Affective disorder in amyotrophic lateral sclerosis
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Author: Professor Li Xiaoguang, copyright belongs to the original author, please indicate the source.
October 23, 2015 -25, the Chinese society of microcirculation neurodegenerative diseases Specialized Committee third academic conference held in Tianjin. In the neurodegenerative disease and emotional disorders forum ", Peking Union Medical College Hospital of Neurology professor Li Xiaoguang introduced the amyotrophic lateral sclerosis (ALS) and the affective disorder, and stressed: the treatment of patients with ALS is not limited to the primary disease, affective disorder management is also very important.
Amyotrophic lateral sclerosis, ALS
Amyotrophic lateral sclerosis (ALS) is a typical progressive degenerative disease of the nervous system. Due to the degeneration of the upper and lower motor neurons, the muscles of the bulb, limbs, trunk, chest and so on are gradually weakened and atrophied. The average age of onset of ALS is 55 years old, usually insidious onset, slow progress, with a fatal, the patient died of respiratory failure due to multiple deaths, the average survival of patients from the onset of the disease for 3.5 years. China currently has about 6-8 ALS patients.
Professor Li Xiaoguang pointed out that, in addition to sporadic ALS also has a family type, mutations in the pathogenesis of ALS played a very important role. ALS is not a simple accumulation of motion system, it is shown that the ALS and frontotemporal dementia (FTD) have some common genes; in addition, there are internal relations between ALS and Parkinson's disease and other diseases of the nervous system.
Two, amyotrophic lateral sclerosis and depression and emotional disorders
The characteristics of nerve anatomy and neuroendocrine determine the nervous system disease and depression. One study showed that the incidence of depression in ALS patients was 9%, similar to that of the general population. However, unlike other diseases, ALS associated depression has the following characteristics:
(1) depression in ALS patients is not as widespread or severe as expected.
(2) if ALS patients with depression, will significantly affect the quality of life.
(3) the onset of depression was related to the time of diagnosis, although the patients were susceptible to depression during the whole course of the disease.
(4) depression symptoms were mainly found after ALS diagnosis, depression in the early stage of the disease significantly.
(5) most patients with ALS have a positive attitude toward life, even if the disease progresses, and there is no correlation between depression and disease severity in ALS patients. A study showed that the degree of depression was not proportional to the neurological score.
(6) compared with other symptoms of ALS, the onset of depression was not persistent, and the response was good.
Three. Treatment of amyotrophic lateral sclerosis with depression and affective disorder
Professor Li Xiaoguang pointed out that in the management of patients with ALS, attention should be paid to the identification and intervention of depression and emotional disorders. ALS patients with depression screening and antidepressant treatment can help improve the quality of life of patients. A meta-analysis published in 2011 showed that antidepressants are significantly superior to placebo in the treatment of comorbid disorders of depression.
An analysis of the use of antidepressants in patients with ALS, found for any reason to use more antidepressants are tricyclic, SSRI and SRI; drugs for depression reasons used are SSRI and SNRI. Why is this happening? Professor Li Xiaoguang pointed out that ALS patients may appear salivation and sleep disorders. The use of tricyclic antidepressants may solve the following three problems: (1) reduce salivation; (2) improve mood; (3) improve sleep.
Professor Li Xiaoguang also noted that patients with ALS may develop pseudobulbar palsy. Approximately 25%-50% of patients with ALS at the onset of medulla oblongata may develop pseudobulbar palsy. Pseudobulbar paralysis also called pseudobulbar palsy, is characterized by sudden outbreak of uncontrollable laughing or crying (strong crying and laughter). These events do not necessarily occur in the context of humor or sadness, often spontaneously, and are inconsistent with the patient's emotional state. These events are difficult to control, without depression or other psychiatric symptoms. Such outbursts will increase salivation, lead to suffocation. And pseudobulbar palsy was not directly related to FTD. By romilar (Dextromethorphan Hydrobromide 20mg) and quinidine sulfate (quinidine sulfate) Nuedexta composite capsule composed of 10mg can be used for the treatment of strong crying and laughter.