Overview
Respiratory diseases are often accompanied by varying degrees of mental disorders, such as depression, anxiety, nervousness, fear, etc. The prolonged presence of these psychological disorders not only reduces the patient’s quality of life and further deteriorates the existing somatic functions, but also is an important risk factor for the development of cardiac disorders such as bronchial asthma, hyperventilation syndrome, and neurogenic cough.
Etiology
Respiratory disease leads to respiratory insufficiency, on the basis of which there are multifaceted changes in respiratory physiology, hemodynamics, and cerebral metabolism, resulting in psychiatric symptoms. Common respiratory diseases with mental disorders include pulmonary encephalopathy and bronchial asthma.
1. Causes of pulmonary encephalopathy
There are numerous causes of this disease. In addition to chronic diseases of the lungs (chronic emphysema, chronic bronchitis, pulmonary fibrosis, tuberculosis, lung tumors, etc.), other diseases affecting respiratory function, such as lateral sclerosis, myasthenia gravis, poliomyelitis, myasthenia gravis, scoliosis, heart failure, cranial hypertension, and idiopathic alveolar transmigration, etc., can also be triggered. Infection is the most important precipitating factor.
2. Etiology of bronchial asthma
(1) Exogenous causes
(1) Inhalation of specific and non-specific substances present in the air. Such as pollen, dust mites, animal dander, drugs, certain foods (milk, seafood), etc., these substances have a certain antigenicity, easy to trigger a perverse reaction in susceptible groups.
(2) Changes in temperature, humidity, air ions and other climatic components of each factor can constitute a stressor for people with allergies.
(2) Endogenous causes
(1) Abnormal functioning of neural mechanisms, such as cholinergic hyperfunction, enhanced α-adrenergic effect and/or low β-adrenergic effect, etc., all of which can lead to hyperresponsiveness of the airways and asthma attacks.
2) Respiratory or other infections.
3) Psychosocial factors (psychological stress) are important endogenous etiologic factors, which play an important role in the occurrence, development and prognosis of bronchial asthma. Statistics show that in the composition of all the factors that promote the development of bronchial asthma, mental factors account for more than half of them, of which only a single mental factors to promote asthma is 15%, and allergic reaction with mental factors account for 50%. In addition, in the asthma attack accompanied by anxiety, depression, fear and other emotions, and will further affect the asthma situation, so that the attack is more frequent and persistent, forming a vicious circle. In addition, poor lifestyle behaviors, such as smoking, alcoholism, overwork, etc. can trigger asthma. According to the survey, asthma patients have more family members (mainly mothers) with neurotic characteristics (emotional, sensitive, over-indulgence, etc.), which can lead to the development of children with dependent, sensitive, weak personality, which is also one of the factors causing the occurrence of this disease.
Symptoms
Clinically, all respiratory diseases with mental disorders are highly associated with pulmonary insufficiency.
1. Mental symptoms associated with pulmonary encephalopathy
Psychiatric symptoms of pulmonary encephalopathy are most common in the form of impaired consciousness, which is more than 90%. At the beginning, it can be manifested as intermittent cloudy consciousness and drowsiness, which often occurs during meals and conversations. If the condition improves, a fuzzy state may appear during the recovery from drowsiness to wakefulness. If aggravated, it enters lethargy. If the condition is further aggravated, it may change from lethargy to delirium, confusion, and in severe cases, coma. It may also present as delirium or confusion from the beginning. The condition may fluctuate repeatedly, with several states alternating, or it may suddenly turn into coma.
In some patients, the impairment of consciousness is not obvious. Or only mildly altered, highlighted by suspicion, anxiety, fragmentary hallucinations, hallucinations and delusions of victimization, etc. A few patients may be depressed, or show euphoria, mild manic symptoms and so on. These symptoms tend to be transient or paroxysmal, and some patients may have partial self-awareness.
(1) Obstruction of consciousness: patients from drowsiness to blurred consciousness, such as pulmonary infection, delirium can occur, and in severe cases, coma can occur. When the patient’s consciousness is cloudy or in a semi-comatose state, there may be excitement, irritability, lack of purposefulness of movement, hand grasping and touching, disorientation, sporadic speech, terrifying visual hallucinations, fragmentary delusions, etc. The degree of consciousness disorder often fluctuates. The degree of the patient’s consciousness disorder often fluctuates, sometimes with intermittent wakefulness. With the improvement of the physical disease, the consciousness gradually becomes clear.
(2) Schizophrenia-like manifestations: most of them appear after the disappearance of consciousness disorder or at the early stage of the disease, manifesting as euphoria, talkative, excited and restless, diffuse thinking, hallucination and delusion, etc., and some of them only have transient and fragmentary hallucinations, hallucinations and delusions of being victimized. Some of them show stereotyped speech and rigidity, and a few patients have hysterical-like episodes.
(3) Anxiety and depression state: patients may manifest anxiety, nervousness, fear, depressed mood, self-blame and self-guilt and pessimism.
(4) Elderly or arteriosclerotic patients: after the elimination of impaired consciousness, euphoria, polyphasia, Korsakov’s syndrome-like manifestations (amnesia of recent events, fictionalization, disorientation, etc.) or dementia may occur.
(5) Symptoms and signs of the nervous system: fluttering tremor, spasmodic seizures, myoclonus, pyramidal signs, ocular motility disorders, fundus venosus dilatation, optic disk edema, retinal hemorrhage, etc. are common. Epileptiform seizures can be seen in later stages.
(6) Symptom staging: stage 1 manifests psychomotor inhibition, sleepiness, fuzzy or drowsiness, mild manic manifestations, and occasional fluttering tremor, etc.; stage 2 manifests lethargy, hallucinations, delusions, delirium, fluttering tremor, etc.; stage 3 manifests speech and behavioral disorganization, optic disc edema, pyramidal fasciculations, spasmodic seizures, and myoclonus.
2. Mental symptoms associated with bronchial asthma
(1) Mood disorder type patients are often accompanied by fear and worry, anxiety, irritability, depression and pessimism and other bad emotions during the attack.
(2) Delusional type is mainly dominated by the emergence of delusions. Delusions of victimization, relational delusions, self-incriminating delusions, etc. are common, which may be accompanied by hallucinations, and are also often accompanied by mild blurring of consciousness.
(3) Epileptiform disorder of consciousness is mostly characterized by transient loss of consciousness, similar to epileptic mini-seizures. Patients may also have epileptic convulsions during asthma attacks. The duration of asthma and impaired consciousness are parallel.
Examination
1. Laboratory tests
There are no laboratory specific tests for psychiatric disorders. For routine, biochemical, and immunologic laboratory tests related to primary respiratory disease, see Respiratory System.
2. Other auxiliary tests
When respiratory diseases are associated with mental disorders, especially pulmonary encephalopathy, the electroencephalogram often shows widespread slow-wave alpha waves with delta waves (medium to high amplitude, 2-3 times/second).
Diagnosis
The principle of diagnosis is that any clinical manifestation of impaired consciousness, diminished intelligence or amnesia syndrome should be considered as the possibility of organic mental disorders. However, mental disorders alone cannot be used as a qualitative or localized diagnosis of organic psychosis, and an etiological and taxonomic diagnosis has to be made, and the diagnosis has to be established with the following points:
1. There is a basis for physical illness. There is a confirmed diagnosis of chronic lung disease causing pulmonary insufficiency or severe respiratory failure with symptoms such as dyspnea, cyanosis and edema.
2. To clarify the presence or absence of mental symptoms, such as reduced mental activity, such as comprehension difficulties, unresponsiveness, disorientation, and one of the symptoms of drowsiness, confusion and excitement; drowsiness and confusion to drowsiness or coma, if necessary, combined with laboratory tests, such as a decrease in the partial pressure of oxygen in the blood, carbon dioxide partial pressure increased and EEG diffuse high-amplitude slow-wave and other changes.
3. The emergence of psychiatric symptoms is temporally related to the progression of somatic diseases. Generally, the physical disease comes first, and the mental symptoms occur later, but some physical diseases are difficult to detect in the early stage, which are more hidden or fail to attract attention, and create the illusion that the mental symptoms appear first.
4. Mental symptoms often improve with the remission of physical illness or worsen with its aggravation.
5. Psychiatric symptoms cannot be attributed to other psychiatric disorders. Both other diseases causing consciousness and mental disorders are excluded.
Differential Diagnosis
Psychiatric disorders such as schizophrenia, manic episodes of affective disorders or depressive episodes need to be excluded.
Treatment
1. Treatment of etiology
(1) Pulmonary encephalopathy: Actively treat the primary physical diseases and eliminate the factors that induce pulmonary encephalopathy, including controlling infection, improving cardiopulmonary function, correcting acidosis, and reducing or eliminating cerebral edema; prohibit or cautiously use anesthetics, hypnotic drugs, and antipsychotics; reasonably treat oxygen therapy to improve hypoxia and carbon dioxide retention, and can be given to sustained low-flow oxygen inhalation; strengthen ventilation to improve cerebral hypoxia, reduce intracranial pressure, and maintain electrolyte and acid-base balance. electrolyte and acid-base balance.
(2) Bronchial asthma: in the acute stage, antispasmodic and asthma medicines are also needed to control the attacks; at the same time, the triggers of the attacks can be eliminated, such as controlling the infections, etc. In the remission stage, specific decongestant drugs can be administered. In the remission period, specific desensitization can be carried out, and anti-metamorphic drugs such as hormones can be applied; in the remission period, non-specific desensitization therapy and application of immune enhancers can be carried out. In most cases, after the appropriate etiologic therapy, the mental disorder will be relieved as the primary respiratory disease is controlled.
2. Treatment of mental disorders
Anesthetics and hypnotics are contraindicated in the management of mental disorders. When there is conscious disorder, if the excitement and agitation are mild, it is not necessary to apply antipsychotics, so as not to further inhibit the respiratory function. Diazepam (Valium) or haloperidol can be injected intramuscularly when the excitement is too intense. In order to control the mental symptoms of those who are conscious, small doses of oral antipsychotics such as Phenazepam or olanzapine can be taken. Sedative drugs are not required for impaired consciousness; antipsychotics such as risperidone and haloperidol can be given for schizophrenia-like symptoms; and anxiolytics and antidepressants can be used for those with anxiety and depression symptoms. However, all should start from a small dose, gradually increase the amount, in order not to produce severe drowsiness is appropriate, and pay close attention to the adverse effects of drugs.
3.Supportive therapy
If consciousness disorder is the main cause, supportive therapy should be implemented at the same time, including energy supply, maintaining water and electrolyte balance and vitamin supplementation. The drugs can be used to promote cerebral metabolism, such as adenosine triphosphate (ATP), coenzyme A, cytarabine and so on.
4. Psychotherapy
Psychotherapy should be carried out on the basis of the above treatments, but generally it should be carried out after the acute phase has been relieved or after the recovery of the consciousness disorder, when the patient is in a position to accept it. Psychotherapy depends on the type of mental disorder. Psychotherapy for bronchial asthma, for those with a large functional component, suggestive therapy can alleviate the attacks. Family therapy, such as correcting the educational attitude and educational methods of family members, is also very important.
5.Strengthen nursing care
Nursing work should pay attention to both the care of physical diseases, but also to do a good job of psychiatric special care. Environmental and psychological care can help eliminate patients’ fear and anxiety, and special attention should be paid to the safety care of patients with conscious disorders. Good nursing care is often conducive to a better prognosis and outcome for somatic mental disorders.
Questions you may be concerned about
What about mental disorders associated with respiratory diseases?
Mental disorders associated with respiratory diseases usually require management of the primary respiratory disease, and commonly used methods include low-flow oxygen, use of central respiratory stimulants, and mechanical ventilation.
The mechanism of mental disorders caused by respiratory diseases is mainly pulmonary diseases accompanied by respiratory insufficiency, which leads to hypercapnia, hypoxemia and arterial blood pH drop, and the emergence of clinical symptoms related to insanity.
Low-flow oxygenation can improve the patient’s hypoxia and favor brain recovery. The use of central respiratory stimulants, such as Lobelin, if necessary, can increase the respiratory rate, inhale oxygen, expel carbon dioxide, and alleviate psychotic symptoms.
In addition, if after the above drug treatment, the effect is not good, then the method of mechanical ventilation can be used, which can effectively reduce carbon dioxide retention in the body, increase the body’s oxygen supply, which is helpful for mental disorders caused by respiratory diseases.
It should be noted that the above drugs and operations should be carried out under the guidance of physicians.
Prognosis
The disease often resolves as the primary respiratory disease is controlled and the mental disorder resolves.