OVERVIEW
Mental disorders associated with essential hypertension are the most common type of mental disorders associated with vascular disease. It refers to mental disorders that occur in conjunction with essential hypertension. Mental disorders associated with essential hypertension are mainly characterized by neurosis-like syndromes, but may also include depressive syndromes, hallucinations and delusions. When the blood pressure rises sharply and a hypertensive crisis occurs, there is often a cognitive impairment. The cause of hypertension is still unclear, and long-term emotional instability, mental stress and other factors often make the patient’s blood pressure continues to rise. The sensitivity of hypertensive patients to mental factors is considered to be a likely contributing factor to the development of psychiatric disorders in hypertensive patients.
Etiology
The etiology of primary hypertension is still unclear, and may be related to ageing, psychosocial factors, genetic factors, high-calorie diet, etc. It mostly occurs at the age of 40 to 50, with no gender difference. On the basis of cerebral vascular wall lesions and changes in blood composition and hemodynamics, coupled with factors such as prolonged emotional instability and persistent stress, it can cause a sustained elevation of blood pressure, resulting in spasm of small arteries and fine Arteriosclerosis, and consequently, insufficient blood supply to the brain tissue or even ischemia, resulting in nutritional disorders of nerve cells and transient cerebrovascular crisis or mental disorders. Generally, the onset of the disease is acute and the progression is slow, and the course of the disease fluctuates in a step-like manner, with a variety of clinical manifestations, but it often develops into dementia in the end.
Symptoms
1. Early symptoms
Early symptoms of mental disorders are mainly cerebral debility syndrome. They include head discomfort, emotional instability, sleep disorders, poor concentration, poor memory, decreased working ability, and autonomic dysfunction. At the same time, anxiety, fear, worry and other emotions may also appear. In the middle stage of hypertensive disease, obvious episodes of anxiety and depression often occur, which may be accompanied by excitement and irritability.
2. Limited neurologic signs and symptoms
The more common ones include pseudo medullary palsy, dysarthria, dysphagia, central facial paralysis, hemiparesis of varying degrees, aphasia, dysarthria or dysarthria, seizures, and urinary incontinence. Cerebral hemorrhage or cerebral infarction in different parts of the brain produces different limited symptoms, such as ipsilateral hemianopsia, spatial disorientation and lack of self-awareness when the blood supply area of the posterior cerebral artery is impaired.
3. Intellectual impairment (dementia)
Early stage is limited, i.e., cognitive function impairment is not evenly distributed, and self-awareness and judgment are maintained well despite memory impairment and intellectual impairment. Anxiety and depression only show excessive attention to one’s own disease, and later on, fear, worry, depression and suspicion of disease are produced. The disease often starts suddenly and degenerates in stages. In the later process, some patients develop perceptual disorders and thinking disorders, producing various hallucinations and delusional states, such as being victimized, suspicion of disease, jealousy, theft, delusion, etc., but there is no consciousness disorder. Some patients gradually develop from emotional vulnerability to emotional retardation, obligatory crying and laughing, and emotional outbursts occur in a few cases. With the progress of the disease, if there are somatic comorbidities, mental trauma, acute environmental changes, especially in the case of acute cerebrovascular accident, the dementia symptoms will be stepwise aggravated, and in the late stage, it will become full-blown dementia.
4. Cerebral dysfunction
When hypertensive crisis or hypertensive encephalopathy occurs, patients may have consciousness disorder, which may be accompanied by horrible hallucination or fragmentary delusion, excitement, impulsivity, incoherent speech or pseudo brain tumor-like syndrome, which is manifested as depression, lack of interest, impoverished thinking, stagnant expression, and slow movement, etc. Some patients recover consciousness after a short period of time. Some patients continue to have mania-like or depressive manifestations for a short period of time after recovery of consciousness.
Examination
1. Laboratory examination
The laboratory test results of hypertension associated mental disorder should be consistent with the laboratory test changes of hypertension, and there is no specific laboratory test for mental disorder.
2. Other auxiliary tests
There is no characteristic auxiliary examination for mental disorder. If hypertension is stage III, there is evidence of positive examination of the relevant affected target organs.
Diagnosis
1. According to the new standard of the World Health Organization (WHO): ideal blood pressure: <120/80mmHg; normal blood pressure: <130/85mmHg; high normal value: 130-139/85-89mmHg; higher than systolic blood pressure of 140mmHg and/or diastolic blood pressure of 90mmHg is considered as high blood pressure (must be more than 2 times in a row).
2. A clear history of hypertension prior to the onset of psychiatric symptoms. That is, on the basis of primary hypertension, the patient appears to have cerebral debility syndrome, or anxiety, depression, hallucinations, delusional states and disorders of consciousness, etc., and the psychiatric symptoms fluctuate with the blood pressure and physical symptoms, that is to say, the ups and downs of the symptoms and the fluctuation of the blood pressure have a close relationship.
3. Early stage is dominated by cerebral debilitation syndrome, and consciousness disorder is often found in the late stage.
4. When the patient has no consciousness disorder, the emotion is distinct and the contact is good, but the judgment is lacking.
Treatment
Mental disorder associated with primary hypertension is mainly treated by treating hypertension and controlling mental symptoms at the same time.
1. General treatment
(1) At present, there is no cure for mental disorders associated with cerebrovascular disease, but the treatment can slow down the progress of the disease, reduce or eliminate the symptoms and psychosocial consequences of the disease, and reduce the prevalence of associated diseases and the rate of death.
(2) The understanding and adjustment of the psychosocial impact of mental disorders associated with cerebrovascular disease should be strengthened to identify disease-promoting or perpetuating factors, and early detection and early treatment should be advocated. For patients in the early and recovery period, supportive psychotherapy should be adopted so that patients can understand the nature of the disease they are suffering from, eliminate worries, fears and pessimism, and establish confidence in curing the disease, thus improving their mood, which is conducive to the stabilization and lowering of blood pressure. Consume more low-salt and vegetarian food, and less high-fat, high-sugar and spicy diet. Arranging work and life well, maintaining sufficient sleep, quitting smoking and drinking, and taking part in cultural and sports activities appropriately are also beneficial to the alleviation of hypertension.
(3) Adjust comprehensive treatment and nursing care according to the condition, and correctly apply medication, psychotherapy, psychosocial and rehabilitation interventions. Formulate a comprehensive treatment plan and adjust the comprehensive treatment and care according to the condition, and correctly apply all kinds of medication, such as thrombolytic therapy, anticoagulation therapy, polarization therapy, antihypertensive medication, intellectual medication, and cerebral metabolism improvement medication. Lowering blood pressure is the key to the treatment of this disease, the application of antihypertensive drugs can be used: hydrochlorothiazide, dibazole, calcium ion antagonist. For the treatment of hypertensive crisis, colistin can be taken orally or injected slowly. The purpose is to improve cerebral blood flow, prevent cerebral infarction, promote cerebral metabolism, alleviate symptoms, and prevent deterioration of the condition.
2. Treatment of mental symptoms
For the mental disorder associated with primary hypertension, different medications should be given according to different clinical features. At the same time, attention should be paid to protecting patients, making them lie quietly in bed, controlling their excitement, and preventing the occurrence of failure and hypertensive crisis and stroke. The medication should be started from a small dose and added slowly, and then reduced or stopped when the symptoms improve, and should not be applied for a long time.
For the early stage of cerebral debility syndrome, psychotherapy and medication can be given. Psychotherapy mainly allows patients to have a full understanding of their own disease and look for countermeasures to eliminate the suspicion of disease and reduce anxiety. Drug treatment is mainly symptomatic, such as the use of sedative sleeping pills to improve sleep. For anxiety and depression, antidepressants such as selective pentazocine reuptake inhibitors and tranquilizers such as Valium can be used appropriately. For hallucinations and delusions, small doses of antipsychotics such as risperidone, quetiapine, olanzapine, etc. can be used. The use of each drug is started from a small dose, slowly adding drugs, the use of drugs should be short, if the symptoms are controlled, then the drug should be reduced and gradually discontinued. For the paralysis and aphasia left after stroke attack, acupuncture treatment and adherence to the training of restoring function can be done. Nursing care should be strengthened for patients with intellectual impairment or those who cannot take care of themselves.
Psychotherapy has become a measure that must be considered in the treatment of geriatric diseases. Psychotherapy addresses not only clinical symptoms but also geriatric problems. The more severe the organic mental disorder and the more it jeopardizes the security and independence of the older person, the more he or she will display regressive behaviors that seek dependence and help. It is important to note that in the management of these problems, the elderly should not be overly demanding, and psychological support should be the mainstay, with a rich, full life also contributing to the psychological resilience of the elderly. In the psychotherapy of the elderly, special attention should be paid to the phenomenon of empathy, consideration and respect for the elderly is the basis for establishing a good relationship, not only to make the elderly feel acceptance and recognition, but also to understand their weaknesses and peculiarities. Psychotherapeutic techniques for elderly patients focus on psychological support, assistance and interaction.
Prevention
The key to mental disorders associated with essential hypertension is to prevent the onset and progression of essential hypertension. Primary prevention of hypertension refers to effective preventive measures to control or reduce the risk factors for developing hypertension in those who have risk factors that cause hypertension but have not yet developed hypertension, in order to reduce the incidence of the disease. The purpose of primary prevention is twofold: (1) to identify people who may develop hypertension in the future, i.e., high-risk groups, and to prevent them before their blood pressure rises; and (2) to prevent the entire social population. The high-risk groups are those with a clear family history of hypertension, those whose blood pressure was already high when they were children or teenagers, and those who have a tendency to develop hypertension, such as obese people. Secondary prevention refers to the effective treatment of those who already have hypertension to prevent further progression of the disease and the occurrence of complications or recurrence of hypertension. Tertiary prevention refers to the resuscitation of severe hypertension to prevent complications and death. Included in tertiary prevention is rehabilitation.