OVERVIEW
Overview
Mental disorders associated with abnormal thyroid function are those associated with hyperthyroidism (hyperthyroidism) and hypothyroidism (hypothyroidism). In hyperthyroidism or hypothyroidism, the overproduction or underproduction of thyroid hormones can cause metabolic changes in the brain, leading to corresponding neuropathy and mental disorders.
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Department
Psychiatry, Endocrinology, Neurology
Clinical symptoms
The psychoneurological disorders of hyperthyroidism include impatience, irritability, heightened emotion, hyperactivity, and delirium. The psychoneurological disorders of hypothyroidism include apathy, mental retardation, impaired consciousness, and unsteady gait.
Hazards
Patients have various manifestations of mental abnormality with varying degrees. Severe cases not only seriously damage health, but also lead to inability to live and work normally.
Examination
Psychoneurotic disorder associated with hyperthyroidism: thyroid function test, electroencephalogram, etc. Psychoneurotic disorder associated with hypothyroidism: thyroid function test, thyroid peroxidase antibody, electroencephalogram, etc.
Diagnosis
Diagnosis is made on the basis of medical history, and mental and neurological symptoms such as impatience, irritability, mental retardation, etc., combined with thyroid function tests and electroencephalogram.
Treatment principle
Treatment of the primary disease and symptomatic treatment of psycho-neurological diseases.
Curability
If the primary disease is effectively treated, the mental disorder will be relieved or disappear.
Dietary advice
A high-calorie, high-protein, high-vitamin diet is recommended for hyperthyroidism; a high-protein, high-sugar, high-vitamin, low-fat diet is recommended for hypothyroidism.
Causes
Causes
Hyperthyroidism or hypothyroidism is caused by changes in brain metabolism due to over or under secretion of thyroid hormones.
Symptoms and Diagnosis
Typical symptoms
1. Hyperthyroidism with mental symptoms (1) neurasthenia syndrome: mostly occurring in the early stage of the disease, with insomnia, forgetfulness, fatigue, impatience, poor self-control, and agitation. (2) Personality changes: varying degrees of impatience, irritability, fear, depression, sadness or joy, sensitivity and suspicion, increased irritability, emotional instability, etc. (3) Manic or depressive state: high emotion, excessive activity, increased excitement, euphoria, nosiness, and associations. Some patients have segmented delusions and hallucinations similar to manic state, with occasional fear, anxiety, pessimism, depression and so on. (4) Hallucination and delusion state: hallucinations are mostly verbal and critical, and delusions are usually more systematic and persistent, such as victimization and sin. (5) Disorders of consciousness: most often appear at the onset of thyroid crisis, in a state of delirium, accompanied by severe psychomotor excitement, followed by rapid entry into coma. (6) Long-term severe hyperthyroidism may present with memory loss and intellectual disability, etc. 2. Hyperthyroidism with neurological symptoms may be manifested as myasthenia gravis, tremor of limbs, periodic paralysis, paralysis of eye muscles, etc. A variety of autonomic dysfunctions are often present. A variety of autonomic dysfunction symptoms often appear.3. Hyperthyroidism with psychiatric symptoms (1) Psychiatric disorders of cretinism: mental retardation. (2) Mental disorder of juvenile mucous edema: symptoms similar to those of cretinism in young people. (3) Psychiatric disorders in adults with hypothyroidism: mental retardation, disinhibition, mania or depression, hallucination and delusion, and disorders of consciousness.4. Neurological symptoms associated with hypothyroidism in adults with cretinism: hearing and dysarthria, and narrowing of the visual field. In adults, there are facial paralysis, ataxia, and unsteady gait.
Diagnostic basis
1. Psychoneurological disorders associated with hyperthyroidism (1) History of hyperthyroidism. (2) Clinical manifestations such as impatience, irritability, high emotion, hyperactivity, delirium, etc. 2. Hypothyroidism accompanied by psychoneurotic disorder (1) History of hypothyroidism. (2) Clinical manifestations such as apathy, mental retardation, impaired consciousness and unsteady gait. (3) Electroencephalogram (EEG) shows diffuse low-amplitude slow waves and rare alpha waves in cretinism, and low-amplitude slow waves and almost no alpha waves in mucous edema.
Treatment
Treatment policy
Treat the primary disease and treat the psychoneurological disease symptomatically.
Drug treatment
1. Treatment of hyperthyroidism with mental disorder (1) Firstly, control hyperthyroidism. Antithyroid drugs such as methyl or propylthiouracil, methimazole, carbimazole, etc. can be used. Pethidine, chlorpromazine and promethazine can be given in thyroid crisis. (2) Treatment of mental disorders: for those with symptoms of neurosis, tranquillizers can be used as anxiolytics; for those who are mentally excited, restless and accompanied by hallucinations and delusions, antipsychotic drugs can be given. In order to avoid extrapyramidal reactions, benzodiazepines can be used. Antidepressants can be used for those with depression, and small-dose antipsychotics can be used for those with hallucinations, delusions of excitement, agitation and schizophrenia-like mental symptoms. (3) Hyperthyroidism can be treated with radioactive 131I, but it should be implemented after the mental symptoms are controlled.2. Treatment of hypothyroidism with mental disorders (1) Thyroxine replacement therapy: for pregnant women with simple goiter, oral iodine treatment should be given as early as possible; for children with cretinism, thyroid preparations should be taken as early as possible. For hypothyroidism, in addition to thyroid preparations, cerebral metabolizers such as piracetam, alpha-amino-tyrosine, glutamic acid and a large number of vitamins should be given. Mucous edema in adults is treated by giving mainly thyroxine. Comatose individuals with mucous edema may be given thyroxine along with iodocerotonin. (2) Low-dose antipsychotics are used to control delusions and hallucinations, and antidepressants and anxiolytics may be given for severe depression and anxiety.
Surgery
Surgery can be performed if the hyperthyroid glands are significantly enlarged, but it should be performed after the psychiatric symptoms are under control.
Other treatments
The psychotherapy of hyperthyroidism with mental disorder should be based on supportive psychotherapy, giving mental comfort to the patient, i.e., making patient explanation, comfort, guidance and encouragement, etc., and providing health education about the disease in order to eliminate concern, tension, sensitivity or depression.
Prognosis
If the primary disease is effectively treated, the prognosis is good.
Nursing care
Daily care
1. Keep the indoor environment clean, open windows and doors regularly for ventilation, and keep the indoor temperature and humidity appropriate. 2. Actively treat thyroid disease as prescribed by the doctor and take medication on time. 3. Talk to the patient more often, listen to his/her complaints, understand his/her behaviors, provide psychological support, and encourage him/her to participate in social activities more often.
Dietary management
(1) Hyperthyroidism: eat a high-calorie, high-protein, high-vitamin diet, avoid tobacco, alcohol, strong tea and coffee. (2) Hypothyroidism: Eat a high protein, high sugar, high vitamin, low fat, light, easy-to-digest diet, and eat small, frequent meals.