Disintegration

Introduction 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. Disintegration of thinking is one of the differential diagnosis of the deterioration of psychomotor activity.

Cause

Common causes classification:

1. Metabolic disorders: It is 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. In patients with Parkinson's disease, anti-shock palsy can cause paralysis, with hallucinations and delusions. Corticosteroid psychosis refers to the occurrence of prednisone at a dose of 40 mg/d or more. The behavioral effects of corticosteroids often start with euphoria and palpitations, and excessive activity. Any drug that is injected intrathecally, such as iodine, is also prone to induce ambiguous behavior. Drug withdrawal syndrome can be caused by a variety of drugs, including barbiturates, other weak tranquilizers, sedatives, amphetamines, cocaine and heroin (diacetin), as well as alcohol. After 72-96 hours of alcohol withdrawal, tremors began to appear, with severe inflammatory, tremor, sweating, tachycardia, fever and horror.

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.

4. Stroke: Warts are non-specific consequences of any acute stroke, but confusion after cerebral infarction often disappears within 24 to 48 hours. Persistence can be caused by specific strokes including right middle cerebral artery occlusion and frontal and posterior apical areas, as well as occlusion of the posterior cerebral artery leading to bilateral or left occipital region (fusiform). The latter lesion often involves the right hemisphere and can progress slowly and cause agitation, visual field changes, and even Anton (denying visual loss) syndrome. Hepatic occlusion can also occur after occlusion of the anterior cerebral artery or rupture of the anterior communicating aneurysm involving the anterior and posterior cingulate.

Other cerebrovascular diseases including high bilateral carotid stenosis, hypertensive encephalopathy, subarachnoid hemorrhage, and central nervous system vasculitis such as systemic lupus erythematosus, temporal arteritis, and Behcet's disease may also occur, migraine patients, especially children There may be sputum, and transient ischemic attack (TLA) must be emphasized, even if the vertebrobasilar insufficiency is insufficient.

5. Epilepsy: In 3 cases, epileptic abnormal EEG activity is associated with delirium.

(1) Attack period: absence of persistent state, complex partial seizure persistence state, convulsion-free tonic state or periodic ectopic epileptiform discharge (PLEDs).

(2) After the attack: complex part of the attack or after the onset of tonic-clonic seizures.

(3) Interictal period: including epileptic seizures, which are characterized by irritability, agitation and emotional symptoms associated with impending seizures.

6. Perioperative cause: The cause of paralysis in perioperative patients is multifactorial. Perioperative factors include the effects of residual anesthetics and drugs, especially preoperative anticholinergic drugs; postoperative hypoxia, perioperative hypotension, electrolyte imbalance; infection; psychological stress. The sputum can start at any time after surgery, but it is obvious on the third day after surgery and on the seventh day, but it can last for a long time.

Patients over the age of 60 are particularly at risk for heart and eye surgery. Hemorrhoids occurred in 30% of patients with open heart or coronary artery bypass grafts. Additional factors were reduced postoperative cardiac output and excessive cardiopulmonary bypass time, increasing the risk of microembolism. Acute conscious ambiguity in 7% of cataract surgery patients may result from sensory deprivation.

7. Other causes: Patients with dementia, Lewy body disease, Parkinson's disease, and neuroimaging with brain atrophy and subcortical ischemic changes are particularly prone to convulsions, concussion in brain trauma, brain contusion, intracranial hematoma Others can cause embarrassment. Moreover, the subdural hematoma of the elderly may have only a slight history of no head trauma, and the tumor with fast growth on the screen with increased intracranial pressure is particularly prone to paralysis. Paraclinical processes produce marginal encephalitis and multifocal leukoencephalopathy, acute demyelinating disease, diffuse multifocal lesions, and traffic or non-communicating hydrocephalus, etc., can cause paralysis. The transient general forgetting of the patient began to be paralyzed, followed by disproportionate anterograde amnesia, and the retrograde amnesia improved several hours before the onset. Werncke encephalopathy patients have paralysis, eye movement, nystagmus, ataxia, and often residual residual amnesia (Korsakoff psychosis).

Fractures in the elderly often have paralysis, and 50% of hospitalized patients with hip fractures have paralysis. Orthopedic patients with suspected fat embolism should check the fat in the urine, sputum or cerebrospinal fluid. Anemia, thrombocytopenia, and disseminated intravascular coagulation (DIC) in blood diseases can cause paralysis. Finally, heat stroke, electric shock, high temperature, etc. can also be the cause of convulsions.

an examination

Related inspection

Brain MRI examination EEG examination

EEG examination

Electroencephalography is a graph obtained by amplifying and recording the spontaneous biopotentials of the brain from the scalp by means of an instrument.

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 slowdown; however, low voltage fast activity predominance often occurs 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

The diagnosis should be differentiated from the following symptoms:

1. Abnormal mind control: Normal people's thinking is subjectively controlled by themselves, while some patients with schizophrenia feel that their thinking is not under their control, or that their own thinking is no longer their own, but is subject to an external force. control. It means that the patient feels that his or her mind is not his or her own, that the thinking activity loses autonomy, or that it is controlled by external forces. For example, thinking deprivation, thinking insertion, thinking dissemination and other experiences.

2. Thinking stagnation: The so-called thinking disorder refers to the abnormality in the amount and speed of thinking association activity. The clinical manifestations of thinking disorders are diverse. Thinking viscosity: It means that association is not easy to develop, showing obvious inertia, always entangled in the same problem.

3. The breakdown of thinking: The so-called thinking disorder refers to the abnormality in the amount and speed of thinking association activity. The clinical manifestations of thinking disorders are diverse. The breakdown of thinking: the break between associations between concepts, the lack of intrinsic link between the various conceptualities of establishing associations. There was no connection between the last ten days, and it became a pile of statements.

4. Relaxation of thinking: The so-called thinking disorder refers to the abnormality in the amount and speed of thinking association activity. The clinical manifestations of thinking disorders are diverse. Relaxed thinking: thinking is loose. It means that Lenovo's content is loose, lacks the theme, and there is a lack of connection between one problem and another. It is manifested in the fact that the patient speaks or writes when he or she writes, and the answer to the question is not relevant, making the examiner feel that the conversation is difficult.

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