2. Department of Neurology, which mainly diagnoses and treats cerebrovascular diseases (cerebral infarction and cerebral hemorrhage), migraine, brain inflammatory diseases (encephalitis and meningitis), myelitis, epilepsy (convulsion), Parkinson's disease, epilepsy, cerebral palsy, ataxia, torsion spasm, autism, Alzheimer's disease, nervous system degeneration, metabolic diseases and hereditary diseases, trigeminal neuralgia and sciatica.
3. Check:
① Neurology can detect diseases of brain, nerve, muscle and spinal cord. Neurological examination includes medical history, mental state evaluation, physical examination and laboratory diagnosis.
② The difference between psychiatric examination and evaluation of patients' behavior is that the evaluation of neurology requires physical examination. However, abnormal behavior often suggests clues to changes in brain organs.
(3) Before physical examination and laboratory examination, the doctor meets with the patient to learn about his medical history. Ask the patient to describe the current state, and make clear where, when, frequency, severity, duration and whether these symptoms affect daily work and life.
(4), patients should tell the doctor the past and present history of disease or surgery, severe cases should know about blood relatives, allergic symptoms and drugs currently used. In addition, doctors should also ask patients whether they have any difficulties related to work or family, or whether they have encountered any confusion, because these situations will affect patients' health and body's ability to resist diseases.
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Extended data
The standard process and clinical pathway for diagnosing insomnia are as follows:
(1) Collection of medical history.
Clinicians need to carefully ask about medical history, including specific sleep situation, medication history and possible material dependence, and conduct physical examination and mental and psychological state evaluation. The specific contents of obtaining sleep status data include the performance of insomnia, the rules of work and rest, the symptoms related to sleep, and the influence of insomnia on daytime function. Medical history data can be collected through self-rating scale tools, family sleep records, symptom screening forms, mental screening tests, family members' statements, etc. The recommended process of medical history collection (L ~ 7 is a mandatory assessment item and 8 is a recommended assessment item) is as follows:
(1), through systematic review, it is clear whether there are diseases such as nervous system, cardiovascular system, respiratory system, digestive system and endocrine system, and it is necessary to check whether there are other types of physical diseases, such as skin itching and chronic pain.
(2) Ask whether the patient has emotional disorder, anxiety disorder, memory disorder and other mental disorders.
(3) Review the application history of drugs or substances, especially the abuse history of psychoactive substances such as antidepressants, central stimulants, analgesics, sedatives, theophylline drugs, steroids and alcohol.
(4) Review the overall sleep situation in the past 2-4 weeks, including sleep latency (the time from going to bed to falling asleep), wake-up times, duration and total sleep time. When asking the above parameters, we should pay attention to the average estimated value, and it is not appropriate to use the sleep situation and experience of a single night as the diagnosis basis; It is suggested to use the body movement sleep detector for 7-day cycle sleep evaluation.
(5) With the help of Pittsburgh Sleep Quality Index (PSQJ) questionnaire and other scale tools, it is recommended to use physical sleep detector to evaluate 7-day sleep and finger pulse oximeter to monitor blood oxygen at night.
(6) Assess daytime function by consulting or using scale tools, and exclude other diseases that damage daytime function.
(7), for patients with daytime sleepiness, combined with consultation screening sleep breathing disorders and other sleep disorders.
(8) Before the first systematic evaluation, it is best for patients and their families to complete a 2-week sleep diary, record the daily bedtime, estimate the sleep latency, record the number and time of waking up at night, record the total bed rest time from the beginning of going to bed to getting up, estimate the actual sleep time according to the waking time in the morning, calculate the sleep efficiency (that is, actual sleep time/bed rest time × 100%), and record the abnormal symptoms at night (.
(2) Scale evaluation.
(1), systematic review of medical history: It is suggested to use Cornell Health Index to semi-quantitatively review the medical history and present situation, and obtain basic data related to physical and emotional aspects to support evidence.
(2) Evaluation of Sleep Quality Scale: insomnia severity index; Pittsburgh sleep index; Fatigue severity scale; Quality of life questionnaire; Sleep belief and attitude questionnaire, Epworth sleep scale evaluation.
(3) Emotion includes self-rating and other scales related to insomnia: Beck；; Depression scale; State trait anxiety questionnaire.
(3) Assessment of cognitive function.
Pay attention to IVA-CPT；; Recommended for functional evaluation; Wechsler memory scale is recommended for memory function.
(4) objective evaluation.
Insomnia patients' self-evaluation of sleep status is more prone to deviation, so it needs to be identified by objective evaluation methods.
(1), sleep monitoring all night polysomnography (PSG) is mainly used for the evaluation and differential diagnosis of sleep disorders. PSG can be used to evaluate the differential diagnosis of patients with chronic insomnia. Multiple sleep latency test is used to diagnose and differentiate narcolepsy and daytime sleepiness. In the absence of PSG monitoring, body motion recorder can be used as an alternative method to evaluate patients' total sleep time and sleep pattern at night. Finger pulse oxygen monitoring can know the blood oxygen during sleep and should be done before and after treatment. Before treatment, it is mainly used to diagnose whether there is hypoxia during sleep, and during treatment, it is mainly used to judge the effect of drugs on breathing during sleep.
(2) The event-related evoked potentials can provide objective indicators for the diagnosis of emotional and cognitive dysfunction. Neurofunctional imaging has opened up a new field for the diagnosis and differential diagnosis of insomnia, but it cannot be popularized in clinic because of the expensive equipment.
(3) Etiological exclusion examination Because sleep diseases are often related to endocrine function, tumor, diabetes and cardiovascular diseases, it is suggested to carry out thyroid function examination, sex hormone level examination, tumor marker examination, blood sugar examination and nocturnal heart rate variability analysis of dynamic electrocardiogram. Some patients need head imaging examination.
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