

(2) Abnormal function of the central serotoninergic system

The central serotonin (5-HT) has the function of maintaining emotional stability. Manic or depressed, the function of the central 5-HT is low. The level of 5-HT and its metabolite 5-hydroxyindole acetic acid (5-HIAA) in the patient's cerebrospinal fluid is lower than normal.

(3) Multiple amine metabolism disorder hypotheses

Some experts believe that the occurrence of mania is caused by the lack of central 5-HT and the excessive central nervous system NE; depression is caused by the lack of central 5-HT and NE deficiency. This constitutes a hypothesis of multiple amine metabolic disorders.

(four) neuroendocrine dysfunction

The circadian cycle fluctuation of plasma cortisol in normal people has a certain regularity. Neuroendocrine dysfunction in patients with depression, characterized by dysfunction of the hypothalamic-pituitary-adrenal axis. The level of cortisol in the blood of depressed patients is higher than that of normal people, and the fluctuation of cortisol circadian cycle in plasma is disordered.

The work in this area is still in the initial stage, and its clinical significance needs further evaluation.

(5) Abnormal electrolyte metabolism

During manic episodes, the ability to drain sodium from cells is impaired; during depression, the ability to transfer sodium from the blood to the cerebrospinal fluid is reduced. When the disease improved, the above abnormalities gradually recovered.

Fourth, spiritual factors:

The onset of manic depressive psychosis may be related to mental stimuli, but can only be considered as a predisposing factor.

an examination

Related inspection

Electrocardiogram EEG examination

It is characterized by high mood or irritability, and the symptoms last for at least one week. In the state of high mood, there are at least three of the following symptoms:

1. Speech is significantly more than usual;

2. Lenovo speeds up, or the concept is erratic, or the speed of self-satisfaction can't keep up with thinking activities;

3. Inattention or diversion;

4. Self-evaluation is too high, reaching the level of delusion;

5. Self-feeling, such as a particularly flexible mind, or a particularly healthy body, or a particularly energetic;

6. The need for sleep is reduced and not tired;

7. Increased activity or emotional excitement;

8. Behave rashly or pursue pleasure, regardless of consequences, or be adventurous;

9. Sexual desire is clearly advanced.

Differential diagnosis

Schizophrenia

It is common in clinical practice to misdiagnose adolescent schizophrenia as mania. The opposite is also true. This is because schizophrenia can also have a circulatory course, and clinical manifestations can also have motoric excitement. However, after several episodes of schizophrenia, the course of circulation is gradually less obvious, and it is a chronic progressive disease. Although the clinical phase is excited and agitated, the emotions are not relaxed and happy, but the mood is erratic and the behavior is also impulsive. Clinically, some patients with depressive disorder have psychotic characteristics that are incompatible with their mood, but they are short-lived and long-lasting with the course of the disease.

2. Toxic psychosis Some drugs such as corticosteroids, isoniazid, and A. can cause a manic state.

According to the history of medication, the relationship between the time of administration, the dose and the incidence of the disease, and the improvement after the withdrawal or reduction of the drug can be identified. Toxic psychosis is often accompanied by varying degrees of disturbance of consciousness.

3. Brain organic psychosis

For example, paralytic dementia and senile psychosis may be manic, but there are often mental disorders, and the emotions are not high, but mainly euphoria. Detailed medical history, physical and neurological examinations help identify.

4. Mental disorders caused by physical illness

Hyperthyroidism can be mildly manic, but the emotions are not really high, but mainly anxiety and emotional instability. Accompanied by symptoms and signs of primary somatic disease.

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