Quantitative and qualitative disturbances of consciousness: twilight stupefaction, stupor and others

Head of the consultation department - neurologist, specialist in the field of extrapyramidal pathologies, doctor of the highest category

Khabarova Svetlana Viktorovna

Psychiatrist

Short-term freezing is characteristic of special epileptic seizures called absence seizures. Blackouts characteristic of such seizures most often last from 3 to 30 seconds. Due to the absence of any pathological manifestations and short duration, absence seizures may remain undiagnosed for a long time. Others often perceive such short-term seizures as episodes of daydreaming or thoughtfulness. This form of epilepsy most often begins in childhood from 3 to 9 years. Most often, girls are susceptible to this form of the disease. The frequency of short-term seizures characteristic of this form of epilepsy. can reach several tens and sometimes hundreds per day.

Externally, absence seizures can manifest themselves as sudden blackouts of consciousness, in which the patient’s posture remains unchanged, and the facial muscles relax somewhat, the gaze stops and is fixed in a straight position. All these factors together give the face a meaningless, absent expression. In most cases, the patients themselves do not notice seizures. The exception is those cases when the duration of the seizure is so long that the patient, for example, manages to lose the thread of the conversation.

Most often, absence seizures are detected in childhood absence epilepsy. DAE is a benign idiopathic form of epilepsy. However, without treatment, simple absence seizures can be accompanied by generalized convulsive seizures. ADE can be diagnosed by conducting an EEG study with an accuracy of up to 100%. In some cases, an EEG allows not only to record an attack, but also to record it in parallel with the main recording. To select the most adequate therapy, it is also worth conducting EEG sleep monitoring, which, if there is epileptiform activity during sleep, will allow it to be recorded.

The selection of treatment and anticonvulsants is carried out by the attending epileptologist. The choice of drugs and treatment methods in each case is purely individual, and depends on the patient’s age, the severity of pathological changes on the EEG and the frequency of attacks. With timely and correct treatment, DAE in most cases proceeds favorably, and in 90% of cases, a complete cure is observed over time.

It is extremely important for the patient to receive adequate treatment, since without it, benign DAE can develop into less harmless forms of epilepsy with generalized seizures of awakening.

In medical practice, in addition to simple absences, there are also pseudo-absences, characteristic of paleocortical temporal lobe epilepsy, and atypical absences, found in Lennox-Gastaut syndrome.

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Stunned or lethargic

When faced with dazedness or inhibition, patients react poorly to their environment and speech, and they become indifferent to everything they see, hear and feel. If the disease worsens, simple stupor can turn into a coma

, that is, a complete “turn off” of consciousness. After exiting this state, the patient will remember absolutely nothing about what happened. The patient may fall into a coma if he has diabetes, kidney or liver failure, as well as some other diseases.

Treatment

The diagnosis of “twilight disorder of consciousness” is made by a psychiatrist, studying the clinical picture and based on a conversation with the patient and his relatives. You will also need a consultation with a neurologist and a number of specialized specialists, as well as studies such as MRI and CT of the brain, EEG, etc.

If during the process of darkening the patient committed a crime: caused damage to property, harm to health or murder, then a forensic psychiatric examination is carried out. It, among other things, involves the study of documents compiled by law enforcement officers, forensic reports, and witness statements.

Treatment is carried out in the psychiatric department of the hospital with the help of antipsychotics and tranquilizers. The psychotic type of disorder will require individual psychotherapy. It is necessary in the event of a crime committed by a patient.

If the twilight state is of a non-psychotic type, then the underlying disease is treated.

Naturally, individual treatment tactics are selected for each patient, depending on the above factors.

Delirium (hallucinations)

This syndrome means that the patient may experience various kinds of hallucinations - deceptions of the senses and perception. For example, a person may hear voices that are not there or see something that does not exist. At the same time, the patient is completely confident that everything is happening for real, and cannot distinguish reality from illusion. In this regard, the patient may experience severe behavioral deviations. They can manifest themselves in both positive and negative emotions, depending on the nature of the hallucinations.

For this reason, the patient can be dangerous both to himself and to others and society in the broad sense of the word. When “returning to reality,” the memory of hallucinations is preserved, but the memory of reality is most often not. This symptom often manifests itself in severe poisoning and infectious diseases.

Why does consciousness disappear?

The main causes of disturbances of consciousness include:

• psychological disorders without visible structural changes in the brain;
• disorders of cerebral circulation and electrical activity of the brain;
• infectious, metabolic and mental diseases;
• drug addiction, alcoholism, substance abuse;
• concussions and traumatic brain injuries.

Oneiric state (“waking dream”)

This symptom is associated with an influx of vivid hallucinations, most often with fabulous, impossible and even absurd content. The patient sees all these images and pictures, but, unlike delirium

, maintains the position of an external observer and does not actively participate in the “action”.

At the same time, the patient’s orientation in space and understanding of his own personality are disrupted. The memory of illusions is partially preserved. This symptom often occurs with congenital heart disease and certain types of infections.

Main etiological factors

The reasons for such violations are related to:

• severe head injuries;

• organic brain lesions against the background of malignant or benign neoplasms, cysts, abscesses;
• infections affecting the functions of the central nervous system;
• alcohol and drug abuse;
• congenital pathologies of the central nervous system;
• psychiatric diseases, in particular schizophrenia, severe psychosis, etc.
• circulatory disorders, formation of hematomas after a stroke.

Identifying the exact cause of the disorder of consciousness plays a key role in determining the tactics of further treatment.

Amentive clouding of consciousness (amentia)

This is a condition in which the patient completely loses all ability to navigate both in space and in himself and his experiences. Everything he sees and feels is perceived in fragments and is not something whole. The processes of thinking and understanding what is happening are disrupted. of delirium occur

and
oneiric state
, causing fear.
The speech of such people can be thoughtless and incoherent. They are also characterized by a sharp change in activity, that is, excitement can suddenly give way to apathy
and helplessness. My mood also changes unusually often.

The amental state can be quite long - up to several months, and it is sometimes replaced by short periods of “enlightenment”. The dynamics of the disease completely depend on the physical condition of the patient, and this condition itself is characteristic of sepsis and cancer intoxication. In general, the very fact of an amental state, as a rule, indicates a serious illness in the patient.

Sopor

Due to the complete loss of consciousness, this condition is often called subcoma. The patient practically does not react to stimuli, with the exception of loudly and repeatedly repeated questions, and may unconsciously resist any actions (transfer to another bed, give an injection, etc.).

Stupor occurs:

• hyperkinetic, accompanied by meaningless muttering, chaotic movements;
• akinetic, characterized by immobility, but the reaction to painful stimuli remains.

Twilight stupefaction

Twilight stupefaction is considered one of the most specific symptoms in medicine in general. It is characterized by complete loss of memory for the period of morning and evening (twilight). The patient's ability to navigate in space is severely impaired, severe hallucinations are possible, which the patient is afraid of, as well as incoherent speech and muttering. Fortunately, this symptom is quite rare and is not accompanied by a complete loss of consciousness (unlike, for example, epilepsy).

A characteristic feature of mental confusion in somatic diseases is that some of the memories are erased. The darknesses themselves are short-lived and proceed dynamically, often moving from one to another and to a normal state.

First aid for impaired consciousness

During a patient's attack, people around him must take urgent measures. If consciousness is completely lost, you need to try to bring the person back to his senses: give him a sniff of ammonia, put a napkin soaked in cold water on his head.

You should also immediately call an ambulance, even if the person who has lost consciousness has managed to recover from the fainting state.

In case of partial loss of consciousness, the provision of first aid may be complicated by the patient’s inappropriate behavior. If there is an incomplete loss of contact with reality, it is necessary to conduct a constant dialogue with the person so that a complete break with reality does not occur.

The patient should not be left alone with himself. However, others need to remember that in such a state a person may be susceptible to various kinds of hallucinations. He is capable of harming those he loves.

Glossary of terms

In this section we have collected all the terms that you might encounter in this article. Gradually, we will collect from these explanations a real dictionary of a narcologist-psychiatrist. If some concepts remain unclear to you, leave your comments under the articles on our site. We will definitely help you figure it out.

Amentive clouding of consciousness (amentia)

– a form of clouding of consciousness, characterized by the patient’s confusion, incoherence of his speech and thinking, and disorder of movements. With amentia, complete clarity of consciousness does not occur at all, communication with the patient becomes impossible.

Hallucination

– images arising in the patient’s mind without external conditions. As a rule, hallucinations appear with the use of psychoactive substances (alcohol, drugs, many psychotropic medications), significant fatigue, as well as with mental disorders and neuralgia. Regular and prolonged hallucinations are a common occurrence in schizophrenia and are significant complications of its clinical picture.

Delirium

– a type of mental disorder associated with impaired consciousness (at first, clouding syndromes appear, then up to coma).
Accompanied by true hallucinations
(mainly visual), illusions, delusions,
senestopathies
and other symptoms. After recovering from delirium, the patient may forget both real events and hallucinations. A patient with delirium can be dangerous to himself and others.

True hallucinations

– a type of hallucination in which an imaginary object is located in objective space. They differ from illusions in that they do not occur in people who do not have mental disorders.

Comatose state (coma)

- a borderline state between life and death that threatens life. It is characterized by the patient’s loss of consciousness, lack of reactions to external stimuli or a significant decrease in such reactions, loss of reflexes, disturbances in breathing and pulse, and temperature regulation.

Oneiric state (oneiroid, schizophrenic delirium)

– mental pathology associated with a qualitative disturbance of consciousness (the so-called “oneiric disorientation”. The patient sees detailed pictures, experiences pseudo-hallucinatory sensations that are confused with reality. The patient is lost in time and space, may be confused in his own personality. Many include people around them in their fictional situation One of the characteristic signs of oneiroid is considered to be the transformation of the human “I” - for example, when a person begins to consider himself a tree or a bird.

Schizophrenic delirium

– the same as
oneiric state (oneiroid)
.

Causes and types

The causes of pathology are divided into two groups:

• organic - epilepsy, epileptiform syndrome, brain diseases, including tumors, damage to the medial temporal regions as a result of traumatic brain injury and a number of other conditions;
• functional - hysterical psychoses and narrowing of consciousness, affective states, unexpected situations with consequences in the form of severe psychological trauma.

There are twilight psychotic and non-psychotic disorders. The first include the following types, which have characteristic manifestations:

1. Dysphoric twilight state of consciousness. A person acts in an orderly manner, he is self-absorbed, detached from the outside world, sad, does not respond to someone addressing him, or utters some stereotypical words that are not related to what the interlocutor is saying. The face is gloomy, even angry. Such patients can recognize familiar people and situations, but act inappropriately and are unable to critically evaluate what they are doing. Fleeting sensations of having a double, birth and death, etc. may arise.
2. Delusional twilight disorder of consciousness. Delusional ideas are formed, and the patient’s behavior corresponds to their content. It seems to him that someone is pursuing him, wants to harm him, make him suffer, kill him. He is focused, behaves in an orderly manner, but normal communication with him is impossible. The patient’s actions are aimed at protecting against an imaginary threat dictated by delusion, most often antisocial. When the condition returns to normal, memories of the experience remain.
3. Hallucinatory disorder is characterized by the presence of illusions and frightening visual and auditory hallucinations. Communication is impossible, since such a patient does not perceive reality and the appeal to him at all. He hums, pronounces or shouts individual words or phrases, most often inarticulate. As a reaction to terrible visions, aggression arises, the outbreaks of which result in very harsh actions performed with enormous force - beating, killing with bare hands or with the help of sharp objects.

A number of psychiatrists identify another type of psychotic twilight state of consciousness - oneiric. It is characterized by colorful fantastic or fairy-tale hallucinations, accompanied by catatonia - impaired motor functions, i.e. excitement or stupor.

Non-psychotic cloudings of consciousness include:

1. Somniloquy - talking in your sleep.
2. Somnambulism - sleepwalking, sleepwalking. Occurs in children and adolescents.
3. Trances are long-term automatic actions. Most often, the patient leaves for another city.
4. Outpatient automatisms are brief automatic actions. For example: a person leaves home, gets on public transport, and, upon waking up, finds himself incomprehensibly how and why in an unfamiliar place. The patient looks confused, thoughtful, there are no hallucinations or delusions. He does not remember at all what happened to him in a state of darkness.
5. Genser's syndrome is a hysterical variant that occurs as a result of prolonged stress. The impetus for the development of the disorder is some kind of traumatic event, an unexpected exposure to unsafe, unusual conditions. The patient can only talk about these events, but he is not alienated from the world. The individual behaves like a clown, “falls into childhood” - he lisps, grimaces, and obviously answers simple questions absurdly. Knowing the purpose of things, he distorts their use, for example, he tries to pull gloves on his feet. Emotions suddenly change to the opposite. After an attack, the patient has fragmentary memories of what happened, which are restored after a good sleep.

The twilight state takes a person from reality to hallucinations. The latter replace a situation that was traumatic for him. Examples of darkness: amok - excitement, aggression and murder; the ritual of shamans - they introduce themselves into darkness and “infect” the participants in the action with it. An example can be given from literature - Lady Macbeth, the heroine of Shakespeare's tragedy of the same name, experiences a twilight episode in her sleep.

Diagnostic methods

Given the variety of forms of the disease, each case requires an individual approach, and, unfortunately, doctors at the Leto mental health center sometimes cannot help. Thus, patients in a state of stupor, stupor and coma require emergency hospitalization. In such cases, all diagnostic and therapeutic measures are carried out in intensive care units.

Doctors at the Leto clinic diagnose qualitative disorders of consciousness. To determine the cause of the disease, an encephalogram is performed, a computed tomography scan of the brain is required, and, if necessary, a PET scan. We also ask for basic laboratory tests. Sometimes the patient is referred to related specialists.

Principles of therapy

Drug treatment is indicated. With a deep disorder of consciousness, contact with reality is lost, and not a single psychotherapist is able to “reach out” to the individual. Relief of acute symptoms is carried out in the hospital of the Leto clinic under round-the-clock medical supervision. If necessary, we will arrange transportation to the medical center.

The list of drugs used, their dosage, and duration of treatment depend on individual characteristics and the diagnosis. As a rule, sedatives and drugs for symptomatic therapy are used. After the patient’s condition improves, the patient is discharged, but the doctor must describe in detail the further treatment plan and talk about the need for consultations to correct the treatment plan.

Coma

One of the most severe disorders of consciousness, characterized by its complete loss. There is also no reaction to any irritants, control of almost all vital functions is lost. The depth of coma is assessed on a 5-point scale. The following criteria are taken into account:

• independent opening of eyes;
• physical activity;
• speech;
• reaction of the pupils to light stimuli;
• convulsions;
• breath.