Mental disorder associated with physical infection
Introduction to mental disorders associated with physical infections
A mental disorder associated with a physical infection is a systemic infection associated with viruses, bacteria, spirochetes, fungi, protozoa or other microorganisms, parasites, etc., such as influenza, pneumonia, falciparum malaria, sepsis, leptospirosis, schistosomiasis, Mental disorders caused by AIDS, etc. There is no evidence of direct infection in the skull. The prevention of mental disorders caused by physical infection is to prevent primary infectious diseases. For example, more than 90% of malaria deaths are cerebral malaria, which is caused by a highly virulent neurotropic Plasmodium falciparum. The sinister malaria caused by infection, so timely diagnosis, correct treatment and adequate treatment is the key to preventing cerebral malaria.basic knowledge
Sickness ratio: 0.0001%
Susceptible people: no specific population
Mode of infection: non-infectious
Complications: depression schizophrenia
Causes of mental disorders associated with physical infections
(1) Causes of the disease
All kinds of acute and chronic infections are the cause of such mental disorders. It can be seen in the process of pneumonia, influenza, epidemic hemorrhagic fever, typhoid fever, malaria, AIDS or other physical infections. see.
The pathogenesis of infectious mental disorders has not yet been elucidated. It is generally believed that the occurrence of mental disorders is related to many factors, the nature of pathogens and the intensity of toxins, the speed of action, time, quantity, and abnormalities caused by infection, or with brain tissue. Temporary edema, hemorrhage, hypoxia, etc., and elevated body temperature and body exhaustion can be the cause of mental disorders. In addition, the same infection can produce mental symptoms in some patients, while others do not. Produced, this situation is related to individual differences such as age, health status, type of nervous system, responsiveness, immunity, stress characteristics, such as children with various infectious diseases, tend to produce disturbance of consciousness, but in the elderly In the early stage, it is easy to produce depression and anxiety, which indicates that the above factors also affect clinical manifestations.
The Pavlovian school believes that under the action of infection, the cerebral cortex produces protective inhibition and phase state, which affects the normal coordination function of the cortex and the lower part of the cortex. If the infection is light, the body's resistance is strong. Generally speaking, this kind of spirit The prognosis of the disorder is better. Conversely, the deepening of the poisoning leads to the destruction of the central nervous cells, exhaustion, and deep inhibition. The patient presents with severe disturbance of consciousness and coma, and the prognosis is poor.
Bonlioeffer (1908) proposed the concept of "external response type" psychosis. He believes that infection can cause similarities. The mental response determined by the innate personality structure, that is, the mental disorder associated with infection does not depend on the nature of the disease. According to this theory, the original infection is different, but the mental disorder caused by it is similar. This opinion has its own factual basis, but the characteristics of the original infection also have a certain impact on mental disorders.
Cyxapeba believes that the effect of certain infectious diseases is acute, so the specificity of pathogens is not easy to be revealed in a certain period of time, and protection in the cerebral cortex at this time. The defense response of sexual inhibition is dominant, so the clinical manifestations are mostly various disturbances of consciousness. Second, because mental disorders occur in the same stage of infectious diseases, such as the state of paralysis is more common in the early or severe stage of the disease, and the mental disorder is mostly in the disease. The terminal debilitation phenomenon is obvious; thirdly, because they have the same pathophysiological mechanism, some experts have proved that the central nervous system has a specific reaction in addition to a certain toxic factor, and there is a general reaction.
It is worth mentioning that human immunodeficiency virus (HIV) infection, also known as acquired immune deficiency syndrome (AIDS), is an infectious disease caused by retrovirus. Mainly through sexual contact or blood and blood products and other infections, leading to human immune dysfunction, characterized by decreased cell-mediated immune function, causing opportunistic infections and opportunistic tumors, the incidence rate has increased in recent years, due to this The neuropsychiatric complications of the disease are quite prominent and diverse, which has attracted the attention of the psychiatric community. The etiology and pathogenesis are:
1HIV is not only lymphatic, causing immunodeficiency, but also pro-nervous, HIV directly acting on the central nervous system is the main cause of neuropsychiatric disorders.
2 Most of the microorganisms cause opportunistic infections can cause central nervous system damage, among which more common are toxoplasmosis, cryptococcal meningitis and multiple white matter.
3 opportunistic brain tumors are also one of the causes of central nervous system damage in AIDS patients, leading to neuropsychiatric disorders, such as primary central nervous system lymphoma that occurs in the later stages of the disease.
4 adverse drug reactions Many drugs for the treatment of HIV infection and treatment of opportunistic infections can cause neuropsychiatric adverse reactions, 5 in the middle and late stages of AIDS, due to hypoxia, dehydration, sepsis, liver and kidney failure, hyponatremia Symptoms, hypercalcemia, hypoglycemia and other factors affecting the metabolism of the central nervous system can cause neuropsychiatric symptoms.
Prevention of mental disorders associated with physical infections
Mandatory inspection and mandatory segregation: At the beginning of the AIDS epidemic, due to the aversion to the pre-disease lifestyle of AIDS patients, a few conservative Americans have proposed to conduct HIV antibody testing nationwide, and those who are positive are forcibly isolated; The patient was treated with detention until death, and the public had a fear of AIDS. Once there was a child who was banned from HIV, the incident of burning HIV-positive people, compulsory serum testing and mandatory isolation measures were eventually The veto is considered: if there is no effective treatment, compulsory inspection is meaningless; the mode of transmission of HIV is clear, mandatory isolation is not necessary, and isolation measures for victims of the disease are inhumane. China was in 1987. It is stipulated that Chinese people who have lived abroad for more than one year and returned to China for settlement or residence for more than one year will be tested for mandatory HIV serum antibodies, but this regulation is quite inconsistent in the implementation of customs.
National Health Education: From the perspective of epidemiology, disease intervention for the entire population is primary prevention. Primary prevention is through radio, television, newspapers, magazines and other media, lectures, street charts and other activities, including: universal AIDS Relevant knowledge such as the spread of AIDS, reduce public fear of the disease; promote healthy lifestyles such as staying away from drugs, loyal monogamous relationships, etc., universal health education can increase the public's awareness of AIDS, increase self Protection awareness, but education for all has its limitations, that is, it can not meet the needs of different groups of people, it is difficult to spread effective information to susceptible people, so secondary prevention for vulnerable people is a necessary supplement for primary prevention. .
Complications of mental disorders associated with physical infections Complications depression schizophrenia
The disease is caused by viruses, bacteria, spirochetes, fungi, protozoa or other microorganisms, parasites and other systemic infections, such as influenza, pneumonia, falciparum malaria, sepsis, leptospirosis, schistosomiasis, AIDS, etc. obstacle. Therefore, the complications are mainly complications caused by infectious factors, such as bacterial infection can cause the infection to spread throughout the body to form sepsis. Treponema pallidum infection can be complicated by rash, bone syphilis, neurovascular syphilis. Severe pneumonia can be complicated by ARDS, etc. The complications are clear according to the source of the infection, so it is necessary to determine the source of the infection before the specific complications can be identified.
Symptoms of mental disorders associated with physical infections Common symptoms Attention deficits, irritability, irritability, restlessness, social fear, slow mental disorder, meningitis, meningeal irritation, incoherent thinking
1. Common clinical features of somatic infectious psychiatric disorders Psychiatric symptoms manifested by physical infections have their own characteristics, but they have many similarities in the acute phase of infection and post-infection mental illness. Somatic infections The common mental disorders associated with them can be summarized into the following five categories.
(1) Disorder of consciousness: This is the most common symptom in the acute phase of infectious psychosis. The degree of disturbance of consciousness varies from mild consciousness to severe paralysis, insanity and even coma. Secondly, the disturbance of consciousness occurs mostly during the high fever period, and parallel with the rise and fall of body temperature. A few patients occur after the fever, and very few patients appear before the fever. Some patients have symptoms of consciousness that are still up and down. The characteristics of night weight, some patients can maintain a waking period of several minutes to several hours, the duration of the patient's consciousness disorder is also different, only a few hours short, up to more than one month.
(2) Infectious hallucinations: occur in the acute phase, the patient's consciousness disorder may not be obvious, or clinically difficult to detect, hallucinations are more common in auditory hallucinations, the content is more fixed, and closer to reality, such as hospitalized patients can hear The doctor or nurse calls him or criticizes him or the patient is talking about him. The child patient can hear the mother calling him, so he can produce corresponding behaviors, such as performance screaming, etc. Some patients have partial judgment on the hallucination and thus influence the behavior. Not much, this symptom can last for a long time, but it can automatically recover.
(3) Weak state: more common in the terminal or recovery period of acute infectious diseases, characterized by physical or mental weakness or exhaustion, when there may be hyperesthesia, easy to be shocked, easy to be nervous, such as patients can not tolerate loud and bright, Often feeling general malaise, soreness, short-term examination or a moment of conversation, the patient feels extreme fatigue in energy and physical strength, emotional instability, fragility, irritability and depressive symptoms, the patient is always dissatisfied, seeing everything feels uncomfortable Everything is stimulating him, making him bored, angry, the patient is languid, jealous, complaining, emotionally excited, becoming very fragile and unstable, often crying unreasonably or monotonously choked, this crying is not accompanied by Obvious sorrow, shallow sleep and more dreams, inability to concentrate, memory loss, the patient's symptoms gradually recover with the general condition of the general condition, which is the identification point of patients with neurasthenia, serious cases, can be obvious Suppress the state, the reaction to the outside world is weak, only some simple actions can be done, such as opening the mouth, sticking out the tongue, etc., answering the question slowly, the voice is low or Able to answer, in terms of the body often show significant consumption state, pale, weight loss, weakness, sweating, heart palpitations, loss of appetite, etc., after the weak state of the duration of infection vary, sometimes takes a long time to rest and supportive therapy.
(4) Amnesia: After acute infection, it is more common in middle-aged and elderly people. It is mainly characterized by weakened or lost ability to memorize recent events, and its retention is also weakened. Because of memory impairment, there may be disorientation, but there is no fiction and error. This memory disorder is temporary and generally recovers with the improvement of physical health. A small number of patients forget to persist for a long time, for several months or years.
(5) Personality change: more common in children with central nervous system infection, but after a serious systemic infection can also appear personality changes, children with excitatory increases, active, so-called behavior debauchery and cruel, some good lying , theft, this type of personality change lasts longer, and is not easy to heal, and becomes a lasting sequela.
2. Several common acute infection-induced mental disorders
(1) Mental disorders caused by influenza: Influenza is a respiratory infection caused by influenza virus, which can often lead to mental disorders. The symptoms are more acute and the symptoms are obvious. It can be divided into two types, A and B. Types of neurological symptoms are more common and serious, and the mental symptoms of influenza are more common in the fever period or late fever.
In the case of influenza, the occurrence of mental symptoms has a certain process. The earliest symptoms before the onset of mental symptoms are headache, general weakness, fatigue, extreme weakness, daytime sleepiness, nighttime insomnia, early onset of mental symptoms, visible sleepiness, perceived disturbance , non-photorealistic, accompanied by a terrible episode of pain in the precordial area, and a mood disorder with depression, an anxiety and depression during the fever period, the patient is restless, self-blame and guilty, and the murder is rare. The state is short-lived, and after a fever, there is a debilitating state or a depressed state. The patient shows distraction, slow thinking, weak understanding, and depression. This state can last for a period of time, and no sequelae remain.
A small number of patients have disturbances of consciousness during high fever, but to a lesser extent, such as drowsiness and confusion. When the consciousness is blurred, a special form of "wet illusion" may appear, which is a psychiatric disorder unique to influenza. The main manifestation of "wet illusion" is that the patient feels that water or other liquid is poured into the body, or that it feels like using an empty needle to inject water into the body so that the body feels swollen, or sees a flood of lakes, which can occur at the same time of hallucinations. The symptoms of anxiety and delusion that are submerged by water, this symptom lasts for a short time, hours to days.
1 mental symptoms when influenza:
A. Depression, debilitating state: more often in the febrile period or after retreat, with the most prominent symptoms of depression and neurasthenia, showing depression and sorrow, dull speech, sluggishness, depression, loss of appetite, and even negative attitudes.
B. Disorder of consciousness: high fever, secondary infection, there may be disturbance of consciousness, clinical manifestations, confusion or lethargy, may be accompanied by convulsions or convulsions.
2 physical symptoms include neurological symptoms and signs:
A. Brain weakness syndrome.
B. Bradycardia, extreme instability of vasomotor nerves.
C. Autonomic dysfunction.
D. Asymmetry or reduction in knee reflexes may occur in severe cases.
(2) Psychiatric disorders caused by pneumonia: all kinds of pneumonia can produce mental disorders, the production of mental symptoms and viruses, bacterial toxins cause the body's function and metabolic disorders, directly or indirectly damage brain cells, and ultimately lead to brain dysfunction, lungs Acute infection, pneumonia, psychiatric symptoms, high fever, the most common disturbance of consciousness, most patients receive antibiotic treatment at an early stage, so the emergence of cognitive disorders is light, common confusion, serious paralysis is rare, but in the elderly or In pediatric patients, it is prone to sputum status, acute lung infection has disturbance of consciousness and bacterial toxins, dehydration and sodium deficiency associated with sodium deficiency, acute hypoxemia and other factors, especially in patients with lobar pneumonia, flow The blood in the capillaries of the diseased lung leaves is in poor contact with the alveolar gas, and the oxygen uptake and carbon dioxide excretion are incomplete, so that the partial pressure of oxygen in the arterial blood can be drastically decreased, forming hypoxemia, which can cause disturbance of consciousness. In the case of oxygen inhalation therapy, the time of disturbance of consciousness is generally not long, and it is improved with the control of pneumonia.
In chronic emphysema, chronic bronchitis and bronchial asthma, psychiatric symptoms may also occur. In patients with extremely high respiratory resistance such as chronic emphysema, due to respiratory infections, etc., hypermetabolism or physiological ineffective cavities Increase, arterial blood carbon dioxide partial pressure rises, the pH value in the nerve cells decreases, causing the carbonic anhydrase activity to decrease, the conduction to the stimulation is reduced, and neuropsychiatric symptoms may occur, such as memory loss, forgetfulness, lethargy, and slow answering questions. , understanding difficulties, time and place orientation disorder, until coma, or the opposite manifested as irritability, emotional or manic state, neurological examination revealed limb tremors, convulsions, sometimes visible optic disc edema, pneumonia caused by mental symptoms:
1 disturbance of consciousness: the most common, the lighter is drowsy, the other is coma, the majority is paralyzed, the thinking is incoherent, excited, restless, disorientation and illusion and hallucinations, etc., the disturbance of consciousness is controlled with pneumonia in a few days. And it is getting better.
2 dementia syndrome: some patients may have near memory impairment and mental retardation, more common in elderly patients with chronic bronchitis and pulmonary insufficiency.
3 types of manic state: a small number of patients with nervous temperature can appear nervous, restless or excited, more words, euphoria and other symptoms.
4 brain weakness syndrome: in the recovery period of the disease, most patients may have weakness, fatigue, insomnia, memory loss, depression, sweating, palpitations and other symptoms.
(3) Mental disorders caused by malaria: Malaria may be associated with mental disorders, mostly in cerebral malaria, and occasionally by vivax malaria, a highly virulent neurotropically infected Plasmodium falciparum Most of them are caused by malaria outbreaks or in malaria-free populations (such as children, adolescents and non-immune people entering high malaria areas), due to the large number of protozoa in the blood and poor body resistance. A sinister type of malaria, the common types of sinister malaria are brain type, super high heat type, cold type, gastrointestinal type, of which brain type is more common.
The pathogenesis of sinister malaria has not yet been fully elucidated. There are microvascular obstruction theory, disseminated intravascular coagulation theory and inflammatory response theory. The latter are based on more adequate animal experiments and clinical data, and have obtained the support of the majority. In the case of sinister malaria, blood flow caused by increased cerebral vascular permeability, local blood stasis, hypoxia, or even tissue necrosis, or small blood vessels contracting organs such as liver and kidney, causing local blood supply deficiency, are caused by malaria The metabolites of protozoa stimulate the results of inflammatory reactions produced by the human body. The changes in organ function and histology caused by inflammatory congestion and even blood flow are completely restored. At the beginning, they are also irreversible and finally make The patient died, and the pathological changes in the brain caused by falciparum malaria were brain tissue edema and hyperemia.
There are few reports of neuropsychiatric symptoms of brain type, and there is no specificity. According to reports by Redlich and Freedman, in acute cases, mainly conscious disturbances, some convulsions, in subacute and chronic patients, with emotion Indifferent, emotional depression, and some anxiety, snoring or personality disorder, Daroff divided 19 patients with neuropsychiatric disorders into the following five groups:
1 disturbance of consciousness is the most common, 8 cases are from drowsiness or coma.
2 abnormal movement.
3 focal neurological signs.
4 acute organic psychosis, there are 4 such as mental disorders, disorientation, mental retardation.
5 acute personality changes in 3 cases, accompanied by delusional response, Wintrob (1973) reported that in acute cases, there are paralysis, delusions, tension, excitement or mania, in subacute cerebral malaria, irritability, insomnia, Excitement, disorientation, vision, auditory hallucinations, delusions, and some degree of memory loss and disturbance of consciousness (such as lethargy, lethargy, etc.), reported in the mental symptoms of malaria patients, mainly manifested as depression, delusional depression and suspected disease Sexual syndrome, with encephalitis cases, often have cerebral vascular damage such as seizures and hemiplegia. Lemercier et al found bilateral symmetrical slow wave activity in electroencephalography of 76 patients with cerebral malaria. It is believed that mental factors can promote malaria. When nervous, adrenaline secretion increases. Parasites are caused by malaria caused by the reticuloendothelial system of the spleen being squeezed out, and people with mental burdens are less resistant to malaria episodes.
There are also cerebral malaria in our district. According to regional statistics, cerebral malaria accounts for 2% to 8% of falciparum malaria. More than 90% of malaria deaths are cerebral malaria, and cerebral malaria changes rapidly. The patient began to have severe headache, nausea, vomiting, irritability, and varying degrees of disturbance of consciousness; some were indifferent, unresponsive or in a state of drowsiness; and some showed coma, convulsions, excitement, etc. The nervous system can be seen with strong neck, positive Klinefelter sign, positive pyramidal sign, hyperreflexia, increased muscle tone. Most patients have seizures, incontinence, occasional hemiplegia, paraplegia, strabismus, aphasia, and hearing loss. Etc., intracranial pressure can be increased, the vast majority of cases recovered after treatment, a few residual tremor, dysphagia and other symptoms, according to statistics, 57.6% of cerebral malaria occurred in the first week of onset, so timely diagnosis, correct treatment, treatment Adequately, the elimination of Plasmodium as soon as possible is the key to preventing cerebral malaria.
(4) Mental disorders caused by acute bacterial dysentery: Adults suffering from acute bacterial dysentery rarely have mental disorders, but in the elderly or children and poor constitution, when children suffer from dysentery, mental symptoms are more common before the disease. On the basis of trauma or physical illness, the most common mental symptoms are disturbance of consciousness. There may be initial paralysis, fever and phlegm, and delusions may occur. If the child is afraid of someone poisoning him, he refuses to eat. To kill him and fear, etc., children can also have epileptic seizures.
(5) typhoid fever, paratyphoid-induced mental disorder: this type of infectious disease is more prone to mental symptoms, typhoid fever is caused by typhoid bacillus intestinal infection, often accompanied by mental symptoms, mental illness caused by typhoid fever caused by bacterial toxins In the early stages of typhoid fever, there may be some prodromal symptoms such as headache, sleep disturbance, fatigue, dull expression, dullness, and at the end of the week after the illness, most patients have lethargy, dull expression, unresponsiveness and paralysis. 2 weeks or 3 weeks, the patient's condition continues to develop, the body temperature continues to rise, there are obvious mental symptoms, confusion or fever, uneasiness, whispering or loud noise, can have the illusion of illusion of the piece, accompanied by tension, Fear, a few patients also have fictional symptoms, when the body temperature drops, the mental symptoms disappear, and a weak state can occur during the recovery period of typhoid fever.
It is worth noting that, on a global scale, typhoid fever varies from region to region and climate, and the psychiatric symptoms are very different. The predisposing factors for psychiatric symptoms are complex, and are related to infection and mental factors. Some typhoid fever Clinical manifestations of psychiatric symptoms as its main clinical phase, without fever and other symptoms of typhoid fever, easily misdiagnosed as acute schizophrenia, severe depression, mild mania, or acute brain syndrome, should be given high attention, its clinical spirit Symptoms can be divided into the following three categories:
1 disturbance of consciousness: mostly occurs in the period of high fever, which can be expressed as confusion or embarrassment, indifferent expression, distraction, self-speaking, confusion, often accompanied by sight, auditory hallucinations, and others express excitement and fragmentary delusions, after It turned into a state of confusion.
2 Illusion delusions: more often appear after fever.
3 types of manic state: more occur in the pre-temporal or physical disease improvement period, performance excitement, words, euphoria, busy, emotional instability, similar to light mania, but the symptoms of thinking and running are not prominent, the duration is short.
(6) Mental disorders caused by epidemic hemorrhagic fever: epidemic hemorrhagic fever, an acute infectious disease characterized by fever and hemorrhage. The pathogen may be a virus, and its epidemic is endemic and sporadic, epidemic hemorrhagic fever. The brain sees the brain: the meninges, the brain surface and the brain parenchyma have different degrees of vascular congestion, brain swelling and cerebral palsy, and the brain parenchyma has different degrees of necrosis. Under the microscope, the brain parenchymal cells are chronic and ischemic. Change, surrounded by glial cells around the nerve, the pathogenesis of epidemic hemorrhagic fever is not fully understood, with neuropsychiatric disorders more difficult to clarify, may be associated with bacterial toxins, high fever, brain edema, hypoxia and necrosis, and due to complicated uremia, Pulmonary edema, visceral hemorrhage, myocardial damage, failure and other factors are related to the disease, about one-third of the cases have mental disorders, the clinical manifestations of epidemic hemorrhagic fever are divided into five phases: fever period; hypotensive period; oliguria period; During the urinary phase; during the recovery period, mental and neurological symptoms occur mostly in the hypotensive phase and the oliguria phase. The latter is especially common, mainly from disturbance of consciousness, from lethargy, lethargy to coma. There are also performance delirium, mental confusion and hazy state, duration of symptoms one to two weeks, with severe complications such as poor prognosis.
1 mental symptoms:
A. Consciousness disorder: Most common, different degrees of severity, can be expressed as lethargy, lethargy, coma, convulsions, paralysis and mental disorders, among which sleepiness or paralysis is more, and consciousness disturbances tend to fluctuate repeatedly.
B. Excited state: A small number of cases can present irritability, excitement, and disturbance of consciousness.
C. False dementia: I can find it.
2 neurological symptoms: epileptic seizures, pyramidal tract signs, meningeal irritation, cortical syndrome, intracranial hemorrhage, fundus hemorrhage and tremor.
(7) Mental disorder caused by rabies: Because rabies virus invades the body, systemic reactions and brain nerve cell damage are caused by the action of viruses and their toxins, which in turn causes brain dysfunction. The clinical manifestations are:
1 cerebral weakness syndrome: occurs mostly in the prodromal period of the disease, with fatigue, headache, insomnia, anorexia, weakness, wound itching and numbness as outstanding performance.
2 Anxiety, fear state: As the disease progresses, anxiety, anxiety, and sensitivity to sound, light, wind, and water are very sensitive. When the patient smells the water or sees the water, the whole body is paralyzed, but the symptoms of water scarring often appear. Late disease.
3 Spiritual agitation: As the disease progresses, the aggression increases, the collision, shouting, and non-stop, can be accompanied by hallucinations. This agitation state can be relieved briefly, but eventually leads to physical failure, and there is very little injury during the incitement. behavior.
3. HIV/AIDS related mental health problems
(1) The discovery of AIDS and its global prevalence:
1 The arrival of the AIDS era: In June 1981, the Centers for disease control and prevention (CDC) in Atlanta published a report that five male homosexuals had very rare Cartesian lungs. P. carinii pneumonia is being treated in Los Angeles hospitals. One month later, the National Institute of Health (NIH) reported that 26 male homosexuals were diagnosed with Kaposi's sarcoma. This cancer is usually seen only in the elderly and patients after organ transplantation using immunosuppressive agents. Because these patients are characterized by extremely low immune function and are homosexual, NIH originally named it GRID (gay- Related immune deficiency), thought that this disease may be related to the lifestyle of homosexuality, and soon found that heterosexuals also became victims of the disease, renamed AIDS (acquired immuno deficiencv syndrome) - that is, AIDS, in August of the same year, The CDC has registered 104 AIDS patients, 43 of whom have died. In May 1983, NIH and the Pasteur Institute of France jointly issued AIDS in the media, that the human immunodeficiency virus (HumanImmunodeficiencv Virus, HIV), which affirmed that AIDS is an infectious disease.
2 The prevalence of HIV and AIDS in the world: The indifference adopted by the US government in the early days of the AIDS epidemic led to the proliferation of this century plague in the United States: according to the 1998 report of the CDC, the top 10 causes of death in the United States in 1996 AIDS ranks 7th, while it ranks 3rd in the 22-44 age group; as of December 1998, there were 688,000 registered AIDS cases (of which 410,000 have died) and 650,000 ~900,000 people are HIV-infected.
Globally, according to UNAIDS estimates, there are currently 33 million people living with AIDS or carriers. By the end of 1998, 14 million people had died of AIDS. In 1998, 580 people were infected. Tens of thousands of people in some sub-Saharan African countries have a virus infection rate of 30% or even 50%. In Asia, there are 7.2 million people living with HIV, of which 1.2 million are new cases in 1998. South Asia and Southeast Asia have become the fastest growing areas of HIV infection. Cambodia, Thailand, Myanmar and India, which are adjacent to China, are the countries with the highest HIV infection rates in Asia.
In 1985, China discovered the first case of AIDS patients. This is a tourist from abroad. In the following years, AIDS cases were reported to foreigners and overseas Chinese in China. Only 4 cases were found in Zhejiang due to the use of American Amour. The company imported the infected factor VIII and infected with HIV. On August 19, 1989, Ma Wei, the chief of the virus department responsible for AIDS surveillance in Yunnan Province, used the relationship between the students and went to the Ruili City Drug Addiction Treatment Center to collect 50 serum samples of drug users. A total of 26 HIV-positive people were detected. Since then, 146 HIV-infected people have been found in Yunnan drug users, which indicates that AIDS has been developed from foreign input to domestic dissemination. As of September 1999, 31 provinces nationwide. A total of 15,088 HIV-infected people have been found in the municipalities, including 477 AIDS patients and 240 deaths. However, due to the difficulties of census and the concealment of AIDS, in May 2000, according to relevant experts, conservative estimates of HIV infection in China The actual number of people has exceeded 500,000. If the control is not effective, the number of HIV infections in China will exceed 10 million by 2010.
3 Demographic characteristics of HIV-infected and AIDS patients: In the United States, AIDS cases are classified by exposure factors, and gay men (or more accurately men who have sex with men, Men who have sex with men, MSM) account for 48 %, 26% of injecting drug users, and heterosexuals, especially those who have sexual contact with injecting drug users, account for 10%. It is worth noting that the prevalence and prevalence of AIDS are much higher among blacks and Hispanics than whites. The spread of AIDS among women is also increasing year by year. In developing countries such as Africa and Asia, heterosexual transmission is the main mode of transmission of AIDS. In China, 2/3 of HIV-infected people are infected by injecting drugs, and 10% are caused by sex. Contact spread, such as Zheng Xiwen and others, found that in the intravenous drug users in Ruili, Luanchuan County, Yunnan, the HIV positive rate was as high as 80%, and the annual seroconversion rate was over 40% (Zheng Xiwen, 1994), intravenous drug use. The high incidence of HIV infection in the population has spread to the interior. For example, Wang Shaozhi and others conducted a HIV sero-epidemiological survey on 1649 faculty members of the labor camp in Sichuan Province. The detection rate of HIV was the highest, reaching 5.3%, only 0.65% of mouth suckers (Wang Shaozhi, 1998). In recent years, the proportion of sexual transmission including homosexual behavior and blood transfusion has increased, such as Fujian Province in 1987. In 1997, a total of 569,870 samples were tested, and 70 HIV positive cases were found, of which 75% were heterosexual contact transmission (Yan Yansheng, 1999). The minority population in China only accounted for 8% of the total population, but registered Among HIV-positive cases, ethnic minorities account for 36%. For example, in Yunnan, 80% of infected people are ethnic minorities such as Yi and Jingpo.
4 Risk factors for promoting HIV transmission in China:
A. The resurgence of drug abuse in China: There were 596,000 drug users registered in China in 1998. The public security department estimates that the actual number of drug users is several times the number of registered persons, and more than 85% are young people under the age of 35, and the mode of drug abuse is The phenomenon of snorting and intravenous injection is becoming more and more common. Among the injecting drug users, there is a relatively high proportion of needles shared, and the proportion of unsafe sex is also high, such as Wu Zunyou and other 192 cases of intravenous drug users in Yunnan. The survey found that 73% of people share injection equipment. Among all drug users, premarital/extramarital sex is four times that of non-drug users, and only 2.5% of unsafe sex uses condoms (Wu Zunyou, 1998) .
B. Unsafe sex: refers to a person who does not understand the HIV infection status of the other person to conduct unprotected sexual intercourse, mainly including defamation behavior and multi-sex partner behavior. According to the statistics of the public security department, in 1996, a total of prostitutes were arrested. 420,000 people, and the actual number of people engaged in prostitution may be between 3 million and 4 million, accompanied by an increase in the incidence of sexually transmitted diseases. In 1997, the number of reported cases of sexually transmitted diseases was 461,500, an increase of 15.8% over the previous year. The infection rate of sexually transmitted diseases among women engaged in commercial activities in the women's education center averaged 30%. Guo Shenyuan et al. monitored sexually transmitted diseases for 859 persons detained for sexual crimes and found that the prevalence of sexually transmitted diseases among male detainees was 22.22%. The female has a prevalence rate of 24.77% and the highest prevalence of syphilis (Guo Shenyuan, 1998). From a physiological point of view, genital ulcers caused by sexually transmitted diseases increase the chance of HIV virus invading the human body.
C. Increase in population mobility: Due to the tremendous changes in China's social and economic structure in the past 20 years, the flow of large numbers of people, especially rural people, across the country is roughly estimated to be around 120 million. There are many HIV in the floating population. Susceptibility factors such as young age, high life pressure, leaving the spouse, low level of education, poor self-protection awareness, such as Li He and other surveys of long-distance freight drivers in Guangxi and Shandong, found that the infection rate of gonorrhea is about 10%. (Li He, 1998), the increase in foreign exchanges, the increasing number of people in and out of the Internet has also provided opportunities for the HIV epidemic. For example, from 1985 to 1994, China screened more than 4 million people and found 1774 HIV-positive people. 151 Chinese people returned to China, accounting for 8.5%, and 288 foreigners coming to China, up to 16%. The Beijing Health and Quarantine Bureau conducted HIV surveillance for foreign students, even among students who received a negative certificate issued by a government hospital. HIV positive.
(2) Clinical manifestations:
1 virus characteristics: HIV, a source of AIDS, is a reverse transcription RNA virus consisting of a single positive strand RNA genome, reverse transcriptase and structural proteins of the outer shell. After HIV enters the human body, its surface membrane glycoprotein can be gp120. Combined with the CD4 receptor on the surface of T cells, it causes HIV to infect lymphocytes. After the virus enters the cell, it removes the protein shell into the nucleus under the action of the enzyme, and transcribes into double-stranded DNA by reverse transcriptase using single-stranded RNA as a template. The double-stranded DNA can be integrated with the DNA of the host cell, and then the single-stranded RNA is replicated, and the protease is assembled into a new HIV virus, and it takes about 72 hours for HIV to invade the human body and bind to the lymphocyte DNA. Once completed, HIV infection becomes a lifelong infection, and no drugs can remove it from the body. The lymphocytes that HIV mainly invades in the body are T4 lymphocytes, which are called CD4 cells because their surface proteins are named CD4+. The result of HIV cell proliferation in lymphocytes is the death of cells. The specific mechanism is not very clear at present, probably because infected lymphocytes can be fused with other uninfected cells. The number of lymphocytes decreases; the cytotoxic T cells produced by the cellular immune response induced by the body can kill the helper T cells infected with HIV; the replication and reproduction of HIV in the cells, and the excessive amount of RNA cause the T lymphocytes to rupture (Wang Aixia, 1996).
2 HIV virus molecular epidemiology: Currently, the HIV prevalent in the world is mainly HIV-1, which is different from HIV-2 found in West Africa in 1986. The latter is less contagious, and the time from infection to onset is also Longer, so the most widespread epidemic in the world is HIV-1. The earliest HIV-1 can be traced back to 1 plasma sample collected in Africa in 1959. According to the variation of HIV-1 surface glycoprotein env and gag, the virus can be used. Divided into M group and O group, M group contains from A to J10 subtypes, currently there are 8 types of strains in China, and B subtypes account for 47%, mainly from the drug users in Thailand, the most widely distributed; C subtype accounts for 24%, mainly from Indian drug users, distributed in Yunnan and Guizhou and Xinjiang; E subtypes from Southeast Asia account for 10%, mainly found in the southwest and southeast coast; a small number of African returning labor infected Africa A, The D and G subtypes are scattered in the inland provinces with more labor export; the F subtypes mainly found in South America are only found in Guangdong, and the HIV-1 subtypes are studied to grasp the source of transmission, develop vaccines, and develop targeted The treatment plan is important (Zeng Yi, 1996).
3 clinical staging: HIV infection can be divided into 7 phases from the course of disease:
A. Virus transmission: HIV infection through sexual activity, blood contact and maternal and child routes.
B. Primary HIV infection: also known as acute HIV infection, usually occurs 2 to 4 weeks after infection, common symptoms are fever, gland enlargement, pharyngitis, rash, myalgia or joint pain, diarrhea, headache, Nausea and vomiting, hepatosplenomegaly, and ulceration of the sacral cavity. Although most people will have the above symptoms, the proportion of patients who can correctly diagnose in this period is very low, because the usual HIV antibody serological test is negative. Only antigen detection, ie HIV, RNA or DNA, can be diagnosed.
C. Serum conversion to yang: After exposure to HIV virus, it usually takes about 3 to 12 weeks for the serum antibody to react positively. This is also the so-called window period.
D. Early HIV disease: This period was defined as 6 months after the seropositive reaction. Studies have shown that treatment at this stage is closely related to prognosis.
E. Asymptomatic infection: The number of viruses in this period is gradually increasing, and the number of CD4 is gradually decreasing, but there are no other symptoms except for extensive lymphadenopathy.
F. Early symptomatic HIV infection: various infections and tumors such as thrush, oral leukoplakia, peripheral neuropathy, recurrent herpes zoster, cervical dysplasia, and idiopathic thrombocytopenia Sexual purpura and listeriosis.
G. AIDS period: CD4 count is less than 200/mm3, and/or indications of AIDS, such as recurrent bacterial pneumonia, herpes simplex with mucosal ulcer, disseminated tuberculosis, Kaposi's sarcoma, invasive Cervical cancer, tissue cytoplasmic disease, Pneumocystis carinii pneumonia, toxoplasmosis, cryptococcal infection, etc., accompanied by lymphoma, weight loss (weight loss 10%, with chronic diarrhea), non-infectious dementia symptom.
H. AIDS progression: The CD4 count of patients in this period is <50mm3, and the average survival time of patients entering this period is 12-18 months. Actually, almost all CD4 counts that die from AIDS complications are in this range. If no treatment is given, the patient's average survival time from the discovery of serum antibody to death is 10 years. The viral load and CD4 cell count are two important factors that determine the length of survival.
Some people also have AIDS clinically divided into three phases: toxic period: completely asymptomatic or only lymphadenopathy syndrome, but there are serological abnormalities associated with HIV; AIDS-related syndrome phase: persistent general lymphadenopathy and certain Degree of T cell dysfunction, manifested as chronic fever, chronic diarrhea, weight loss, weight loss, night sweats, fatigue and lymphadenopathy, anemia, cytopenia and/or thrombocytopenia, IgG increase, HIV antibody positive and other abnormalities; This is the full development and late stage of HIV infection, mainly in the form of typical immunodeficiency, which can occur in a variety of opportunistic infections, such as Pneumocystis carinii pneumonia, fungi, cytomegalovirus, herpes virus and parasitic partners. Very serious infection, and neurological diseases associated with HIV, because HIV is a neurotropic virus, can invade the central and peripheral nervous system, clinically manifested as subacute encephalopathy with progressive dementia, aseptic meningitis For encephalitis and peripheral neuropathy, the ratio of the number of cases in the third phase is about 100:10:1.
4 HIV/AIDS psychological characteristics: Psychiatric symptoms associated with HIV/AIDS may occur before undiagnosed HIV infection. In areas where AIDS is endemic, there are high-risk behaviors such as intravenous drug or sexual disorder, because they are worried about getting AIDS. There will be panic about excessive disease, emotional anxiety, depression, and possibly suspected or even compulsive symptoms. This is the so-called "false AIDS syndrome" that is more common in homosexuals in the early AIDS epidemic. The country has been rare, but it is not uncommon in the East. Miller et al. studied the so-called "AIDS neurosis" in Japan. The main symptom is that although the serum test results are negative, the patient insists that he is infected, and Accompanied by a series of physical bodies, mental symptoms such as multiple physical discomfort, fear, nervousness, although its specific cause is still unclear, but considering this phenomenon may be related to the negative attitude of the mass media to AIDS, intolerant social environment, etc. Cultural factors (Miller E, 1998).
After the diagnosis of HIV infection, due to the sinister nature of HIV/AIDS and the accompanying social stigma, HIV-positive people may show strong psychological reactions such as denial (requiring doctors to repeat tests, denying that they have had any high-risk behavior), anger ( Think of yourself as a victim, or even the idea of revenge), despair (loss of confidence in future life), fear (worry of being an isolated person in the family and society), some people will suicide at this stage to escape the negative effects associated with disease Consequences, from the initial stress state to the acceptance of reality, with a positive attitude towards life, requires a process of psychological transformation that varies from person to person.
If people with HIV or AIDS suffer from mental disorders, they will lead to various behavioral problems and unprotected sexual intercourse, and the quality of life will also decline. More seriously, concurrent mental disorders will delay diagnosis and cause tension between doctors and patients. Interfering with patient compliance with antiviral therapy, and ultimately leading to treatment failure.
(3) Mental disorders common in HIV-positive and AIDS patients:
1 Adaptation disorder: HIV-infected people not only face sudden death, but may also blame themselves for being infected or likely to infect others in the future. Patients will also face criticism from the community, even relatives, friends and family, and the psychological pressure of being abandoned. HIVHIVHIV
HIV(major depression)20%(major depression)9%HIV(Shor-Posner G1997)KoopmanHIVChandraHIV40%36%14%(Chandra PS1998)
Van der RystHIV/AIDS37%9%15%10%3%21%;
Rubinstein11573%(Pittsburgh Sleep Quality Index)(Rubinstein ML1998)
HIV(ICD-10HIV associated dementiaHAD)
90%HIV65%80%HAD-(HIV minor cognitive-motor disorder)(AIDS-dementia complexADC)ADCCD4<200/mm320%7%ADCPETHIVHIV()HIVBaldewegHIV(Baldeweg T1997)