[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 examination 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of patients before illness is often sensitive, suspicious, subjective, stubborn, self-centered, self-pitying and withdrawn, which can be caused by the weak state of the body after illness, as well as by changes in the environment and individual physiological and psychological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.
Hypochondriac patients 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.
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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.