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患者,男,40岁,因精神异常10天入院。10天前车祸后出现烦躁多语,行为异常,大小便失禁,全身大汗,伴幻听,迫害妄想,在精神病院拟“继发性精神病,脑器质性病变待排”转入本院。18年前有“精神病”史,住院2月后愈,5年前有“甲亢”史,服药1月后症状消失。一姐有“甲亢”史,体检:T37.3℃,P140次/分,R22次/分,BP20/11kPa,神志尚清,呈兴奋状态,应答不切题,部分定向力障碍。消瘦,多汗,良性突眼,双侧甲状腺1度肿大,质中,未闻及血管杂音,双手有水平细颤。实验室检查及辅助检查:Hb142g/L,WBC11.8×10~9/L,N0.88,L0.12,ESR23mm/h,TT_(?)3.85nmol/L,TT_4258.69nmol/L,TSH3.0mU/L,血电解质、肝肾功能及头颅CT检查未见异常,诊断:甲亢性精神障碍(亚躁狂症),入院后曾多次肌注安定镇静无效,改以氟哌啶醇与丙基硫氧嘧啶、心得安联合使用,5天后精神障碍明显减轻,第12天精神症状完全消失,住院29天好转出院。
Patient, male, 40 years old, admitted to hospital due to mental disorders for 10 days. 10 days ago after the car accident irritability and more language, abnormal behavior, incontinence, sweating, with hearing, persecution paranoia, in the mental hospital to be “secondary mental illness, brain organic disease to be discharged” to the hospital . 18 years ago, “mental illness” history, more hospitalized in February, 5 years ago, “hyperthyroidism” history, medication symptoms disappeared in January. A sister has a history of “hyperthyroidism”, physical examination: physical examination: T37.3 ℃, P140 beats / min, R22 beats / min, BP20 / 11kPa, conscious Shangqing, was excited state, answering the question, part of the disorientation. Thin, sweating, benign exophthalmos, bilateral thyroid 1 degree enlargement, quality, no smell of vascular murmur, hands and feet level tremor. Laboratory tests and laboratory tests: Hb142g / L, WBC11.8 × 10 ~ 9 / L, N0.88, L0.12, ESR23mm / h, TT_ (3.85nmol / L, TT_4258.69nmol / L, TSH3. 0mU / L, blood electrolytes, liver and kidney function and CT examination showed no abnormalities, diagnosis: hyperthyroidism (sub-mania), admitted to the hospital after repeated intramuscular sedation sedative, change to haloperidol and C Sulfadiazine, propranolol combination of use, 5 days after the mental disorders significantly reduced, the first 12 days of psychiatric symptoms completely disappeared, 29 days hospital admission improved.