Quantitative and qualitative disturbances of consciousness: twilight stupefaction, stupor and others. Tiganov A.S.

Syndromes of confusion.

Syndromes of clouded consciousness are a disorder of consciousness in which the reflection of the real world is disrupted not only in its internal connections (abstract cognition), but also in external ones. In this case, the direct reflection of objects and phenomena is upset. In these cases, they speak of a disorder of objective consciousness, meaning a simultaneous violation of sensory and rational cognition. Syndromes of stupefaction are different. At the same time, they have common characteristics (Jaspers): 1) detachment from the real world, expressed in an unclear perception of the environment, difficulty in fixation or complete impossibility of perception; 2) there is always a disorientation expressed to one degree or another in place, time, surrounding persons and situations; 3) thinking is more or less incoherent, judgment is extremely weakened, often excluded; 4) remembering ongoing events and subjective phenomena is difficult, memories of the period of stupefaction are fragmentary or absent altogether.

These include:

Stun

Delirium

Oneiroid

Twilight stupefaction, etc.

Stun- a symptom of switching off consciousness, accompanied by a weakening of the perception of external stimuli. Patients do not immediately respond to questions surrounding the situation. They are lethargic, indifferent to everything happening around them, inhibited. As the severity of the disease increases, stupor can progress to stupor and coma. A comatose state is characterized by the loss of all types of orientation and responses to external stimuli. When emerging from a coma, patients do not remember anything about what happened to them. Switching off consciousness is observed in renal, liver failure, diabetes and other diseases.

Delirium- a state of darkened consciousness with difficult orientation in place, time, environment, but maintaining orientation in one’s own personality.

Patients develop abundant illusions of perception (hallucinations), when they see objects and people that do not exist in reality, or hear voices. Being absolutely confident in their existence, they cannot distinguish real events from unreal ones, therefore their behavior is determined by a delusional interpretation of the environment. There is strong excitement, there may be fear, horror, aggressive behavior, depending on the hallucinations. Patients in this regard can pose a danger to themselves and others. Upon recovery from delirium, the memory of the experience is preserved, while the events that actually occurred may fall out of memory. A delirious state is typical for severe infections and poisoning.

Oneiric state(waking dream) ---- characterized by an influx of vivid scene-like hallucinations, often with unusual, fantastic content. Patients contemplate these pictures, feel their presence in the unfolding events (as in a dream), but behave passively, like observers, in contrast to delirium, where patients actively act. Orientation in the environment and one’s own personality is impaired. Pathological visions are retained in memory, but not completely. Similar conditions can be observed with cardiovascular decompensation (with heart defects), infectious diseases, etc.

Amentive state---- (amentia- a deep degree of confusion of consciousness) is accompanied not only by a complete loss of orientation in the environment, but also in one’s own “I”. The environment is perceived fragmentarily, incoherently, and disconnectedly. Thinking is also impaired; the patient cannot comprehend what is happening. There are deceptions of perception in the form of hallucinations, which are accompanied by motor restlessness (usually in bed due to a severe general condition), incoherent speech. Excitement may be followed by periods of immobility and helplessness. The mood is unstable: from tearfulness to unmotivated gaiety. The amental state can last for weeks and months with short light intervals. The dynamics of mental disorders are closely related to the severity of the physical condition. Amentia is observed in chronic or rapidly progressing diseases (sepsis, cancer intoxication), and its presence, as a rule, indicates the severity of the patient’s condition.

Twilight stupefaction- a special type of clouding of consciousness, acutely beginning and suddenly ending. Accompanied by complete loss of memory for this period. The content of psychopathological products can only be judged by the results of the patient’s behavior. Due to profound disorientation, possible frightening hallucinations and delusions, such a patient poses a social danger. Fortunately, in somatic diseases this condition is quite rare and is not accompanied by complete detachment from the environment, unlike epilepsy (see).

A feature of stupefaction syndromes in somatic diseases is their erasure, short duration, rapid transition from one state to another and the presence of mixed states.

Treatment.

It should be aimed, first of all, at the underlying somatic disease, because the mental state depends on its severity. Treatment can be carried out in the hospital where the patient is, but two conditions must be met.

Firstly, such a patient must be examined by a psychiatrist and give his recommendations. Secondly, if the patient is in acute psychosis, he is placed in a separate room with round-the-clock observation and care. In the absence of these conditions, the patient is transferred to the psychosomatic department. If a disease of the internal organs is not the cause of mental disorders, but only provoked the onset of a mental illness (for example, schizophrenia), then such a patient is also transferred to the psychosomatics department (in case of a severe somatic condition) or to a regular psychiatric hospital. Psychotropic medications are prescribed by a psychiatrist on an individual basis, taking into account all indications, contraindications, possible side effects and complications.

Prevention : somatogenic disorders should be aimed at prevention, early detection and timely treatment of somatic diseases.

violation of the reflection of the real world both in its external connections (disorder of objective cognition) and in internal ones (disorder of abstract cognition). Syndromes of clouded consciousness are different, but they have a number of common features:

1) detachment from the outside world, expressed in difficulty or complete impossibility of perceiving the environment;

2) disorientation in time, place, surrounding persons;

3) incoherence of thinking along with weakness or impossibility of judgment;

4) memories of the period of stupefaction are fragmentary or completely absent.

To diagnose a state of stupefaction, the presence of all of the listed signs is necessary. The following types of clouding of consciousness are distinguished. Stunning is characterized by a change in the threshold of excitability, when weak stimuli are not perceived by the patient, medium ones are perceived weakly and only strong ones cause a response. Patients are aspontaneous, motionless, their ideas are poor, judgments are slow, assessment of the environment, and the formation of complex connections are impossible. There are no dreams. The affect is monotonous, monotonous. Patients are indifferent to their surroundings or euphoric. Memories of the stunned period are poor or absent. Confusion, delirium, and hallucinations are not observed during stunning.

There is a distinction between nullification - a mild degree of stunning. Increasing stupor leads to stupor, and subsequently to the development of coma.

Delirium is the most frequently occurring type of stupefaction, characterized by an influx of vivid sensory pareidolia, visual scene-like hallucinations, true verbal hallucinations with false orientation in the environment. There are three stages in the development of delirium (Liebermeister). The first stage is characterized by an elevated mood with talkativeness, acceleration of associations, an influx of memories in the form of vivid, clear images, and restlessness. Hyperesthesia and mild photophobia are often observed. Falling asleep is disrupted, sleep is accompanied by vivid dreams. The second stage is characterized mainly by illusory disorders. Patients become increasingly talkative, and illusions appear in the form of pareidolia. Real ideas about objects are replaced by false ones. Sleep is disturbed: patients have difficulty falling asleep, dreams are vivid, disturbing, usually frightening, and often confused with reality. There is an improvement in sleep in the morning. The third stage is characterized by the appearance of hallucinatory disorders. Along with the influx of visual hallucinations, excitement arises, accompanied by fear, protection from ghosts, and a delusional perception of the environment. In the evening, there is a sharp increase in hallucinatory and delusional disorders; in the morning, the described state is replaced by soporotic sleep. Delirium is characterized by light intervals with clearing of consciousness. This is where the development of delirium ends in most cases.

In addition to the three stages described, there are delirium delirium and occupational delirium. They usually develop after the third stage of delirium; their occurrence is a prognostically unfavorable sign. Mumbling, or muttering, delirium is expressed in disordered, chaotic excitement within the bed, monotonous, meaningless grasping movements (symptom<карфологии>, or fleecing), indistinct quiet muttering and lack of reaction to the environment. Following delirium that persists, stupor and coma often develop. Occupational delirium is characterized by a predominance of excitement in the form of automated motor acts over an influx of hallucinations. Patients perform their usual actions: a janitor sweeps the floor with an imaginary broom, a tailor sews with a non-existent needle, etc. Disorientation and lack of reaction to the environment are the same as with delirium delirium;

Amentia is characterized by confusion and incoherence (incoherence). The latter consists of a violation of synthesis: patients, perceiving individual objects, cannot understand the environment in a generalized, holistic form. Patients are excited in bed: they continuously move their head, arms, legs, calm down, then become excited again, their speech is incoherent (they pronounce individual words, syllables, sounds). Affect is changeable: patients are sometimes smiling, sometimes indifferent to their surroundings, sometimes tearful. Excitement is interrupted by periods of calm with helplessness and depression.

With amentia, isolated visual hallucinations and illusions may be observed (more often in the evening and at night). At the height of amentia, catatonic disorders may develop in the form of agitation or stupor.

After the disappearance of amentia, patients do not reproduce a period of upset consciousness.

The environment is perceived by patients in a fantastic way: some consider themselves to be on other continents, planets, flying into space, others - traveling through the underground kingdom, dying in a nuclear war, being present at the death of the world. Depending on the content, expansive and depressive oneiroid are distinguished.

Oneiric stupor is usually accompanied by catatonic disorders: agitation or stupor. The expansive content of the oneiroid often corresponds to excitement, and the depressive content - stupor.

Twilight disorder of consciousness is characterized by disorientation in the environment, an influx of frightening visual hallucinations, an affect of anger and fear, frantic excitement with an aggressive character, or, much less frequently, outwardly ordered behavior. Characterized by the sudden onset and critical resolution of twilight disorder of consciousness. Under the influence of a growing anxious-evil affect and frightening hallucinations, patients commit acts of extreme cruelty and are prone to destructive actions and murder. There is complete amnesia during the period of upset consciousness, but sometimes in the first moments after clearing consciousness the patient can remember some episodes from what happened to him, which are subsequently completely amnesic.

Aura of consciousness is a type of clouding of consciousness in which an influx of hallucinations, psychosensory disorders and depersonalization phenomena, states of ecstasy or fear, and vegetative disorders occur. The listed phenomena remain in the patient’s memory, while what is happening around the patient is not perceived or remembered.

Visual hallucinations are usually panoramic, colored in bright red and blue tones, olfactory hallucinations - in the form of the smell of smoke and burning, auditory - in the form of verbal true and pseudohallucinations.

Depersonalization disorders are usually combined with psychosensory disorders. Autonomic disorders are manifested by attacks of palpitations, dizziness, etc. An aura of consciousness is usually observed in patients with epilepsy, and in some cases it precedes the onset of an epileptic seizure, in others it exists independently (see Epilepsy).

The listed types of clouding of consciousness are observed in intoxication, infectious, somatic diseases, organic diseases of the central nervous system, and epilepsy. Thus, stunning is characteristic of organic lesions of the central nervous system, delirium is observed mainly in infections, intoxications, somatogenic diseases, amentia - in severe infectious and somatic diseases, oneiroid - in schizophrenia, epilepsy, severe organic diseases of the central nervous system and, finally, twilight disorder of consciousness - with epilepsy and organic brain lesions.

Treatment. The occurrence of stupefaction syndrome requires immediate hospitalization in a psychiatric hospital and the adoption of measures aimed at identifying the reasons that caused stupefaction.

For different types of confusion, a different therapeutic approach is needed, depending on the underlying disease.

CONSCIOUSNESS

Disorder of reflection of the surrounding reality - the real world, objects, phenomena, their connections. It manifests itself as a complete or partial inability to perceive the environment, auto- and allopsychic disorientation, impaired time orientation, thinking disorders, amnesia upon exiting the P.s. state. (full or partial). According to M.O. Gurevich, distinguish between syndromes of disorder of consciousness (twilight state, delirium, oneiroid) and loss of consciousness (coma, stupor, stupor).

Syndromes of disturbed consciousness occur when the activity of the cerebral cortex is disrupted and are characterized as disintegrative; they occur with pathological production (delusions, hallucinations) and are characteristic of acute psychoses.

Switching off consciousness occurs as a result of damage to the brain stem; it is not disintegration, but loss of the function of consciousness of varying degrees of depth and occurs without psychopathological production.

Syndromes of clouding of consciousness include some psychopathological conditions in which a violation of cognition of the surrounding reality is detected. The latter manifests itself both in the inability to correctly perceive and understand the environment, and in the loss of the ability for abstract thinking. Attempts to give a unified definition of stupefaction syndromes have encountered significant difficulties. The extreme diversity of psychopathological pictures of these conditions allowed some psychiatrists, and primarily W. Mayer-Gross, to express a categorical judgment about the impossibility of carrying out this task. The definition of stupefaction syndromes as conditions characterized by the inability to perceive the environment due to the loss of the demarcation line between the subject and surrounding objects or the loss of control over the “searchlight beam of knowledge”, which chaotically highlights individual fragments of reality, cannot be considered successful. Therefore, in clinical psychiatry, greater importance is attached to signs of confusion. To this day, the general signs of stupefaction syndromes described by K. Jaspers have not lost their significance. It must be emphasized that only the combination of these signs gives grounds to qualify this condition as a stupefaction syndrome, since individual signs can be observed in other psychopathological symptom complexes that have nothing to do with stupefaction syndromes. The first sign of stupefaction syndromes is detachment from surrounding reality, manifested by difficulty or complete inability to perceive the environment. The psychopathological manifestations of detachment are different: in some cases the patient does not perceive the environment, and it does not determine the patient’s mental activity, while there are no positive psychopathological symptoms; in other cases, detachment from the environment is directly related to the influx of hallucinations, the development of delusions and other psychotic disorders (state of overload). And, finally, detachment can manifest itself as an affect of bewilderment, similar to the state of a healthy person trying to understand something or encountering something incomprehensible and unfamiliar, and a symptom of hypermetamorphosis - hypervariability of attention (C. Wernike), characterized by extreme instability of attention, distractibility, especially to external stimuli. Second sign - disorientation in the environment, those. in place, time, surrounding persons, one’s own personality. The presence or absence of disorientation in one’s own personality is an extremely important sign, which is realized in different ways in different types of stupefaction syndromes. Third sign - thinking disorder consisting in weakness or impossibility of judgment, incoherence of thinking. The nature of thinking disorders is judged by the characteristics of the patient’s speech: in some, the phenomenon of oligophasia is observed - the patient uses a limited number of words in speech, speech seems extremely poor and unexpressive; For others, attention is drawn to extreme difficulty in answering fairly simple questions or when trying to assess a particular situation. With incoherent speech, patients utter phrases that do not contain meaning; individual words have no connection with each other. Often speech consists of individual syllables and sounds. Fourth sign - complete amnesia of the period of darkened consciousness or partial. In some cases, there is complete amnesia during the period of stupefaction, in others, memories of psychopathological disorders and the surrounding reality are fragmentary. Sometimes patients clearly remember the content of painful experiences, but are completely amnesic of both what is happening around them and their own behavior. The following types of stupefaction syndromes are distinguished: stupor, delirium, amentia, oneiric stupefaction, twilight stupefaction and aura of consciousness. Stun — a type of clouding of consciousness, manifested in an increase in the threshold of excitability of the central nervous system, in which weak stimuli are not perceived, stimuli of medium strength are perceived weakly, and only stimuli of sufficient intensity cause a response. Patients do not respond to questions asked in a quiet voice, show a weak, often only indicative reaction to ordinary speech and answer questions spoken loudly enough; At the same time, understanding complex issues, as a rule, turns out to be impossible. The same reactions are observed in patients to light, smells, touch, and taste stimuli. When deafened, there is an impoverishment of all types of mental activity, a characteristic difficulty in the associative process, which applies both to the understanding and assessment of the environment, and to the reproduction of past experience, which is limited to the simplest automated concepts and skills. Patients usually have difficulty comprehending the situation as a whole, while individual phenomena of what is happening, usually the simplest ones, are assessed relatively correctly (confusion and various psychopathological disorders such as hallucinations, delusions, mental automatisms, etc. are incompatible with the picture of stunning). Patients are aspontaneous, inactive, their facial expressions are monotonous and poor, their gestures are inexpressive; Left to their own devices, they remain in the same position for a long time. The mood is most often indifferent, but complacency and euphoria are often observed. There are no memories of the stun period. There are mild degrees of stunning - nullification of consciousness, which is clinically manifested by absent-mindedness, slowness, low productivity, difficulty in understanding issues, comprehending the situation, and solving problems. The development of stunning should be considered a prognostically severe sign: stunning in a fairly short time can turn into somnolence, stupor and coma. Delirium — a type of clouding of consciousness, clinically manifested by an influx of visual hallucinations, vivid sensory pareidolia, and pronounced motor agitation. Despite the fact that visual hallucinations predominate in the picture of the condition, verbal hallucinations, acute sensory delusions, and affective disorders may occupy a certain place in it. In the development of delirium, it is customary to distinguish 3 stages. In the first stage, attention is drawn to elevated mood, extreme talkativeness, restlessness, hyperesthesia, and sleep disturbance. The elevated mood background is unstable. Anxiety and anticipation of trouble appear periodically. Sometimes irritability, capriciousness, and touchiness are noted. Patients experience an influx of vivid memories relating to both the recent and distant past. Memories are accompanied by vivid figurative ideas about the events that took place and excessive talkativeness of the patients. The speech of patients is also dominated by memories of past events, sometimes the speech is inconsistent and incoherent. A significant place in the picture of the condition is occupied by increased exhaustion and hyperesthesia, intolerance to bright light, loud sounds, and strong odors. All of the above phenomena usually increase in the evening. Sleep disorders are expressed in vivid dreams of unpleasant content, difficulty falling asleep, feeling weak and tired when waking up. In the second stage, illusory disorders in the form of pareidolia predominate: patients see various fantastic images, motionless and dynamic, black and white and color, in the patterns of the carpet, wallpaper, cracks on the walls, and the play of chiaroscuro; Moreover, at the height of the development of pareidolia, the imaginary image completely absorbs the contours of the real object. There is even greater lability of affect. Hyperesthesia increases sharply, and symptoms of photophobia appear. Periodically, short periods of light appear, during which the patient develops a correct assessment of the environment, consciousness of the disease, illusory disorders disappear, sleep disturbances are observed: sleep becomes superficial, frightening dreams are frightened with reality, and hypnagogic hallucinations arise at the moment of falling asleep. In the third stage, visual hallucinations are observed. Along with the influx of visual, usually scene-like hallucinations, there are verbal hallucinations and fragmentary acute sensory delirium. Patients are in a state of sharp motor agitation, accompanied by fear and anxiety. Light intervals are possible when patients experience severe asthenic disorders. In the evening, one has to observe a sharp increase in hallucinatory and delusional disorders, an increase in excitement; in the morning the described state is replaced by a short soporous sleep. This is where the development of delirium most often ends. If the duration of delirium is short and amounts to several hours or a day, and its development is limited to the first two stages, then we speak of delirium abortifacient. Severe types of delirium, resistant to treatment, observed for a long time, are defined as prolonged delirium. With a sudden reverse development of delirium, residual delirium is observed in some cases. Deliriums are also distinguished: delirium delirium and occupational delirium. They usually develop after the third stage of delirium. Their occurrence is a prognostically unfavorable sign. At murmuring delirium chaotic disorderly excitement is observed, usually limited to the boundaries of the bed, inarticulate incoherent muttering with the utterance of individual words, syllables or sounds. At the height of excitation, choreiform hyperkinesis or a symptom of picking (carphology) develops, expressed in meaningless grasping movements or small movements of the fingers, smoothing or gathering into folds clothes, sheets, etc. Following delirium that persists, stupor and coma often develop. At professional delirium there is a deeper clouding of consciousness than with ordinary delirium, and the picture of the condition is dominated by excitement in the form of automated motor acts, rather than an influx of hallucinations. Patients perform their usual actions: a tailor sews a non-existent suit with a non-existent needle, a janitor sweeps the floor with an imaginary broom, etc. Patients experience disorientation in the environment and lack of reaction to the environment. A study of occupational delirium shows that in these cases, stupefaction is most similar to oneiroid. Proof of the latter is that the patient feels like an active participant in the events taking place, perceives the surroundings as illusory, and in most cases there are no visual hallucinations. The development of delirium indicates the presence of a somatic disease, infection or intoxication. The occurrence of exacerbating and occupational delirium, as a rule, is the result of the simultaneous development of several hazards: a combination of a somatic or infectious disease with intoxication, as well as a consequence of the development of additional exogeny in somatically weakened individuals. Amentia — clouding of consciousness, in which confusion and incoherence (disintegration) are observed, i.e. the impossibility of comprehending the environment in a generalized, holistic form and the impossibility of assessing one’s own personality. Characterized by pronounced agitation, limited to the confines of the bed: patients make movements with their heads, arms, legs, calm down for a while, then become excited again. The mood of patients is extremely changeable: they are sometimes tearful and sentimental, sometimes cheerful, sometimes indifferent to their surroundings. Their speech is inconsistent, incoherent, consisting of a set of nouns and verbs of specific content or individual syllables and sounds. There is a certain correlation between the nature of the affect and the content of the patients’ statements: in a low mood, the spoken words reflect sadness, sadness; if patients are in a high mood, speech is replete with words expressing joy, pleasure, satisfaction. During the day, more often in the evening and at night, isolated visual hallucinations and illusions, episodes of figurative delirium or signs of delirious stupefaction are observed. At the height of amentia, catatonic disorders in the form of agitation or stupor, choreiform manifestations or a symptom of corfology (picking) can develop. Amentia is also characterized by short-term states with the disappearance of excitation, the development of a picture of asthenic prostration, often accompanied by partial orientation in the environment and formal contact. These states, like the entire period of amentive stupefaction, are amnesic for the patient. A number of modern researchers believe that amentia is the extreme and most severe variant of persistent delirium. The similarity of some signs of the psychopathological picture of such conditions allows us to consider this position worthy of attention. The occurrence of an amental state indicates an extremely severe somatic condition of the patient. Amentia is observed in severe forms of somatic, infectious and non-infectious diseases, less often with intoxication. Oneiric (dreamy) stupefaction is manifested by the patient’s complete detachment from the environment, the fantastic content of experiences, the modification and reincarnation of the Self (dream-like oneiroid) or a state in which there is a bizarre mixture of fragments of the real world and bright sensual fantastic ideas abundantly emerging in the mind (fantastically illusory oneiroid). Experiences during oneiroid are of a dramatic nature: individual situations, often fantastic, unfold in a certain sequence. Self-awareness changes and is deeply upset: patients feel like participants in fantastic events playing out in their imagination (dream-like oneiroid) or in the environment around them (fantastic-illusory oneiroid). Patients often act as historical figures, statesmen, astronauts, heroes of films, books, and plays. The content of the events playing out in their imagination can be different - less often ordinary, more often fantastic. In the latter case, patients perceive themselves as being on other continents, planets, flying in space, living in other historical conditions, participating in atomic wars, and being present at the death of the Universe. Depending on the content there are expansive And depressive oneiroid. Oneiric clouding of consciousness is most often accompanied by catatonic disorders in the form of agitation or stupor. There is a characteristic dissociation between the patient’s behavior, which can manifest itself as inhibition or a rather monotonous pattern of excitation, and the content of the oneiroid, in which the patient becomes an active actor. The appearance of the patients is characteristic. With fantastic-illusory oneiroid, they are confused, look around in bewilderment, their gaze slides from one object to another, without lingering on any of them for a long time (a symptom of hypermetamorphosis). With dream-like oneiroid, they are busy, the environment does not attract their attention. On the patient’s face there is an expression of delight, joy, surprise or horror, anxiety, which is directly dependent on the content of the oneiroid. Oneiric stupefaction does not occur suddenly: in most cases it begins with a state of exaltation with lability of affect or a predominance of elevated or depressed background mood, sleep disorders occur; unusually vivid dreams alternate with insomnia. Patients periodically experience episodes of fear, a feeling that something is about to happen to them, that they are going crazy. The development of oneiroid clouding of consciousness is usually preceded by states with acute sensory and antagonistic delirium, which are essentially stages of oneiroid development. The picture of acute sensory delirium with the nature of staging (delirium of intermetamorphosis) is characterized by constant variability of the environment and persons. Patients claim that a performance is unfolding around them, a film is being filmed, the movements and gestures of those around them are full of special meaning and meaning, in the speech of the people around them they catch a special meaning, often understandable only to them. Unfamiliar faces seem to have been seen before, and familiar and relatives seem to be strangers, made up as acquaintances, relatives, relatives (Capgras symptom, or symptom of a positive and negative double). The described state is replaced by a state of acute antagonistic (Manichaean) delirium, when in the environment patients see or feel two opposing camps, two parties fighting among themselves, one of which is usually the bearer of a good principle, the other of an evil one; patients feel and feel themselves to be at the center of this struggle. With the development of acute antagonistic delirium against the background of manic affect, the forces on the side of the patient win the battle; if the struggle between two principles unfolds in the picture of depression, the patient’s supporters suffer a fiasco. Then there is a state with a tendency to involuntary fantasizing, vivid ideas about flights, travel, wars, world catastrophes, and the described fantasizing can coexist with the perception of the real world and orientation in the environment - oriented oneiroid. Subsequently, oneiroid clouding of consciousness itself develops. Amnesia with oneiroid stupefaction, as a rule, is not observed. Patients in some cases reproduce the contents of the oneiroid in sufficient detail, but usually poorly remember the real situation, in other cases they remember both fragments of fantastic experiences and the environment around them. In a number of cases, after the end of oneiroid, patients discover complete amnesia during the period of stupefaction, but later they have memories of what happened. Twilight state characterized by a sudden onset and sudden resolution of the state, deep disorientation in the environment, pronounced agitation or outwardly ordered behavior, an influx of various types of hallucinations, acute figurative delusions, an affect of melancholy, fear and anger. After the end of the period of stupefaction, patients develop total amnesia; only in some cases, after leaving the painful state for several minutes or hours, memories of psychotic symptoms are retained (retarded amnesia). There are simple, hallucinatory and delusional versions of twilight stupefaction. At simple version the behavior of patients is outwardly quite correct, but usually attention is drawn to a detached, gloomy or gloomy facial expression, the stereotypical nature of statements or the almost complete absence of spontaneous speech; movements are extremely slow or impulsive. The point of view that with a simple version of the twilight state there is no psychopathological symptomatology whatsoever is questionable. Individual statements from patients, sudden suspicion and wariness, conversations with a non-existent interlocutor suggest the development of short-term delusional or hallucinatory states. In the picture hallucinatory twilight states Various types of hallucinations predominate: visual, auditory, olfactory. Visual hallucinations are often panoramic and scene-like, usually painted in red and blue tones, and have different contents: sometimes it is the sight of an approaching crowd, buildings and objects falling on the patient. In some cases, hallucinations are of a religious and mystical nature: patients see saints, evil spirits, and the struggle of these antagonistic forces. Auditory hallucinations accompany visual hallucinations or are independent and are of a commentary or imperative nature. Observed olfactory hallucinations in the form of the smell of burning, smoke, decomposing corpses can also accompany visual or auditory hallucinations or arise as independent hallucinatory states. Delusional variants of twilight stupefaction most often characterized by figurative delusions with ideas of persecution and greatness. Delirium usually has religious and mystical content. Delusional states are often accompanied by various types of hallucinations. For all psychotic variants of twilight states, affective disorders are typical - fear, anxiety, anger, rage, enthusiasm or ecstasy. Hallucinatory and delusional variants of such states can be accompanied by both outwardly ordered behavior and pronounced chaotic disordered excitement with a tendency to aggression and destructive tendencies. The existing point of view that hallucinatory twilight states are accompanied by excitement, and delusional variants are accompanied by apparently correct behavior, is not absolute. In addition, they highlight oriented twilight stupefactions, in which patients show signs of approximate orientation in time, place and surrounding persons. Typically, these conditions occur in the picture of severe dysphoria. Aura of consciousness — short-term, usually lasting a few seconds, confusion of consciousness, in which a variety of disorders arise from somato-vegetative to psychotic. The content of the latter is stored in the patient’s memory, and what is happening around is completely amnesic. There are viscerosensory, visceromotor, sensory, impulsive and mental auras 1. Classic example viscerosensory auras is an “epigastric aura”, manifested by an unpleasant sensation in the epigastric region and a feeling of nausea. Visceromotor auras in contrast to viscerosensory auras, they are extremely diverse in their manifestations: with pupillary auras, the pupil either narrows or dilates, regardless of the degree of illumination, the skin either sharply turns red or turns pale; with gastrointestinal auras, pain occurs in the abdominal cavity, and peristalsis increases sharply. Sensory auras are characterized by the appearance of senestopathic disorders of varying localization and intensity, elementary visual, auditory and olfactory hallucinations, as well as conditions similar to Meniere's syndrome. Impulsive auras are manifested by certain motor acts, violent screaming or forced singing, a state of sharp, usually meaningless motor excitement. The most diverse seem to be psychic auras, characterized by acutely developing disturbances in thinking (ideational auras), psychosensory disorders, states of “never seen before” and “already seen before”, depersonalization phenomena, hallucinations, pictures with clouding of consciousness, close to dreamlike, oneiric, in which the environment is perceived unusually, often fantastically .

Types, signs, treatment of twilight stupefaction

Twilight disorder is a separate variant of qualitative disorders of consciousness. Twilight stupor is essentially a psychotic disorder with productive symptoms.
Until today, this type of oppression of consciousness does not have an exact unambiguous definition. Some scientists indicate that with this disorder, the patient experiences a kind of dual “alternating” consciousness. This definition indicates the periodic variability of a person’s state: one moment the patient is in normal, clear functioning of the psyche, the next moment he experiences painful psychotic symptoms.
Such judgments of experts are based on the fact that, indeed, the leading distinguishing feature of twilight stupor from other qualitative disorders of consciousness is the unforeseen spontaneous occurrence of symptoms. This disorder is characterized by the complete absence of any factors that predict the development of the disorder. Symptoms of clouding of consciousness appear suddenly and are aggravated with lightning speed.

Another difference between this disorder and other forms of qualitative depression of consciousness is the transient nature of the illness episode. The attack of loss of clarity of consciousness is characterized by its short duration. For most people, symptoms of the disorder are recorded within a few minutes. In severe cases of the disorder, the episode of loss of full mental functioning lasts several hours. In isolated cases, symptoms of abnormal brain function are detected within a few days or weeks.
There is another distinctive sign of twilight stupefaction. This qualitative disorder ends as unexpectedly as it starts. The patient's painful symptoms suddenly disappear. The end of a psychotic episode marks the onset of deep terminal sleep.

Almost all people who have suffered an episode of twilight disorder experience a total loss of memory of events that occurred during the episode of illness. However, in some cases, the patient retains partial, often fragmented, memories of the events of the painful period. As a rule, the subject is able to reproduce the incident only for several minutes after the end of the attack. He remembers his thoughts, experiences, words. He talks about the content of hallucinatory images. Reports his actions and actions. However, after some time, the individual loses memory of the facts that occurred.

All researchers point out that when clear consciousness is restored, a person interprets the action he performed as an alien act committed by someone else. There is no complete connection between the actions performed by the subject and his self-awareness. The interruption of the phenomenon of self-awareness during the period of illness explains the patient’s inability to self-regulate behavior and determines the peculiarities of interpretation of the acquired experience.
One of the characteristic symptoms of twilight disorder is a person’s partial or complete detachment from the environment, his alienation from events occurring in reality. During the period of illness, a person perceives information about the phenomena of reality in the form of fragmented, distorted pictures. Or the patient’s perception of reality is completely distorted.

In twilight disorder, the psycho-emotional state is dominated by destructive emotions and feelings. At the same time, all his experiences reach the dimensions of affect and are perceived very painfully. Human thinking is subject to intense, groundless, obsessive fear. He is gripped by irrational anxiety and feels the uncertainty of his own future. He is haunted by difficult-to-define premonitions, thoughts of the inevitability of a catastrophe.

His soul is engulfed in black melancholy and oppressive melancholy. Corroding sadness, all-consuming despondency outwardly manifests itself as angry irritation towards everything that happens. The patient becomes conflicted and unfriendly. He behaves extremely hostilely and aggressively both with strangers and with close people. In twilight disorder, outbursts of rage occur spontaneously. Without any reason, a benevolent and sweet person suddenly becomes an unkind and malicious person. At the moment of an outburst of anger, an individual is capable of not only insulting and offending others, but also causing them physical harm.
Almost always, with twilight disorder, a person loses the integrity of self-awareness and is deprived of the ability to objectively navigate his own personality. Characteristic personality traits are partially or completely erased.
The patient is not able to plan and carry out purposeful actions that would correspond to the current situation and would not be contradictory to the existing principles in society. Often, being in a state of stupefaction, the subject experiences auto-aggression. He commits actions aimed at causing harm to himself. He may, contrary to the natural instinct of self-preservation, cause himself severe bodily harm or behave in such a way that it is likely that his life will end much earlier than the allotted time.

Often in the clinic of twilight disorder there are true hallucinations from various analyzers. Vivid visual, auditory, tactile, olfactory, and gustatory hallucinatory images appear. The patient perceives the emerging hallucinatory objects and phenomena as really existing components of reality. Plots of hallucinations completely displace real objects and events from the world of perception. Another symptom of some variants of clouding of consciousness is the emergence of illusions - distortions in the perception of reality. Often in patients, acute sensory delirium indicates a lack of clarity of consciousness. The delusional sayings uttered by the subject directly indicate how he perceives his own personality and the world around him. Most often, the delusional ideas expressed are devoid of connection with each other: they are inconsistent in content and contradictory in meaning.

In the manner of behavior of a person in a state of stupefaction, two styles can be determined. One group of patients acts illogically and unsystematically. They do some pretty strange things. Their behavior is chaotic and unfocused. The behavior of other patients looks quite normal outwardly. It seems to others that the person is behaving according to a pre-drawn plan. All his actions are perceived by people as consistent and logical. However, no matter what behavior a person demonstrates, his actions are determined by a painful psycho-emotional state and productive symptoms - hallucinations.

Twilight disorder: symptoms of certain variants of stupefaction
All cases of twilight stupefaction can occur in one of the following options, which have differences in etiological factors and occur with certain clinical symptoms. Psychiatrists distinguish the following types of disorders:

Human motor activity also undergoes changes. At one moment the patient's movements are slow and inhibited. In the next moment, he becomes excited: his facial expressions, gestures, and movements are chaotic and expressive. In some patients, active or passive negativism is determined. Whatever the subject is asked to do, he does the opposite. Or he doesn’t fulfill requests and demands at all. A typical symptom of a simple variant of twilight stupefaction is loss of the ability to carry out purposeful motor activity.
In some cases, the patient experiences symptoms of ambulatory automatism: the subject performs illogical, inappropriate and useless actions. Without having to do so, he can leave the house, walk to a stop, get on a bus and travel a certain distance on it. Coming out of the bus, a person does not understand where he is, how he ended up here.

Paranoid (delusional) variant
Symptoms of the delusional form of stupefaction do not appear immediately, but arise gradually. The main difference between this option is the occurrence of acute delirium. The psycho-emotional state of the patient changes significantly: debilitating melancholy, furious anger, and withering anxiety become the predominant feelings. As the disorder worsens, the patient experiences hallucinations, most often visual and auditory. Hallucinatory images instill fear and horror. The stories that appear are very expressive and rich in content. All thinking and behavior of the patient is subordinated to painful obsessive experiences and perceived hallucinatory images.
A characteristic symptom of the paranoid variant of stupefaction is episodic affective outbursts. At such moments, the patient completely loses control over his actions. He behaves hostile and aggressive. Starts conflicts with others, starts fights. In a state of passion, the subject often commits criminal acts. It can cause harm to the health of both random strangers and loved ones.

It is not possible to establish normal contact with the patient. Since he is overwhelmed by delusional ideas, he does not respond to appeals addressed to him. The patient’s narratives tell about what experiences overcome him. In his stories, the patient mentions some offenders and ill-wishers. His painful conclusions are based on past events when someone accidentally offended and insulted him. He has an obsession that this mythical offender has developed a plan of revenge, the goal of which is the physical destruction of the patient. This is why a subject gripped by productive psychotic symptoms begins to take countermeasures.
His behavior completely reflects the state of his inner world. However, the patient’s actions are often externally perceived by people around him as pre-planned actions. A person’s appearance indicates clouding of consciousness. He looks focused and collected. The absent look is noticeable. There is an unusual silence and isolation observed in the person.
The paranoid episode ends suddenly. Most often it hurts to fall into deep sleep. After awakening, he has no memories of the period of illness. He interprets the actions he has performed as actions performed by someone else. He completely denies his involvement in the offenses he committed.

Delirious (hallucinatory) variant
Symptoms of the hallucinatory form of stupefaction occur with lightning speed. Initially, the patient experiences a distortion of the perception of reality in the form of illusions. Hallucinations from the visual and auditory analyzers soon follow. The images that appear are filled with an ominous, frightening meaning. One storyline can be traced between individual hallucinations.
It is impossible to establish connections with the patient: he does not perceive stimuli from the outside and does not respond to changes in the environment. The individual does not understand questions and requests. He is unable to adequately express his experiences. His speech is represented by sounds similar to mooing.

Because his mind is overwhelmed by terrible visions, the patient experiences overwhelming fear. He is extremely hostile towards others. From time to time he has outbursts of fierce anger for no reason. The patient ceases to control his actions. In this state, he can cause significant harm to himself and those close to him.
At the end of the attack, the memories of the events that occurred are completely erased. The person does not remember what he felt or how he behaved.

Oneiric (dream-like) variant
A dream-like form of clouding of consciousness is characterized by the patient’s emergence of absurd thoughts that have a mythical, fantastic content. The individual is transported into a world of illusions. The emotional state is dominated by inexplicable and uncontrollable fear. All of the subject's experiences are very intense and painful.
Visual hallucinations are soon added to the distorted perception of reality. The emerging images are represented by non-existent creatures, fairy-tale characters, and fantastic paintings. The person sincerely believes in the existence of such objects and phenomena. The person becomes a direct participant, and often the main character, of hallucinatory plots. The patient's behavior fully corresponds to the visible pictures.

A characteristic symptom of oneiric stupefaction is a change in motor activity. The patient most often remains in one position. He can stay in one position for days on end, without trying to move or change his body position.
After exiting the oneiric state, a person partially retains memory of events. He can tell you what hallucinatory images he had. However, his stories are fragmented.

Dysphoric (oriented) variant
Signs of a dysphoric type of disorder arise without any warning signs and become aggravated very quickly. Likewise, the end of an episode of illness is marked by a lightning-fast extinction of psychotic symptoms.
The difference between the dysphoric variant of depression of consciousness is the insignificant depth of the disturbances. A person understands who he is. He orients himself normally in space. He recognizes familiar faces.
In the dysphoric form of the disorder, the subject appears as if he is not fully awake. He is lethargic and sleepy. Speaks slowly, smoothly and quietly. He moves, swaying from side to side.
The foundation of the oriented variant of depression of consciousness is a pathologically low mood. Subject is anxious and irritable. He is exhausted by melancholy and anger towards others. It seems to outsiders that the person fiercely hates the whole world.

Hallucinatory images are not present all the time, appearing from time to time, putting a person into a state of panic. Sizzling sadness and all-consuming hatred often reach the level of passion. At the moment of an attack, a person begins to destroy and destroy everything that is in his field of vision. At such a moment, he has no control over his emotions and actions at all.
After regaining clarity of consciousness, the patient retains memories for a short time. However, after two to three hours, there is a total loss of memory about the episode of the disorder.

Hysterical variant - Ganser syndrome
Hysterical stupefaction is formed against the background of long-term stress. Symptoms of Ganser syndrome occur after an extreme traumatic event. The impetus for depression of consciousness can be a person’s sudden exposure to unusual, uncomfortable, unsafe conditions.
With the hysterical version of the disorder, complete alienation from the real world does not occur. In most cases, the patient can be contacted. However, all his narratives boil down to a description of events that became tragic for him.
A characteristic sign of Ganser syndrome is a kind of return of the patient to his childhood. His behavior and speech resemble those of children. He makes faces, grimaces, behaves as if he were a clown. The patient deliberately distorts the pronunciation of certain sounds. He may begin to lisp and be out of tune. He pretends that he cannot pronounce some words. He gives deliberately absurd answers to simple questions. For example, when asked how many fingers he has on his hands, he answers that there are eleven.

There is pronounced distortion when performing typical actions. The patient may diligently pull socks on his hands, and he will try to put gloves on his feet. Although he understands the purpose of these wardrobe elements. Some individuals do not demonstrate any reactions when exposed to pain receptors. They may not seem to feel pain, such as from a needle stick.
A complete loss of the ability to orientate oneself in time, place, and one’s own personality is recorded. The emotional state of the patient is unstable: emotions of joy instantly change to feelings of grief.
After the episode of confusion ends, the person has fragmentary memories of the events that occurred. After deep sleep, a person's memory function is fully restored.

Twilight consciousness disorder: emergency care and treatment
If it is suspected that the subject has developed twilight stupefaction, people around them should immediately call a medical team. The protocol for the provision of medical services stipulates that in this situation a psychiatric team should arrive on an emergency call within 10 to 20 minutes. Since a person’s behavior during twilight stupefaction can lead to unpredictable consequences, the patient is hospitalized in a psychiatric hospital, where he will be examined and subsequently treated.
Before the ambulance arrives, the main task of witnesses to the disorder is to ensure the safety of the patient and their own safety. It is necessary to isolate the individual from contact with society. The optimal course of action is to address the person in a calm, friendly tone and unobtrusively but persistently invite him to sit on the sofa.

If the patient demonstrates aggression and tries to leave the room, the front door should be closed. He must not be allowed to leave the room and come into contact with other people, since it is impossible to predict his behavior. Doctors recommend maintaining some distance when communicating with the subject. He may perceive being too close to a patient as threatening attacks against him.
It is necessary to ensure that there are no things, objects, liquids, or flammable substances near the patient, the use of which would involve causing physical harm. An individual in a state of stupefaction must not be allowed to come close to windows or go out onto balconies.
Considering that many patients with twilight stupefaction are in a state of pronounced psychomotor agitation and demonstrate aggressive and auto-aggressive tendencies, the main measure at the prehospital stage is to secure the patient by physical restraint.

To avoid causing harm to oneself and others, the patient is administered intramuscularly or intravenously the antipsychotic drug Aminazine in a dose of 2 ml of solution, which corresponds to 50 mg of chlorpromazine hydrochloride. 2 ml of aminazine solution is diluted in 20 ml of 5% or 40% glucose solution (Glucosum). Also, the patient, while maintaining normal blood pressure, can receive an intravenous or intramuscular injection of Cordiamin in a dose of 2 ml of solution. To relieve (relieve) psychomotor agitation and agitation, and stabilize the heart rate, intramuscular or intravenous administration of 2 ml of a solution of the tranquilizer Seduxen is advisable. If twilight stupefaction is not accompanied by pronounced agitation, it is recommended at the initial stage of treatment to carry out psychostimulating therapy by subcutaneous injection of 1 ml of caffeine-benzoate sodium solution for injections.

The medical institution provides:

After completing a course of pharmacological therapy, all patients are recommended to undergo a course of psychotherapeutic treatment. If, during the period of a disorder of consciousness, a person has committed a socially dangerous act that violates the existing law and order and caused harm to other members of society, by decision of the court, an outpatient commission forensic psychiatric examination is carried out to establish the mental status of the patient.

Twilight stupefaction represents one of the variants of qualitative dysfunction of the psyche. This disorder belongs to the group of productive psychotic disorders.

The main difference Twilight stupefaction from other qualitative disorders is a sudden onset in the absence of any precursors of loss of clarity of consciousness with lightning-fast development of symptoms.

This condition is characterized by a transient attack - short duration of the disorder episode. The twilight state most often lasts for several minutes. Less commonly, this anomaly can last several hours. Only in exceptional cases can this qualitative disorder be observed in the patient for several days. Another feature of twilight stupor is the sudden cessation of the disorder.

The standard characteristic of this pathology is complete detachment of the individual from the real world, alienation from current events. The patient perceives the events occurring in the form of fragmentary fragments. Or his perception of reality is completely distorted.

During twilight stupefaction, the individual retains the ability to carry out complex motor acts and other habitual sequential actions that occur without conscious control.

The emotional status is dominated by intensity of affect. The subject is under the influence of intense irrational fear. His mood is sad. He experiences a feeling of angry irritation towards others. He displays malevolence and rage. Often the patient behaves extremely aggressively and can cause harm to other members of society. It should be noted that the patient’s emotional status is unstable: affective outbursts occur in the form of attacks.

With twilight stupefaction, there is complete disorientation of the subject in his own “I”. He is deprived of the opportunity to carry out purposeful activities that would correspond to the existing situation and would not contradict social foundations. Often, with this disorder, an individual commits auto-aggressive actions and behaves contrary to the natural instinct of self-preservation inherent in any mentally healthy individual.

This disorder is characterized by the appearance of vivid hallucinatory images that displace real objects and phenomena and are perceived by the patient as objectively existing factors. A typical symptom of twilight stupefaction is the development of acute sensory delirium. Delusional outbursts reflect the patient’s illusory perception of the world around him. The content of delusional inclusions lacks any consistency; their essence is changeable and inconsistent.

The style of behavior of patients can be traced two directions. Some patients perform actions and perform automated actions that from the outside are perceived as pre-planned, orderly and consistent, which misleads people. The behavior of other patients is chaotic, inconsistent and unfocused. They are distinguished by brutal, aggressive actions, the plot of which is based on hallucinations, often of a threatening and frightening nature.

After the end of an acute painful condition, a person often experiences terminal (deep) sleep. Almost all patients experience total memory loss. Only in some cases does partial memory retention of the events that took place occur: memories of thoughts, feelings and one’s own actions during the period of twilight stupefaction are retained for several minutes after the end of the painful episode.

In most cases, the development of twilight stupefaction in the subject implies the existence of a high threat and serious danger to the life and health of both the patient himself and the people around him. That is why the assumption of the development of such a variant of depression of consciousness requires immediate hospitalization of the patient in a psychiatric clinic. Treatment of twilight stupefaction at home or in outpatient departments is not possible.

Twilight stupefaction: forms, causes and symptoms

This type of qualitative violations can occur in several forms:

• simple;
• paranoid;
• delirious;
• oneiroid;
• oriented;
• hysterical.

Simple form

This type of disorder develops suddenly. The person is completely disconnected from real events. He does not accept the appeal addressed to him and does not give answers to questions. It is impossible to make contact with him.

Voluntary speech is either completely absent or represented by frequent repetition of the same sounds, syllables, and words. Outwardly, the subject appears thoughtful and absent-minded. He seems to be completely immersed in his own thoughts. Delusional inclusions and hallucinations are absent in the simple form of the disorder.

Motor activity at one moment manifests itself at a minimal level, up to a complete absence of movement. In the next moment, the patient experiences psychomotor agitation with active or passive negativism. Some patients are able to perform simple sequential actions, but complex motor acts are impossible for them.

Sometimes states of ambulatory automaticity that last several minutes occur. A person performs illogical automated actions. For example, he gets into a subway car and, after traveling some distance, discovers that he is in an unfamiliar environment. The person does not understand how he ended up in this place.

Paranoid form

Symptoms of the paranoid variant of the disorder do not develop instantly, but gradually. The patient’s interpretation of the events of the surrounding world reflects the plots of his existing productive disorders in the form of delusional inclusions. You can learn about what delusional ideas overcome the patient from his stories, since verbal contact with him can be established.

Very often in his narratives the subject mentions past grievances and disappointments. From his stories you can glean information about what tragic events happened to him in the past. Moreover, his personal history has a direct impact on his current behavior. For example, the hero of his delirium may be a person who once offended him in the past. Then the patient begins to pursue him.

Outwardly, the actions and actions of a subject with a paranoid variant of the disorder look orderly and thought out in advance. However, in fact, the patient’s behavior is predetermined by the content of his delusional ideas. The prevailing thoughts are that he is being persecuted and wants to physically destroy him. The patient is convinced that someone is trying to cause him harm, which will lead to his death.

A person in this state is overwhelmed by melancholy, anger, and anxiety. He experiences visual and auditory hallucinations. All visions are frightening. The images that emerge are very bright and rich. Affective outbursts of rage combined with an obsessive delusional idea often become the cause of dangerous antisocial actions.

At the end of the episode, the person completely loses memory of his actions. He denies that he committed any illegal acts.

Delirious form

An episode of the disease develops acutely. This type of depression of consciousness is characterized by the appearance of illusions, to which visual and audio hallucinations are very quickly added. The plot of the scenes that appear sequentially is connected in content. Hallucinations are frightening and threatening.

It is not possible to establish full contact with a person. The patient is completely detached from reality and does not perceive real events. He does not understand and does not respond to requests addressed to him. The patient expresses or shouts out inarticulate sounds, hums or utters some incomprehensible words.

The frightening scenes of the patient's hallucinations are reflected in his behavior. The patient behaves very hostile and aggressive. Outbursts of violent rage are often recorded. In this state, the individual commits atrocious acts with particular cruelty. He can severely beat a random passerby, often inflicting beatings of such force that they lead to the death of the person. A patient with this type of confusion may grab a knife and inflict multiple stab wounds on a loved one. In a fit of fury, he can strangle a peacefully sleeping relative.

This form of qualitative disorder occurs as a result of a diffuse metabolic disorder, most often as a result of intoxication of the body with neurotoxins, narcotic drugs, alcohol, and psychotropic drugs. Upon completion of the painful attack, real events and pathological experiences are completely amnesic.

Oneiric form

This type of clouding of consciousness is caused by significantly expressed experiences of fear and anxiety. The patient has inappropriate and absurd thoughts. His emotions and feelings are manifested with maximum intensity.

The main symptom of the oneiric variant of the disorder is the occurrence of hallucinations, illusions and delusions of fantastic content. The subject is, as it were, transported into a world created by his imagination. His behavior reflects the ideas that arose in his fantasy. He is a participant in the hallucinatory event he is experiencing.

A typical symptom of this form of impaired consciousness is partial or complete immobility of the patient. A person can lie, sit, or stand for hours without trying to change his position. At the end of the episode of illness, partial amnesia is possible: complete memory loss, as a rule, does not occur.

Dysphoric form

Based on a background of painfully low mood. A person feels sad, angry and irritable. He is hostile, rude and harsh towards everyone around him. The subject is ironic and sarcastic. In a state of frantic excitement, the patient may attack other people and cause them serious physical harm. Unbridled rage and uncontrollable violence leads to the fact that the individual begins to destroy everything that comes into his field of vision.

Dysphoric confusion occurs rapidly and suddenly. The end of the episode of the disorder also occurs with lightning speed and spontaneously.

Oriented option

A distinctive feature of this form of the disorder is the insignificant depth of clouding of consciousness. The subject can indicate in which specific place he is located. He recognizes and correctly names the names of relatives.

The leading sign of the oriented variant is the short-term appearance of hallucinatory images and delusional ideas. At the peak of clouding of consciousness, a person is gripped by total fear. He treats those around him viciously and aggressively.

The appearance of patients with an oriented form of stupefaction is also characteristic. The person looks as if he is not completely awake and is in a half-asleep state. His gait is shaky and unsteady. Speech is slow and devoid of any emotional nuances.

After the episode of distress ends, the subject has vague memories of what happened for one to two hours. However, after this temporary variant, complete loss of memory for events during the period of illness occurs.

The oriented form of the disorder most often occurs against the background of severe post-traumatic stress disorder or may be a consequence of an acute reaction to stress.

Hysterical option

This form of clouding of consciousness is characteristic of hysterical psychoses - reactive psychogenic disorders that usually arise as a result of severe emotional shocks and serious mental trauma.

In a hysterical form of stupefaction, called Ganser syndrome, the patient does not experience complete detachment from the real world. With the right approach, it is possible to partially establish contact with him, but productive interaction with him is impossible.

The patient's actions and statements reflect the events that provoked the painful condition. However, the subject prefers to speak in a childish manner: he deliberately does not pronounce certain sounds, has a lisp or burr, and incorrectly pronounces typical words. To simple questions that require a monosyllabic answer, the individual deliberately answers incorrectly and absurdly. He fully understands the meaning of complex addresses, but there is “mimic speech” - the subject is not able to express his thoughts correctly and consistently.

The patient is completely disoriented in space, time, and his own “I.” Some subjects are characterized by lethargy, while others, on the contrary, are animated and behave expressively.

The emotional status during hysterical stupefaction is unstable. The predominant sensations are fear and anxiety. The behavior of patients is dominated by elements of clownery, childishness, and foolishness. They grimace and act childish.

At the end of an episode of disorder, a person retains fragmented memories of his experiences and actions. After terminal sleep, the picture of the suffered attack of depression of consciousness acquires integrity.

Twilight stupefaction: treatment methods

If there is a suspicion of the development of this disorder, it is necessary to isolate the person from society and call an ambulance. It is necessary to take measures to ensure that there are no objects near the patient that could be used to attack others or harm oneself. Subject must not be allowed to approach the window. Also, he must not be allowed to leave the confines of his own home. You should not get too close to the patient, as this step can be regarded as an attack on his life. Since the patient’s actions pose a high threat to others, he is immediately sent to a psychiatric clinic.

In addition to conducting a psychiatric examination, the patient is examined by a neurologist, narcologist and other specialized specialists. Neuroimaging research methods include computed tomography and magnetic resonance imaging of the brain.

The first measure for psychomotor agitation is physical restraint (fixation) of the patient. As prescribed by the doctor, the patient is given intravenous or intramuscular injections of fast-acting sedatives, neuroleptics and antipsychotics. As a rule, maximum doses of drugs are used. Injections of drugs can be performed: olanzapine (Olanzapinum), aminazine (Aminazine), diazepam (Diazepamum).

Further treatment strategy is chosen individually depending on the underlying disease and the form of confusion. After completing the course of drug treatment, all patients are recommended to undergo a course of psychotherapy. If, in a state of stupefaction, a person committed an illegal act, a forensic psychiatric examination is carried out to determine the mental status of the patient and the possibility of bringing him to criminal responsibility.