The early symptoms of mental illness, like other diseases, are mild and atypical, which are often ignored or not recognized as mental illness, and even delay the treatment opportunity, bringing adverse consequences to patients. If mental illness can be identified early, it is very beneficial to treatment. Early symptoms of mental patients can be manifested as:
(l) Personality changes: For example, people who are enthusiastic and gregarious become indifferent, alienated, unsociable, reticent, fond of being alone, avoiding relatives and friends, hostile, lazy and undisciplined. Or people who used to be very educated become rude, angry and rude to others.
(2) Neurological symptoms: such as headache, insomnia, fatigue, inattention, emotional instability, decreased work and study ability, hysteria-like manifestations, etc.
(3) Emotional changes: Early emotional changes are often manifested as high spirits, complacency, arrogance, meddling, bragging, doing things from beginning to end, and losing his temper; Or depression, depression, frowning, sighing, self-blame, pessimism, and even suicide; Or mood swings, anxiety, lack of adaptive emotional communication, etc. ; Or admire yourself in the mirror, talk to yourself, laugh and cry for no reason, and so on.
(4) Behavior change: Some people show strange actions and behaviors, with many actions, dull repetition and no purpose; Some people are slow in behavior, lazy in life, unable to work and do housework; Some people collect meaningless things, and even carry some unnecessary things such as peels and waste paper with them; Some people repeatedly wash or perform rigid ritual movements.
(5) inattention, memory decline: inattention or dullness, forgetfulness, forgetfulness, and decreased work efficiency.
(6) Sensitive and suspicious: If someone suspects that others speak ill of themselves, others will do whatever they say. Every move is directed at him by innuendo, and even the contents of TV, radio and newspapers are related to him; Some people feel that colleagues, neighbors, even parents and brothers are hurting her, afraid and uneasy; Some people think that everything around them is against him and has some special significance. This kind of person always believes in his own ideas, and no persuasion or explanation from others can change his point of view.
Overview of hypochondria
Hypochondriac neurosis is the abbreviation of hypochondria, also known as disease paranoia. This is a psychological and pathological concept that pays too much attention to one's health, worries or believes that one or more physical diseases exist, often complains about some discomfort, and repeatedly seeks medical advice, which can't be confirmed by various tests. This is a neurosis in which doubts, troubles and fears caused by unrealistic pathological explanations of one's feelings or signs occupy the whole body and mind. Characterized by excessive concern for one's health and persistent prejudice. The patient suspects that he has a disease that does not actually exist, and the doctor's explanation and objective examination are not enough to eliminate his opinion. According to foreign reports, this disease accounts for about 1% of all kinds of diseases. It usually happens after 40 years old, and there are more women than men. There is no epidemiological survey data in China, and the reported prevalence rate in Tianjin is 0.0 1‰, which is higher in men than in women. It is generally believed that culturally backward areas are more common, but from the research of Gopla, white-collar workers are also dense people in cities. This sometimes needs to be distinguished from sub-health state.
[Etiology and pathogenesis]
Hypochondria is caused by illness of relatives and friends or familiar people, or by misinterpreting doctors' words and medical knowledge, or by misunderstanding incorrect popular science propaganda, which leads to excessive concern and worry about one's own health, and leads to the mistaken belief that one is seriously ill, such as worrying about one's own "cancer", "heart disease" and "AIDS". Mild physical discomfort, normal blood vessel pulsation, bony protrusion and vague examination data are taken as evidence of illness, although the results of repeated examinations are normal. This is a mental illness.
The reasons for it were not known Hypochondriac patients often pay too much attention to their own health before they get sick, demanding perfection or stubborn, stingy and cautious personality characteristics. Male patients often have obsessive-compulsive characteristics, while female patients often have hysterical personality. About13 patients are induced by physical diseases, and a few patients may be iatrogenic. The strengthening of psychosocial factors has played a certain role in the persistence of the disease.
The personality of patients before illness is often sensitive, suspicious, subjective, stubborn, self-centered, self-pitying and withdrawn, which can be caused by the weak state of the body after illness, as well as by changes in the environment and individual physiological and psychological conditions, such as doubts about menarche and menopause, or inappropriate words of medical staff. Self-suggestion or conditional association, such as seeing a friend die of myocardial infarction, make patients pay too much attention to their slight chest pain, or suffer from sexually transmitted diseases after extramarital sex, resulting in anxiety and fear.
Normal people pay too much attention to their own health in a certain period, and may have hypochondriac thoughts if they suspect minor common diseases or discomfort, but they can give up hypochondriac thoughts after checking to confirm that they are free from diseases. Such manifestations do not belong to hypochondriac neurosis.
Hypochondriacs usually prove that they have a certain disease by some discomfort or pain in a certain part of the body, a certain system or an organ, and constantly strengthen it in an attempt to win the sympathy of others through various means. According to their different levels of knowledge, they think they have been attacked by wind, cold and virus, suffering from arthralgia, hepatitis, lung disease, cancer and heart disease. Their main complaints are foreign body obstruction in the throat, twisted intestine, blood flow under the skin, insect walking in the body or unstable pain in the part. Some patients complained that they smelled an unpleasant strange smell and had a strange change in their form. Patients may feel nervous, anxious or even nervous, repeatedly ask doctors for examination and treatment, and attach great importance to the subtle differences in examination results, believing that this difference "confirms" the existence of their own diseases. Persuasion and encouragement to others, not from a positive understanding, is often regarded as comfort to oneself and proves the seriousness of one's illness. Driven by the concept of hypochondriasis, patients are running around, seeking medical treatment everywhere and seeking the "latest" diagnosis. A large number of unnecessary or even repeated examinations have been done, and they are often dissatisfied with the negative results of repeated examinations. Although they think they have seized the "evidence" of occasional "positive" results, they are often suspicious.
In addition to the increasingly serious hypochondriac symptoms, patients have a good understanding of others, actively seek medical treatment, no mental decline, no abnormal findings in physical examination or laboratory examination, and the general diagnosis is easier to make clear.
Treatment of depression
The treatment is mainly psychotherapy, supplemented by drug treatment.
Patients should take all medical history and examination data to the medical psychological consultation clinic for medical treatment. Take a scientific attitude, discuss the nature of discomfort symptoms and worry about the cause of illness realistically, and cooperate with doctors to find out the problem.
After the diagnosis, the doctor should inform the patient of the examination results, and explain that a physical examination will not be carried out, and at the same time start psychotherapy. The purpose of psychotherapy is to let patients know the nature of the disease and alleviate or alleviate the influence of mental factors. It is legitimate for patients to care about their health, but don't repeatedly force doctors to do repeated and unnecessary examinations.
First of all, we should try to avoid possible iatrogenic effects. Iatrogenic influence refers to the adverse psychological influence caused by doctors' inappropriate words, attitudes and behaviors on patients. The iatrogenic effects are as follows: (1) Misdiagnosis; (2) Repeated examination and long-term diagnosis; (3) wrong treatment; (4) others. Therefore, we should pay attention to the following points in the treatment practice: (1) Pay attention to the doctor-patient relationship, don't deny the patients' diseases and symptoms, and don't guarantee the treatment easily. Patients should be told not to have too high expectations and requirements for treatment; (2) Don't give in to the patient's request for further examination. On the basis of understanding the patients, skillfully refuse unnecessary examinations, otherwise it will easily lead to the emergence of opposing emotions between doctors and patients; (3) In the course of treatment, when patients have new symptoms and chief complaints, they can't simply be classified as hypochondriacs. We should carefully check whether they are really accompanied by physical diseases, so as not to delay treatment.
It is necessary to fully and accurately understand medical knowledge and related information and pay attention to mental health.
In a word, it is difficult to achieve satisfactory results and time-consuming to carry out psychotherapy for hypochondriacs. However, as long as the patient is not in a mental state, has no obvious mental defects, and is willing to accept psychotherapy, from a practical point of view, psychotherapy can always make a difference and is beneficial to the patient to some extent.
The drug treatment of hypochondriacs is mainly to relieve the anxiety and depression associated with patients, and benzodiazepines can be used. FDD6？ Class a, tricyclic antidepressants and symptomatic analgesics, sedatives, etc. A few cases can be relieved by antipsychotics. According to the author's medication experience, sulpiride not only has anti-delusion effect, but also has anti-depression effect, which has a good curative effect on hypochondriacs. The dosage can be increased from 0. 1g once, twice a day, and gradually increased to 0.6~0.8g per day. At the same time, diphenhydramine 2mg each time, twice a day, to avoid the adverse reactions of extrapyramidal system.
We should be cautious when using electroconvulsive therapy, because electroconvulsive therapy is not only not conducive to the relief of symptoms, but also aggravates the anxiety and tension of patients receiving such treatment, and the mental burden is heavier. It is often difficult to give psychotherapy in the future, which will affect the therapeutic effect.
References:
Hypochondria, also known as hypochondriac concept or hypochondriac disease in medicine, refers to the fact that individuals pay too much attention to their own health or some functions of the body, so that they suspect that they have some kind of physical or mental illness, which is inconsistent with the actual situation. The doctor's explanation and the normal results of objective medical examination are not enough to eliminate their inherent prejudice. Patients often feel allergic. In addition to the unbearable external stimuli with general intensity, they can also "clearly" perceive the normal activities of the internal organs of the body cavity and pay too much attention to them, such as swelling, beating, blockage, involvement, distortion, entanglement, escape, hot air rushing up, etc. These aging diseases become the initial cause and basis of hypochondria, and with personality characteristics such as stubbornness, paranoia and suggestibility, they can develop into hypochondria.
There are also reasons for hypochondriasis: some irresponsible medical popular science magazines are alarmist, their grandstanding words, or the rash and arbitrary comments and judgments of individual medical staff will also cause or strengthen the hypochondriasis of patients. In addition, most hypochondriacs have the concept of hypochondriasis.
The treatment of such patients can be carried out simultaneously from several aspects:
1. Eliminate psychological pressure and prove that you are not sick. For patients with suspected disease concept, comprehensive and detailed physical examination and necessary laboratory and instrument examination should be carried out, and according to the examination results, they can show that they have no physical disease and dispel their ideological concerns.
2. Perfect personality. Hypochondriacs often have personality characteristics such as stubbornness, paranoia, sensitivity and caution. One of the main reasons for hypochondriasis is that people always think too much about pessimism or misfortune and lack self-confidence. Therefore, hypochondriacs should be broad-minded, strive to cultivate optimism and improve their confidence in life. We should go out into the society and enrich our lives, such as planting flowers, fishing, playing chess and drawing. We should also do some work and housework within our power, insist on physical exercise every day, communicate with relatives and friends more, and cultivate a sense of humor, so as to overcome negative pessimism and bad psychological state and finally cure hypochondria.
3. Psychotherapy. Cognitive understanding therapy is an effective method to treat hypochondriacs.
[Clinical manifestations]
At first, they often pay too much attention to their own health and any slight changes in their bodies, and make explanations of hypochondriacs that are inconsistent with the actual health conditions, accompanied by corresponding hypochondriac discomfort, and gradually appear more and more systematic hypochondriacs. The symptoms of hypochondria can be general malaise, pain or dysfunction of a certain part, or even a specific disease. Symptoms are mainly skeletal muscle and gastrointestinal system; As far as parts are concerned, most of them are head, neck and abdomen. Often accompanied by anxiety, anxiety, fear and autonomic dysfunction symptoms. This hypochondriac worry refers to the entanglement with physical health or the suspected disease itself, rather than the distress about the consequences of the disease or the secondary social impact. Patients also know that troubles are bad for their health and they cannot extricate themselves. Seek medical advice everywhere, state the whole story of the illness, and don't believe the examination results and the doctor's explanation or guarantee. Some patients only show symptoms of hypochondriac symptoms such as special olfactory abnormality or peculiar morphology.
[Course of disease and prognosis]
The duration of the disease varies, and the elderly can be delayed for months or years, with poor prognosis. Patients with acute onset, obvious inducement and timely treatment have better prognosis.
[Diagnostic Basis and Differential Diagnosis]
First, hypochondriasis is the main clinical manifestation, paying too much attention to one's own health.
Second, accompanied by symptoms of anxiety and depression;
Third, the ability of work, study and housework has declined;
Fourth, the course of disease is more than 6 months;
Five, exclude schizophrenia, endogenous depression and suspected physical diseases.
[therapy]
The treatment is mainly psychotherapy, supplemented by drug treatment.
First, psychotherapy: mainly supportive psychotherapy, after patiently listening to the patient's statement and careful examination, explain the suspected disease with facts, and avoid hasty examination and simple explanation. If combined with other treatment methods, the curative effect may be better. For patients with high suggestibility, hypnotic suggestion based on supportive psychotherapy may get good results.
Second, drug treatment: not much benefit. Anti-anxiety and antidepressants can eliminate anxiety and depression in patients. Antipsychotics are only effective for a few patients, and pimiqing (2 ~ 8 mg/d) may be effective for hypochondriac patients with single symptom.
Etiology and pathogenesis:
1, genetic factors The disease has a certain family genetic tendency. As a genetic feature, red blood cell (ABO) blood type is related to obsessive-compulsive disorder (OCD). It is found that the incidence of obsessive-compulsive disorder type A is high and the incidence of obsessive-compulsive disorder type O is low. ..
2. Psychosocial factors, as inducing factors, occasionally have obsessive-compulsive ideas in normal people, but they will not last. Only under the influence of psychological and social factors can we persist, such as changes in working environment, heavy responsibilities, many demands, many difficulties, fear of accidents or family discord, difficulties in sexual life, tension caused by pregnancy and childbirth, coupled with the patient's caution, indecision, indecision, lack of self-confidence and anxiety, thus producing obsessive-compulsive symptoms.
3. Organic factors Clinically, obsessive-compulsive symptoms can be seen in patients with lethargic encephalitis, temporal lobe contusion and epilepsy. However, surgical treatment showed that excision of the white matter at the edge of the caudal nerve bundle was effective in improving obsessive-compulsive symptoms, suggesting that it was related to the function of the above parts. In addition, personality characteristics also play a very important role in the pathogenesis, and this kind of patients often have the characteristics of being old-fashioned, conformist and too serious.
Clinical manifestations:
1, compulsive concept
(1) Obsessive-compulsive disorder patients have doubts about the correctness of their behavior. Although I know this doubt is unnecessary, I can't get rid of it. If the patient doubts whether the back door of the house is locked, whether the gas is turned off, and whether the electric light is turned off. The letter has been sent. I don't know if I wrote the wrong address or forgot to say hello. On this basis, the patient has compulsive behavior and is always in doubt and anxiety. They often drive themselves to check the correctness repeatedly for peace of mind, which will affect their work and daily life in serious cases.
(2) Obsessive-compulsive memory patients repeatedly recall the past and experiences, although they know that they have no practical significance, but they appear repeatedly and cannot get rid of them.
(3) Compulsive thinking For some problems that lack practical significance, patients know it is unnecessary, but they think endlessly. If the patient repeatedly thinks, "Why do people have two eyes? "and so on.
(4) Compulsive thinking On some occasions, patients are entangled in a kind of thinking that is contrary to their normal understanding, knowing that this opposite idea is wrong, but they can't resist it, and their hearts are very painful. For example, when he single-handedly: welcomes, congratulates, etc., the patient will immediately \ "\" denounce \ "\" criticize \ "but will not implement corresponding actions.
2. Intention and action of coercion
(1) Obsessive Intention On some occasions, patients will have an idea contrary to the situation at that time, and will be entangled by this intention. The patient knew it was against his will, but he couldn't control it. For example, a mother standing on the balcony with a baby in her arms suddenly has the idea of throwing the baby downstairs, knowing that it is against her will, but she can't get rid of it, but she will never take action. Therefore, patients with this idea are afraid to take their children near the railings of high-rise buildings, so as not to cause fear and anxiety. If it is related to the compulsive thinking of fear content, it is called compulsive fear.
(2) Forced counting is uncontrollable counting related to forced association. Patients can't help counting things, even their own steps, the glass windows of roadside buildings, and the signs on the roadside. It's meaningless for patients to know, but they can't remember it after counting, but they can't control it.
(3) compulsory washing is afraid of not suffering from an infectious disease. When the patient comes into contact with something, he should wash his hands repeatedly until he knows that his hands are clean, but he can't control them, otherwise he will feel uneasy.
(4) Forced ritual actions This is a set of repetitive, rigid and interrelated actions. This ritual action is often of special significance to patients, who complete this ritual in order to get luck and good omen, thus comforting their hearts. I want to complete a set of actions when I enter the door, which means that his child's illness will be successful, knowing that it is meaningless, but if I don't do it, I will be anxious. Most of this disease has a slow onset and a long course. If the acute onset, the inducement is obvious, and there is no obsessive-compulsive personality before the illness, the prognosis is generally good.
Principles of treatment:
1. Psychotherapy based on behavioral therapy. 2. medication.
Expert tip:
Obsessive-compulsive disorder is one of the more intractable diseases. Drug treatment such as clomipramine can alleviate some symptoms, but it is difficult to completely cure them. Behavioral therapy has a certain effect, but it is difficult to consolidate the effect. Methods include shock therapy, systematic desensitization therapy and thinking interruption. Individual suitable cases can be treated with psychotherapy, which is reported to have an ideal effect, but it takes a long time and is not easy to implement. Strict Morita therapy has a good effect on obsessive-compulsive disorder and usually requires hospitalization. At present, the most commonly used treatment for obsessive-compulsive disorder is drug therapy plus cognitive behavioral therapy, which can achieve good results.
Other answers
Etiology and pathogenesis:
1. Psychosocial factors: interpersonal failure, marital changes, loneliness after children leave, influence on life stability, insecurity, etc. Can be regarded as the cause of disease. Some patients are iatrogenic, such as doctors' inappropriate language, attitude or behavior, which arouses patients' doubts. If it is difficult for doctors to make an exact diagnosis of the disease and repeatedly examine the patient, it will lead the patient to suspect that he has some kind of disease. There are also people who doubt the disease through self-suggestion or association after they get sick.
2. Personality characteristics: Susceptible quality is an important foundation of disease, which is characterized by sensitivity, paranoia, subjectivity, stubbornness, caution or excessive concern for the body, and everything requires perfection. Some male patients have obsessive-compulsive personality before illness, while female patients have hysterical personality characteristics.
Clinical manifestations:
1. Psychological disorders are manifested in two forms: one is hypochondriasis, that is, the sensitivity to a certain part of the body increases, which leads to hypochondriasis or excessive attention, while the patient's description of the disease is vague and his position is not constant; Secondly, the concept of hypochondriasis means that patients think they have some kind of disease and describe it vividly. But sometimes I'm sure these diseases don't exist, but I still ask for various tests. Although the examination was normal, the doctor's detailed explanation could not dispel his belief of hypochondriasis, and he still thought that there might be mistakes in the examination, which made him anxious, nervous, anxious and distressed, with strong emotional color.
2. Pain This is the most common symptom. About 2/3 patients have pain symptoms, and the common parts are head, waist and iliac fossa. But often unclear, can not find positive signs, accompanied by insomnia, anxiety, depression. The patient sought medical treatment everywhere without success, and finally came to the psychiatric department for treatment.
3. Physical symptoms are diverse, involving many parts of the body, mostly abdomen, chest, neck and head. The physical symptoms of the patient's chief complaint are scattered and vague, clear and meticulous. For example, the patient complained of stomach swelling and dull pain, slow gastric peristalsis, pyloric obstruction and food difficulty, so the patient came to the conclusion that he had "stomach cancer". Hypochondriac patients are very sensitive to visceral activities that ordinary people can't detect, such as heartbeat or trivial body pain and soreness, and are particularly concerned about nasal secretions, sticky feces and swollen lymph nodes, which are considered as the source of the disease.
4. Course of disease and prognosis. Patients with acute onset have a good prognosis. If hypochondria is accompanied by depressive neurosis and anxiety, the prognosis is good. If the course of disease is more than two years, the prognosis is poor. Because the patient is suspicious, sensitive and suspicious, and pays too much attention to the body, the disease is in a chronic protracted process.
Expert tip:
Hypochondria is one of the more difficult diseases to treat. Cognitive therapy and suggestion therapy, combined with anti-anxiety and anti-depression drugs, can alleviate some symptoms.
References:
Hua Fei Health Network