Stupidity symptoms and treatment. Twilight disorder of consciousness: forms, symptoms, treatment

There are several different forms of impairment of consciousness, and one of these is stupefaction - a transient disturbance of mental activity that can last minutes, hours, days, less often than a week.

This diagnosis is made in the following conditions:

• detachment from the surrounding world, which sometimes reaches the complete inability to perceive reality;
• with partial or complete disorientation in time, place, surrounding;
• with varying degrees of incoherence of thinking, weakness or complete impossibility of correct judgments;
• partial or complete forgetting of the period of darkness.

To make a diagnosis, all of the listed symptoms must be present.

There are 5 main syndromes of clouded consciousness - stupor, delirium, oneiroid, amenicia, twilight stupor.

Stun

This pathology is characterized by impoverishment of the psyche. The person becomes silent, inactive, indifferent, and in a state of dozing. He has difficulty answering simple questions, gives inaccurate/wrong answers. There are no hallucinations, delusions, affective or other disorders.

Sleep passes without dreams. As the pathology progresses, stupor turns into stupor (lack of response to verbal calls, the presence of a motor reaction to physical stimulation, for example, injections), and then into a coma. Stunning that occurs in a mild form is called nullification.

Delirious confusion

Delirium, or delirious syndrome, is the opposite of stupor. It is characterized by many psychopathic deviations, especially visual ones (scene-like hallucinations, numerous fantastic illusions, figurative and visual memories).

At the same time, patients can perceive hallucinations as reality: they react vividly, move actively, catch someone, defend themselves, try to escape, etc. The facial expression is constantly changing. The patient is talkative, but his speech is fragmentary, inconsistent, and may be limited only to screams.

The mood constantly changes: in short intervals panic fear can turn into anxious curiosity, or tearfulness into euphoria.

The doctor may detect unsystematized and fragmentary ideas of persecution, tactile, auditory and olfactory hallucinations. The patient is well oriented in his personality, but falsely in the place and surrounding persons, for example, while in the hospital, he believes that he is visiting.

The state of consciousness during delirium may improve. As a rule, pathology more often manifests itself in the evening and at night. Memories of this period are usually partial and fragmentary. As the disorder progresses, occupational delirium develops - motor overexcitation in the form of habitual, monotonous, repetitive actions (eg movements of a cashier, salesperson), while illusions and visual hallucinations decrease or disappear altogether. Patients become unresponsive, deeply disoriented, and rarely have clear spaces.

Mumbling delirium is accompanied by muttering, motor agitation, and uncoordinated actions. Excitement can be similar to being robbed: the patient monotonously pulls at the blanket, continuously fumbles with his hands, etc. The forms of delirium indicate the degree of the pathology. After the psychosis disappears, the person has no memories of it.

Oneiric stupefaction

Oneiroid, or oneiroid syndrome, is a delusional-fantastic, dream-like clouding of consciousness. Pathology is characterized by influxes of fantastic dreams that arise in the mind, which can completely take over a person (he does not notice those around him) or are combined with pictures of the surrounding environment. Catatonic disorders with lethargy or agitation are common.

As a rule, patients are inactive, silent, practically motionless, their facial expression is frozen.

In the gaze, delight, fear, detachment, amazement, etc. alternately appear. When the patients come to their senses, they say that in this state they were participants in various fantastic events. Sometimes such stories are fragmentary, sometimes they are consistent and complete. After delirium or oneiroid, a patient may remain convinced that all hallucinations were reality (residual delusion). Usually this conviction goes away after days, weeks, months; with epilepsy it can last longer.

Twilight stupefaction

This disorder appears abruptly, does not last long (minutes, hours, sometimes several days), and disappears just as suddenly. This is usually followed by deep sleep. Pathology is expressed in absolute disorientation in the environment, but habitual, automated actions are partially or completely preserved, so patients may not attract the attention of strangers. If during twilight darkness a person wanders involuntarily, ambulatory automatism occurs.

However, the disorder can be more acute, accompanied by fear, speech and motor agitation, and melancholy. Sometimes the patient experiences frenzied rage, delirium, and frightening hallucinations. With such a violation, a person is constantly aggressive, extremely cruel, and commits destructive actions aimed at surrounding people and objects. After the psychosis, he remembers nothing.

They speak of drowsy twilight stupefaction when the patient is abruptly awakened from a deep sleep. He performs monotonous actions, is afraid, commits destructive acts against the background of the latter. Psychosis lasts several minutes, then turns into sleep. There may be a vague memory of the clouding.

It is worth noting that clouding of human consciousness in the form of delirium, stupor, amentia often occurs during intoxication and infectious psychoses, due to pathologies of the central nervous system, for example, with vascular psychoses.

Twilight stupefaction often accompanies epilepsy and traumatic psychoses, and oneiroid - schizophrenia.

Causes of sudden loss of consciousness

The inability to think clearly can range from mild disturbances to an alarming loss of contact with reality. Cases of sudden psychosis can occur to absolutely anyone.

Usually the reasons are hidden in the following conditions:

1. Head injury;
2. Poor supply of oxygen or blood to the brain, for example after a stroke;
3. Progressive degeneration of the brain (ex. Alzheimer's disease);
4. Severe emotional shock;
5. Catastrophically low or excessively high concentration of sugar;
6. Dehydration;
7. In older people, urinary tract infection;
8. Temperature over 40°C;
9. Infections affecting the brain (eg meningitis);
10. Alcohol poisoning of the body;
11. Taking excessively large doses of medications, such as sedatives.

Symptoms of confusion:

• Disorientation;
• Lack of perception of surrounding people;
• Hallucinations;
• Excitation;
• Changes in mood or personality - sudden irritability, depression, strange behavior;
• Loss of activity, interest in usual activities;
• Lack of personal hygiene;
• Memory losses;
• Difficulty speaking, difficulty thinking things through;
• It is impossible to concentrate on a simple task;
• Unpredictable behavior.

What to do if a person has clouding of consciousness?

First of all, you need to immediately call medical care, in particular for head injuries, which are accompanied by dizziness, numbness, weakness, speech disorder, blurred vision, ringing in the ears.

actually twilight violation consciousness is of an organic nature (epilepsy, head injury, intoxication psychoses, to a lesser extent pathological intoxication, pathological affect). The typical picture of twilight disorder is characteristic of epilepsy and is manifested by the following main signs: a) sudden onset and equally sudden end of the painful state. Much less often, a lytic ending of psychosis is observed with the preservation of residual psychotic symptoms and partial memory of the impressions experienced at this time; b) a sharp narrowing of the circle of current ideas, thoughts and motives, due to which only momentary aspects of the immediate environment are perceived; c) externally ordered automated behavior or a state of frantic excitement with chaotic destructive actions; d) deep disorientation, interruption of verbal contact with the outside world and e) total congrade amnesia. Along with the classic version twilight disorder of consciousness there are 1. oriented forms of twilight stupefaction, during which patients recognize familiar people, familiar surroundings, without realizing, however, that their behavior is inadequate to the situation. In some of these patients, dysphoria predominates - a dysphoric variant of twilight stupefaction; 2. in psychotic variants of twilight stupefaction, delusions, hallucinations, affects of fear and rage, and often homocidal behavior are observed.

Oriented psychotic twilight states occur with preservation of the ability to recognize loved ones, fragments of self-awareness, patients give the impression of not fully awakened people (unsteady, shaky gait, slurred speech). This makes it difficult to recognize them in ordinary and forensic psychiatric practice. Careful study of such conditions provides an opportunity to more accurately determine the clinical structure of the disorder. IN domestic psychiatry There are delusional, hallucinatory and dysphoric variants of the oriented psychotic twilight state. 1.1. In the delusional version of twilight darkness, delusional ideas of predominantly persecutory content and behavior corresponding to the content of delirium predominate. 1.2. In the hallucinatory variant, frightening illusions, auditory and visual hallucinations, behavioral disturbances dominate, and hallucinatory agitation may also occur. 1.3. The dysphoric version of the twilight state is characterized by the affects of melancholy, fear and anger. Some researchers distinguish 1. 4. oneiric variant of twilight stupefaction, which is characterized by an abundance of vivid hallucinations of fantastic content and the presence of catatonic symptoms. 1.5. Simple or non-psychotic twilight states (psychomotor seizures of epilepsy), in turn, are divided into: 1.5.1 trances (long-term, sometimes multi-day wanderings performed automatically, moving long distances); 1.5.2. ambulatory automatisms (relatively short episodes of automated walking that occur in the waking state; 1.5.3. states of somnambulism (automatic walking during sleep); 1.5.4. somnolence (somniloquy). Often, twilight states occur in the post-ictal period of epileptic paroxysms or are the equivalent seizure. The duration of twilight episodes ranges from several minutes to a number of days (excluding longer trances).

3. Psychogenic twilight states are characterized by exclusion from the real situation and transfer to a hallucinatory, substituting situation that is traumatic for patients. Such conditions can also occur during sleep (a literary example is Lady Macbeth in William Shakespeare). A peculiar variant of the psychogenic twilight state is amok (see), characterized by attacks of excitement with aggression and homocidal actions. The ritual of shamans is also a psychogenic twilight stupefaction into which they skillfully introduce themselves, and at the same time the participants in this spectacle.

Disturbances of consciousness are manifestations of dysfunction of certain areas of the brain, which may be accompanied by a temporary complete or partial loss of connection with reality, hallucinations, delusions, aggression or a feeling of fear.

Disturbances of consciousness include stupor, stupor, coma, twilight stupefaction and some other conditions in which the patient is not capable of adequate perception reality.

Why does consciousness disappear?

The main causes of disturbances of consciousness include:

• no visible structural changes brain;
• and electrical activity of the brain;
• , metabolic and mental diseases;
• drug addiction, alcoholism, substance abuse;

Types of disorders and disorders of consciousness

Disorders of consciousness are divided into two large groups: quantitative and qualitative. The quantitative group includes coma, stupor (somnolence) and stupor. Qualitative ones include twilight stupefaction, ambulatory automatism, fugue and some other disorders of brain activity.

Main types of disturbance and/or clouding of consciousness:

1. Stupor (). Translated from Latin, this word means “numbness.” A patient in a stupor stops reacting to the surrounding reality. Even strong noise and inconvenience, such as a wet bed, do not cause a reaction in him. During natural Disasters(fires, earthquakes, floods) the patient does not realize that he is in danger and does not move. Stupor is accompanied by movement disorders and lack of response to pain.
2. Twilight stupefaction. This type of disorder is characterized by sudden and also suddenly disappearing disorientation in space. A person retains the ability to reproduce automated habitual actions.
3. Locked-in syndrome. This is the name of a condition in which the patient completely loses the ability to speak, move, express emotions, etc. Those around him mistakenly believe that the patient is in a state of flux and cannot adequately respond to what is happening. In reality, the person is conscious. He is aware of everything that is happening around him, but due to paralysis of the whole body, he is unable to even express emotions. Only the eyes remain mobile, through the movement of which the patient communicates with others.
4. . This is a condition in which the patient is conscious but confused. Him understanding of the surrounding reality is maintained. The patient easily finds the source of sounds and reacts to pain. At the same time, he completely or practically loses the ability to speak and move. After their healing, patients say that they were fully aware of everything that was happening around them, but some force prevented them from adequately responding to reality.
5. . Characterized by constant desire fall asleep. At night, sleep lasts much longer than it should. Awakening usually does not occur without artificial stimulation, such as an alarm clock. It is necessary to distinguish between 2 types of hypersomnia: the one that occurs in completely healthy person, and one that is typical for people with mental and other types of disabilities. In the first case increased drowsiness may be a consequence of the syndrome chronic fatigue or . In the second case, hypersomnia indicates the presence of a disease.
6. Stun(or stunned consciousness syndrome). During deafening, the already mentioned hypersomnia and a significant increase in the threshold of perception of all external stimuli are observed. The patient may experience partial amnesia. The patient is unable to answer the simplest questions, hearing voices and knowing where the source of the sound is. There are 2 types of stunning consciousness. In more mild form the patient can carry out the commands given to him, moderate drowsiness and partial disorientation in space are observed. With more severe form the patient performs only the simplest commands, his level of drowsiness will be much higher, and disorientation in space will be complete.
7. Wakeful coma (). Develops after serious ones. This condition received the name “coma” because, despite being conscious, the patient is not able to come into contact with the outside world. The patient's eyes are open and the eyeballs are rotating. At the same time, the gaze is not fixed. The patient has no emotional reactions and speech. The patient does not perceive commands, but is able to experience pain, reacting to it with inarticulate sounds and chaotic movements.
8. . A mental disorder that occurs with disturbances of consciousness. The patient suffers from visual hallucinations. Him disorientation in time is observed, orientation in space is partially impaired. There can be many causes of delirium. Elderly people and alcoholics suffer from hallucinations. Delirium may also indicate the presence of schizophrenia.
9. . Due to injury and for some other reasons, a person loses the ability to be mentally active. The patient's motor reflexes are preserved. The cycle of sleep and wakefulness is maintained.
10. Dissociative fugue. A type of mental disorder in which the patient completely loses his previous personality and begins to new life. The patient usually seeks to move to a new place of residence, where no one knows him. Some patients change their habits and tastes and take a different name. A fugue can last from several hours (the patient, as a rule, does not have time to radically change his life) to several years. Over time, there is a return to the previous personality. The patient may lose all memories of the life he led during the fugue period. A mental disorder can be caused by events of a traumatic nature: the death of a loved one, divorce, rape, etc. Psychiatrists believe that fugue is a special defense mechanism of our body, allowing us to symbolically “escape” from ourselves.
11. . A confusional disorder in which the patient loses the ability to synthesize. The big picture the world for him breaks up into separate fragments. The inability to connect these elements with each other leads the patient to complete disorientation. The patient is not capable of productive contact with the surrounding reality due to incoherent speech, meaningless movements and gradual loss self.
12. Coma. The patient is in unconscious, from which it is impossible to derive it by ordinary methods. There are 3 degrees of this condition. In a first-degree coma, the patient is able to respond to stimuli and pain. He does not regain consciousness, but responds to irritation with defensive movements. While in a second-degree coma, a person is unable to respond to stimuli or experience pain. In third degree coma, vital functions are in a catastrophic state, muscle weakness is observed atony.
13. Short-term loss of consciousness (,). Fainting is caused by a temporary disruption of cerebral blood flow. The causes of short-term loss of consciousness can be conditions of low oxygen content in the blood, as well as conditions accompanied by disorders nervous regulation vessels. Syncope is also possible with some neurological diseases.

Twilight state of consciousness and its types

Stupefaction (twilight) occurs with, and. This type disorders of consciousness are called transient, that is, unexpectedly occurring and passing quickly.

Long-term stupefactions (up to several days) are possible mainly in epileptics. This condition may be accompanied by fear, aggression and some other negative emotions.

Twilight disorder of consciousness is characterized by hallucinations and delusions. The visions are frightening. Expressed aggression is directed towards people, animals and inanimate objects. A person suffering from twilight darkness is characterized by amnesia. The patient does not remember what he said and did during his seizures, and does not remember the hallucinations he saw.

Twilight consciousness occurs in several variants:

1. Outpatient automatism. This condition is not accompanied by delusions, hallucinations or aggressive behavior. Outwardly, the patient’s behavior is no different from his behavior in his normal state. A person automatically performs all usual actions. The patient may wander aimlessly along the street, following familiar routes.
2. Rave. The patient's behavior does not always change. This state is characterized by silence and an absent gaze. The patient may show aggression.
3. Oriented twilight stupefaction. The patient retains consciousness in fragments and is able to recognize close people. Delusions and hallucinations may be absent. The patient experiences fear or aggression.
4. Hallucinations. The visions that visit the patient during an attack are threatening. Patients see red or blood. Visions may include fictional characters or fantastic creatures that show aggression. The patient begins to defend himself, causing harm even to those closest to him.

At the first signs of twilight conditions, a person must be provided with pre-medical assistance, care and observation. The patient should not be left alone. If consciousness is not completely lost, contact can be maintained with it.

Sometimes familiar faces become the only reference point for someone who has lost touch with reality. You should not wait until the patient completely loses contact with the outside world. He needs urgent transport to the hospital.

First aid for impaired consciousness

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

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

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

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.

Providing medical care

A person suffering from any type of mental disorder must be constantly monitored by a psychiatrist and undergo a medical examination on time. Since the causes of impaired consciousness may vary, treatment may also differ in each individual case.

For example, if a patient suffers from kidney failure, he is prescribed hemodialysis. In case of drug overdose Naloxone is required. Loss of consciousness caused by alcohol poisoning requires large doses of thiamine. In addition, in case of any poisoning, you must first rinse your stomach.

If during the next attack the patient lost consciousness for a long time, fell into a coma, a vegetative state or stupor, the doctor needs to assess vital functions and find out whether the patient’s body can independently support its vital functions.

(Tizercin, ) - drugs most often used in the treatment of disorders of consciousness, administered intramuscularly. To prevent the collaptoid state, Cordiamine is prescribed. If the first signs are present, the patient must be hospitalized. A nurse is assigned to the patient for care and constant monitoring.

Consciousness disorders are a group of mental illnesses and disorders that prevent the patient from providing self-help. The relatives and friends of a sick person have a huge responsibility.

They should not allow the patient to remain left to himself for a long time, and at the first signs of the onset of a seizure, they must be able to help him.

This syndrome is characterized by a sudden onset, short duration and equally sudden cessation, as a result of which it is called transient, i.e. transient.

An attack of a twilight state of consciousness ends critically, often with subsequent deep sleep. Characteristic feature twilight state of consciousness is subsequent amnesia. Memories of the period of stupefaction are completely absent. During the twilight state, patients retain the ability to perform automatic, habitual actions. For example, if a knife comes into the field of vision of such a patient, the patient begins to perform the usual action with it, regardless of whether there is bread, paper or a human hand in front of him. Often, in a twilight state of consciousness, delusions and hallucinations occur. Under the influence of delirium and intense affect, patients can commit dangerous acts. Twilight state consciousness that occurs without delusions, hallucinations and changes in emotions is called ambulatory automatism(involuntary wandering). Patients suffering from this disorder, having left the house for a specific purpose, suddenly and in an incomprehensible way find themselves at the other end of the city. During this unconscious journey, they mechanically cross streets, ride in public transport and give the impression of being lost in thought.

The twilight state of consciousness sometimes lasts for an extremely short time and is called absence(absence - French).

Somnambulism (sleepwalking, sleepwalking)- twilight stupefaction, which is a variant of outpatient automatism, but unlike it, occurs during sleep.

Fugues and trances- short-term twilight (1-2 minutes) clouding of consciousness with motor agitation: the patient runs somewhere, takes off and puts on clothes, and performs other impulsive actions.

End of work -

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It was previously noted that pathopsychological research is complex in nature and, along with the main experimental methods, includes a conversation with the patient and observation

Stages and technology of pathopsychological examination
Pathopsychological research, like any other scientifically based research, is special kind activities in which various components are naturally distinguished

Preparing a pilot study
The preparatory stage is carried out before the direct meeting of the psychologist with the future subject. The purpose of this stage is to plan future empirical research.

Rules for selecting pathopsychological techniques
The choice of specific methods cannot be random; it is also determined by the purpose of the study and the nature of the tasks. As is known, the techniques used in psi

Conducting a pilot study
The purpose of the second stage of the pathopsychological study is to collect empirical data. At this stage, there is direct interaction between the psychologist and the subject, conducting

Analysis and interpretation of experimental psychological research data
The final stage of the research - analysis of the obtained empirical facts, their generalization and interpretation - is very important and often very difficult (especially for a beginner

Perception disorders
In pathopsychology, as well as in psychopathology, they study various shapes disturbances of perception, but the emphasis is not on description individual symptoms and syndromes not identified and

The problem of agnosia in pathopsychology
The study of agnosia has received much attention in neuropsychology, mainly in connection with the problem of localization of functions and the search for their neurophysiological mechanisms (works of A. R. Luri

Pseudoagnosia in dementia
Since the basis of agnostic disorders is a violation of the semantic side of perception, this gave reason to believe that these disorders should appear most clearly in patients with

Pathopsychological studies of deceptions of feelings
As noted earlier, the most severe form of perceptual disturbance is hallucinations. The clinical literature describes in detail a variety of hallucinations as symptoms

Study of violations of the motivational component of perceptual activity
The study of perception disorders from the point of view of psychology would be incomplete if we did not pay attention to the role of the personal component in their occurrence. S. L. Rubinstein pointed out

Memory disorders
The pathopsychological approach to the study of memory disorders is carried out from the position of the activity approach (A. N. Leontyev, G. V. Birenbaum, R. I. Meerovich, B. V. Zeigarnik, A. R.

Impaired immediate memory
An experimental pathopsychological study of disorders of immediate memory was carried out on the material of the two most common psychopathological amnestic syndromes

Vicarious memory disorders
Domestic psychologists(L. S. Vygotsky, A. N. Leontiev, P. I. Zinchenko, etc.) considered memory as an organized activity, depending on many factors, such as the level

Violation of the dynamics of mnestic activity
In some cases, memory disorders manifest themselves not in disruption of individual processes, but in disruption of the dynamics of all mnestic activity. In such cases, the memory of the patients bears

Impairment of the motivational component of memory
Considering memory as one of the forms of mental activity, it is necessary to take into account the role of all components included in its structure when analyzing it (and analyzing its violations). Was previously

Thinking disorders
Disorders of mental activity are considered in the context of pathopsychological experimental studies as violations of the components included in its structure. B.V. Zeigar

Violation of the operational side of thinking
Thinking is a generalized and indirect knowledge of reality, therefore, among logical operations, ensuring the flow of mental activity, the operation of generalization

Violation of the motivational (personal) component of thinking
In Russian psychology, thinking is considered as special shape human activity, formed in practice, when a person has a need to solve some

Violation of the dynamics of mental activity
Like any other activity, thinking has its procedural side, that is, it occurs over time and has a certain changeable dynamics. I.M. Sechenov also pointed out that we

Impaired critical thinking
Mental activity requires, in addition to orientation in the conditions of the task, the performance of logical operations, also comparison of the final and intermediate results obtained with the forecast

General psychological characteristics of human performance
Disorders of mental activity of mentally ill people can be of a different nature. As is known, along with disorders cognitive processes And personal changes could

Clinical manifestations of mental impairment
Impaired mental performance is most clearly manifested in the clinical picture of asthenic syndrome (a state of neuropsychic weakness). The leading manifestation of this syn

Pathopsychological analysis of mental performance disorders in mental disorders
At experimental study of the mental activity of mentally ill people, its disturbances associated with impaired mental performance are revealed. About mental impairment

Personality disorders
Personality disorders are not unambiguous; they can be expressed in changes in the motivational sphere, changes in self-esteem and level of aspiration, communication disorders, self-control

Violation of mediation and hierarchy of motives
The development of activity, and therefore the development of personality, can be analyzed based on the analysis of changes in motives. However, a change in motives is not only a sign

Violation of meaning formation
The pathology of the motivational sphere can manifest itself not only in changes in the mediation and hierarchy of motives, but also in violations of the relationship between their meaning-forming and incentive functions.

Impaired behavioral control
One of the most striking manifestations of personality disorders is a violation of controllability and criticality of behavior. Violation of criticality can take different forms and act in different ways.

Formation of pathological personality traits
In the studies of pathopsychologists (G.V. Birenbaum, B.V. Zeigarnik, N.K. Kalita, etc.), using the example of patients with epilepsy, the process of formation of abnormal features of their character was analyzed