From ancient Greek, the word “coma” is translated as “deep sleep.” In the myths of those distant times, the god of sleep, Hypnos, was called the brother of Thanatos, the messenger and personification of death. In modern medicine, “deep sleep” in a coma is also considered borderline and near-death.
In this state, consciousness is lost, reflexes fade, the frequency and depth of breathing is disrupted, the pulse and vascular tone change abnormally, and the mechanisms of temperature regulation are disrupted.
What causes coma?
The coma is caused by impaired blood circulation in the brain and/or toxic damage to the cells of the central nervous system. These pathologies arise for the following reasons:
- head injuries;
- drowning, suffocation, cardiac arrest;
- stroke;
- decompensated diabetes mellitus;
- meningitis, encephalitis;
- kidney or liver dysfunction as a result of poisoning or disease;
- epileptic seizures that follow one after another.
In addition, there is an artificial medical coma. It is used as an alternative to anesthesia if a neurosurgical operation is performed, as well as when the patient is brought out of an epileptic state.
Main consequences of the condition
There are several outcomes that can result from coma after a stroke. Firstly, the patient will return from a dangerous condition with (in rare cases, complete) restoration of vital functions. Secondly, death as a result of brain death, which can occur due to severe hypoxia.
Thirdly, a way out of the situation without restoration of functions, with preservation of paralysis and paresis, as well as with impaired memory and intelligence. Fourthly, the transition to a vegetative state with the preservation of limited reactions to stimuli, while the person cannot speak or think.
Proven fact: full restoration of health is possible only in 10% of cases.
Depth of coma
A comatose state can develop gradually over several days, or occur suddenly in a matter of minutes. According to the degree of depth, the following stages of coma are distinguished:
- Precoma with severe retardation or, on the contrary, psychomotor agitation. Reflexes are preserved, coordination of movements is impaired, thinking suffers.
- The first degree, in which sleep or stupor occurs. Reactions to external stimuli are inhibited, but the person can take liquid food and make simple movements.
- Second degree, the stage of deep sleep with a complete lack of contact, pathological forms of breathing, rare chaotic movements, weakened pupillary response to light, convulsive muscle twitching.
- The third degree, in which there is no consciousness, there is no reaction to painful stimuli, reflexes are lost, the normal breathing rhythm is lost, blood pressure drops, and body temperature decreases.
- The fourth degree or extreme coma, in which reflexes disappear, muscle tone is absent, and blood pressure and temperature drop sharply. Spontaneous breathing stops. It is supported by artificial ventilation, and nutrients are injected.
Death most often occurs in a state of extreme coma. However, if a person can be brought out of it, and further improvement occurs, then brain functions can be restored partially or completely.
How will bipolar disorder affect my life?
If a patient with bipolar affective disorder takes pharmacotherapy and follows the rules for preventing episodes, the number and intensity of episodes is reduced to a minimum, and in intermissions there are no symptoms at all. Under these conditions, bipolar disorder does not have a significant impact on life.
Bipolar disorder, like any chronic disease, makes changes to your routine: systematic visits to the doctor, taking medications, and preventive measures.
If bipolar disorder is left untreated, episodes will significantly impact work and personal life.
Bipolar disorder, like any chronic disease, makes changes to the regime: systematic visits to the doctor, taking medications, preventive measures.
During the hypomanic and manic phases, mental and physical activity increases, but becomes impulsive and chaotic. The work will be easy, but it will not bring results. You will be able to do many things at the same time, but none will be completed. Hostility and aggression arise towards close people, which gives rise to conflicts. Without malicious intent, you can offend loved ones and not even notice it, quickly switching to something else. A manic episode may be accompanied by delusions and hallucinations, increasing the likelihood of hospitalization.
During a depressive episode, there is neither the desire nor the strength to do anything, so work and study will be difficult. Severe depression forces you to take a leave of absence from your studies or leave from work. In relation to close people, indifference, touchiness and isolation appear.
In addition to what has already been said, such “swings” tire not only you, but also the people around you. For the employer, this is an unstable employee who cannot be relied upon. For loved ones (especially if they do not know about the diagnosis of bipolar disorder), unpredictability of mood causes emotional stress, which leads to misunderstandings and conflicts.
Communicating with a person in a coma
Those who managed to come out of a coma say that they felt as if they were in an extremely deep sleep. Some report that very near-death tunnel, at the end of which a bright light was visible. Almost everyone remembers nothing about the events that led to the coma, and, moreover, about what happened to them in this state.
However, although comatose patients have no reaction to external stimuli, there is reason to believe that some forms of subconscious perception still remain. Therefore, the British Department of Health has made the following recommendations for those visiting a relative, loved one or friend who is in a coma:
- Introduce yourself and share the news in a positive way.
- Talk about your current life as if the person in a coma were an ordinary interlocutor, or rather, a listener.
- Show your support. To do this, just sit next to him and hold the person’s hand.
- Let him listen to his favorite music using headphones.
What symptoms are used to diagnose bipolar disorder? How does the disease manifest itself?
Bipolar disorder is characterized by severe mood swings. The mood for several months, weeks or (less often) for several hours “goes to extremes” - it becomes too cheerful and too bad.
The mood for several months, weeks or (less often) for several hours “goes to extremes” - it becomes too cheerful and too bad.
Mania or hypomania is an elevated mood and violent physical and mental activity. Mental activity becomes heterogeneous - attention captures every detail, but it is difficult to concentrate on one thing for a long time. Thoughts are constantly “jumping”, one idea is quickly replaced by another. All emotions intensify: joy - to euphoria, irritation and resentment - to aggression, suspicion - to paranoia. Physical activity also increases: you almost don’t want to sleep (three hours of sleep seems enough), sexual desire increases. Behavior becomes impulsive, reckless, sometimes even adventurous and eccentric. A person can become obsessed with an idea. During a manic episode, delusions and hallucinations may occur.
Hypomania is liked by everyone who has experienced it at least once. With hypomania, unlike mania, delusions or hallucinations occur less frequently, criticality remains, and aggression is lower. However, hypomania is not a normal mental state; the brain works in an enhanced mode. Reserve resources are used to speed up mental processes, and when they run out, complete exhaustion occurs. With hypomania, the psyche seems to be running a sprint. Imagine if you only run all your life - your body will quickly deplete and wear out. It’s the same with the psyche. Hypomania can develop into more unpleasant states - mania or depression.
Reserve resources are used to speed up mental processes, and when they run out, complete exhaustion occurs. With hypomania, the psyche seems to be running a sprint.
Another sign of bipolar disorder will be not just a bad mood, but depression, from mild short-term to severe long-term. Here everything is the other way around. Activity drops: when you need to do something, there is neither strength nor desire. Mental activity is even more difficult: in addition to the lack of desire and strength, it is difficult to concentrate, remember, analyze, and make a decision. The experience of emotions becomes dull, with the exception of worsening resentment, guilt, hopelessness, confusion, anxiety or indifference. Appetite changes, insomnia or excessive sleepiness appears. Even if you are a very cheerful person, severe depression can cause suicidal thoughts. With severe depression, delusions and hallucinations may occur.
These phases can replace each other and can appear simultaneously. For a long time, only one pole can manifest itself - then even doctors, instead of correctly diagnosing “BAD,” may first diagnose “depression.” The breaks between episodes (intermissions) are different for everyone - it can be a month, a year, three years, five years.
In a healthy person, changes in the activity of mental processes are not so contrasting and are more amenable to regulation. They do not lead to a deterioration in everyday functioning - a person can successfully cope with the professional and academic responsibilities assigned to him, and establish and maintain relationships with others.
Rehabilitation after a coma
To bring a patient out of a coma, doctors make many attempts, and this process takes an indefinite amount of time. If persistent efforts are successful, the person’s consciousness returns, the mood for recovery is formed, and rehabilitation is carried out under the supervision of specialists.
For this purpose, targeted centers with multifaceted rehabilitation programs are created. In the Minsk region, one operates in the Aksakov region. Those who require specialized assistance are there free of charge.
Reminder for the treatment of bipolar affective disorder (BD)
Control of biological factors:
- See a psychiatrist (at least once every three to four months);
- Take medications prescribed by a psychiatrist;
- Lead a healthy lifestyle;
- Set a daily routine.
Control of psychological factors:
- Accept yourself with bipolar mental disorder;
- Take a course of psychotherapy;
- Apply independently acquired skills to prevent and resolve stressful situations;
- If possible, minimize the number of stressful situations.
Control of social factors:
- Help and support of family members;
- Stable and feasible work;
- Communication, spending time with friends and acquaintances;
- Social activity, expanding the circle of acquaintances.
This memo clearly shows that you yourself can do a lot to improve your condition. Almost everything depends on you.
Remember: when protective factors outweigh risk factors, this is a good tool for reducing the frequency and intensity of episodes.
How is it determined that coma has turned into death?
Modern medicine is able to maintain breathing, cardiac activity and provide nutrition for a long time to a person in a deep coma. Death is declared when blood flow to the brain stops and irreversible pathological changes occur.
These changes are diagnosed using computed tomography or magnetic resonance imaging. The absence of any brain activity is determined by electroencephalography methods, and cessation of cerebral circulation is recorded angiographically.
Based on the totality of the obtained indicators, death is diagnosed and, in agreement with relatives, life support equipment is turned off.
Causes
Who can be called:
- High pressure in any part of the brain, which can lead to hemorrhage;
- Lack of blood supply to any organ;
- Degeneration of vascular walls;
- Defect in the development of vascular walls;
- Deposits in blood vessels;
- Intoxication;
- Blood diseases;
- Acute lack of vitamins.
- In addition, high blood pressure, old age, severe emotional shock and atherosclerosis can increase the risk.
Question and answer
Does it happen that a patient comes to his senses after he has been declared brain dead?
Such cases do happen. For example, on December 23, 2011, doctors definitely and objectively confirmed the brain death of 21-year-old American student Sam Schmidt, who fell into a deep coma after an accident. Sam's parents were advised to think about consenting to the removal of their son's organs for transplantation, and an hour later a consultation was to be held on the issue of turning off the equipment that supports life in his body. Suddenly Sam moved his fingers, began to respond to calls and woke up.
How to get to the rehabilitation center in Aksakovshchina?
From the metro station "Pushkinskaya", "Kamennaya Gorka" by minibus 1203 TK, from the railway station, metro station "Kamennaya Gorka" - by minibus 1500 TK.
Do the Belarusian media publish information about those who came out of a coma, about what they felt?
The most recent publication with such interviews was on the TUT.BY website in the “Health” section on May 20, 2021.
