Twilight clouding of consciousness: causes, symptoms, diagnosis and treatment. Twilight states of consciousness

Violation of consciousness is expressed in quantitative and qualitative changes.

To quantitative syndromes violations (oppression) of consciousness include: stunning, stupor, to whom.

To qualitative syndromes violations (stupefaction) of consciousness include: delirious syndrome, oneiroid state, amentia, twilight state of consciousness.

Twilight state of consciousness- short-term sudden loss of clarity of consciousness with complete detachment from the outside world or with its distorted fragmentary perception while maintaining the usual automated actions.

Twilight disorders of consciousness can occur with epilepsy, organic pathology of the brain, hysterical reactive psychoses.

During a seizure, the patient is not able to perceive and evaluate the reality around him, although he has retained his orientation in a narrow area of ​​​​the environment, the patient simply correctly assesses the situation and behaves more or less correctly.

The victim is dominated by frightening hallucinogenic and delusional experiences that provoke the patient to aggressively destructive actions, his actions are unpredictable, aggressive, and therefore dangerous. The victim, despite the seemingly sequence of his actions, is completely disoriented - he cannot give his name, does not orient himself in space and time, does not recognize relatives and friends. Despite the fact that the speech of the victim is coherent and correctly constructed, nevertheless, he cannot answer the question posed and does not expect an answer himself.

The exit from the twilight state of consciousness is often critical, with complete retrograde amnesia, less often - lytic.

Attacks of ambulatory automatism are a kind of twilight states - the victim's consciousness instantly turns off, and he continues to perform automated externally ordered actions. Waking up, the person does not remember what happened.

Somnambulism more common in childhood and adolescence. A person during sleep walks, performing extremely complex automatic actions.

Emergency care for twilight states of consciousness

• First of all, it is necessary to ensure the safety of the victim and the people around him. To do this, the patient is isolated in a separate room, where he is looked after until the ambulance arrives.
• Before transport to medical institution psychomotor agitation of the patient should be stopped.
• The patient is forcibly restrained, while a 0.5% solution of sibazon is injected intravenously in a volume of 2-4 ml.
• If after 5-10 minutes the excitation is not stopped, then the injection is repeated at half the dose from the original.
• A good effect is achieved when neuroleptics are combined with desensitizing drugs.
• sick in without fail hospitalized in a psychiatric hospital.

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Twilight clouding of consciousness (synonym)

a psychopathological disorder characterized by a sudden and short-term loss of clarity of consciousness with complete detachment of the environment or with its fragmentary and distorted perception while maintaining habitual actions. More common in patients with epilepsy seizures or as equivalents), in persons with traumatic brain injury, less often with symptomatic, incl. intoxication and reactive, psychoses. When drunk and chronic alcoholism there may be a variant of S. p. s. - pathological prosonic state.

Depending on the clinical manifestations of S. p. distinguish simple and "psychotic" (hallucinatory-delusional) forms. simple form develops suddenly, can last several minutes, hours, rarely days. At the same time, patients disconnect from reality, stop answering questions; it is impossible to communicate with them. they are slowed down, up to the development of short-term stuporous states; episodes of impulse excitation with negativism are possible. In some cases, consistent, often relatively simple, but outwardly purposeful actions are preserved. If they are accompanied by involuntary wandering (sometimes goes on a trip or performs other fairly complex actions), such S. p. s. called ambulatory automatism.

Bibliographer.: Manual of Psychiatry, ed. G.V. Morozova, vol. 1, p. 158, v. 2, p. 267, M., 1988; Manual of Psychiatry, ed. A.V. Snezhnevsky, vol. 1, p. 63, M., 1983; Saarma Yu.M. and Mehilan L.S. Psychiatric Syndrome, p. 45, Tartu, 1980; Snezhnevsky A.V. General, p. 116, Valdai, 1970.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Twilight clouding of consciousness" is in other dictionaries:

- (syn. twilight disorder of consciousness) a type of impaired consciousness that occurs suddenly and manifests itself as disorientation in the environment with the preservation of familiar automated actions. Accompanied by motor speech excitation, affect ... ... Wikipedia

Violation in the activity of consciousness. It is characterized by deep disorientation in the world around, with the relative preservation of the logical sequence of actions. Accompanied by vivid and frightening hallucinations, strong affects arise ... ... Psychological Dictionary

twilight clouding of consciousness- Category. Violation of the activity of consciousness. Specificity. It is characterized by deep disorientation in the world around, with the relative preservation of the logical sequence of actions. Accompanied by vivid and frightening hallucinations, there are ...

Twilight clouding of consciousness- (twilight state) - clouding of consciousness, a combination of deep disorientation with the preservation of interrelated actions, the presence of vivid hallucinations, fear, anger and longing, the manifestation of aggression. Wed trans...

paroxysmal mental disorder, which is characterized by a pronounced affect of anger, fear, longing, often vivid delirium, hallucinations, with the ability to consistently perform complex actions, which may be accompanied by ... ... Great Soviet Encyclopedia

A disorder of consciousness in which a person performs certain actions, but is not aware of them and does not remember anything about what he did. The condition develops after epileptic seizures, with alcoholism and some diseases accompanied by ... ... medical terms

DUSK CONSCIOUSNESS- (twilight state) a disorder of consciousness in which a person performs certain actions, but is not aware of them and does not remember anything about what he did. The condition develops after epileptic seizures, with alcoholism and certain diseases, ... ... Dictionary in medicine

twilight confusion- violation of the activity of consciousness, characterized by deep disorientation in the outside world with the relative safety of the logical sequence of actions. Accompanied by vivid and frightening hallucinations. There are strong effects ... ... Great Psychological Encyclopedia

clouding of consciousness- - a psychotic state, which, according to K. Jaspers (1923), is characterized by: 1. detachment, that is, a disorder of sensory cognition that separates the patient from reliable sensory information about what is happening in the outside world and in oneself; 2.… … Encyclopedic Dictionary of Psychology and Pedagogy

- (syn. twilight state) sudden onset and just as suddenly ending clouding of consciousness with hereditary amnesia, in which the patient performs interrelated sequential actions due to figurative delusions, hallucinations ... Big Medical Dictionary

See Stupefaction twilight psychogenic ... Big Medical Dictionary

Such states are classic version paroxysmal-twilight disturbance of consciousness. At the same time, the perception of the outside world has an unclear, intermittent character, as if through a fog. There is an affective enthusiasm, fixation on a complex of very changing experiences, which, due to the narrowed tunnel consciousness, can easily turn into terrifying hallucinations or delusions, which can further lead to senseless actions violent nature.
With twilight consciousness, the mood fluctuates from the affect of melancholy, anger, fear to an increase in mood to an ecstatic state. The field of consciousness is significantly narrowed, only one clear tunnel remains, in the narrow circle of ideas of which the possibility of elementary purposeful action with the experience of automatisms. These states of consciousness last from a few minutes to several days or hours.

Twilight states of consciousness are divided into simple (ambulatory automatisms), complex and aura of consciousness.
Simple twilight states appear suddenly. Patients are disconnected from the surrounding reality. They do not answer questions, it is impossible to communicate with them. Their spontaneous speech is absent or limited to the stereotypical repetition of individual interjections, words, short phrases. The movements are sometimes constrained and slowed down, then there is an impulsive excitation. Sometimes the actions of patients remain consistent, patients are captured by the sensation that owns them and is separated from the content of consciousness. If a simple twilight state is accompanied by involuntary wandering, we are talking about ambulatory automatism, which can be short-term with a sharp, often meaningless or chaotic motor excitation. The patient can run somewhere or spin in one place ( fugues), or long time to wander without a goal, while performing actions that give the impression of outwardly purposeful and orderly ( trance). Ambulatory automatism that occurs during sleep is called sleepwalking or somnambulism. Sleepwalkers carry out aimless actions of an automatic nature. Their attention is focused on a very limited range of ideas and objects, they cannot be awakened.

Absence - turning off consciousness for a moment. At this moment, the patients suddenly fall silent with a blank look, as if they have lost their thoughts, and if this happens during work, then an instrument falls out of their hands, while eating - a spoon, while smoking - a cigarette. After the end of such a state, which lasts seconds, they look around in confusion, cannot immediately collect their thoughts. The depth of the disturbance of consciousness during absence corresponds to stunning.

Complex twilight states of consciousness are accompanied by delirium, hallucinations and altered affect. The patient's perception of the environment changes due to the existence of productive disorders. You can learn about them from the involuntary statements of patients, and also because verbal communication with them can be preserved to a certain extent. The actions and words of patients reflect the existing pathological experiences. Among the hallucinations, visual hallucinations predominate, sensually vivid, scene-like, with terrifying content. Auditory and olfactory hallucinations simpler in content, but necessarily affectively significant and intense (roar, clatter, explosions, they). Delusions are usually figurative with ideas of persecution, grandeur, mystical content. Emotional experiences are also intense and marked by tension. Characteristic is fear, insane anger or ecstasy.

After the complex twilight ends, complete amnesia sets in. These conditions are very dangerous due to their unpredictability and frequent aggressiveness, viciousness of patients.

One of the varieties of twilight states of consciousness is pathological intoxication, in which against the background of a lung alcohol intoxication there comes a narrowing of consciousness, which is accompanied by hallucinatory and delusional experiences, often threatening content, so patients can commit a number of inadequate and socially dangerous acts. This state is similar to complex twilight states of consciousness.

Sometimes complex twilight can occur immediately after mental trauma (ganzer syndrome). In the presence of a difficult situation that threatens life and safety, people with hysterical manifestations of personality develop twilight disorders of consciousness, which are primitive. defensive reactions, an expression of an instinctive desire to get out from under the yoke of unbearable reality, "to escape into the disease." Some of them come across as profoundly imbecile ( pseudodementia), they do not give their name, month, date, they cannot count the number of fingers on their hands, they give ridiculous answers to the question, they do not recognize objects and cannot use them. Sometimes patients refuse to stand and walk, if they are put on their feet they fall, often fall into a state of stupor (n seudocatonic stupor). There may be a regression of forms of behavior, in which patients displace reality from consciousness, completely uncritically assess their situation and resemble children with their behavior: they babble like a child, ask for “hands”, enjoy toys, cannot use their knowledge ( puerilism).

A situation that threatened a person's safety could have taken place in the past, even far away. As a rule, this is a severe sexual trauma caused by parents or close relatives in childhood (incest or attempted rape). The result of such a psychotrauma may be the emergence of an alternating consciousness or multiple personality. There may be splitting or even multiple disorder personality with the emergence of multiple states of consciousness. The content of mental life in each of these states allegedly differs from the others. The stereotype of behavior that is formed in one state changes significantly when the patient moves to another state. As a result, the patient does not remember what happened to him and what he did recently; but when returning to the previous state, he remembers the answers, his experiences, actions and events.

Quite often, the structure of the twilight state of consciousness has an aura - a disorder of consciousness, which is accompanied by peculiar sensations ( sensory aura), movements ( motor aura) or mental experiences ( aura with psychopathological phenomena). An aura is observed just before an epileptic seizure. The aura with psychopathological phenomena is closest to the twilight state; clinically, it manifests itself in bright, often hallucinatory experiences, expressive and colorful. In the absence of hallucinations, real objects are perceived extremely contrastingly, expressed, but “somehow not so” - everything around becomes alien, often accompanied by a feeling of “already seen”, in which patients sometimes try to remember something, but cannot do it. In other cases, the aura is accompanied by psychosensory disorders, senestopathies, or states of ecstasy with mystical penetration into the environment (the last version of the aura was observed in F. M. Dostoevsky). Sometimes patients cannot clearly describe their psychopathological experiences. A number of aura variants have less resemblance to classical twilight states, and more resemble special states of consciousness.

A twilight state is a disorder of consciousness, which is characterized by the following symptoms:

- sudden onset and end of a disease state;

-a sharp narrowing of the circle of actual ideas, thoughts and motives, a significant restriction of access to external impressions(probably, the origin of the term itself is connected with this: patients perceive only an insignificant part of the environment, just as with the onset of darkness only a little that is close is seen);

- profound disorientation followed by complete amnesia. But in a number of cases, elementary orientation in the environment, correct recognition of individuals, elements of self-consciousness - oriented twilight clouding of consciousness

- wild excitement when patients can perform unexpected heavy aggressive actions, attacking others, destroying everything in their path. Aggression and cruelty are the hallmarks of the twilight state.

In this state, outwardly correct and formally ordered, as if pre-planned behavior can also be observed; those. externally, patients may appear little changed, often their activity remains consistent, which immediately makes it possible to distinguish these conditions from delirium. However, the very first question addressed to the patient or the word spoken by him shows that the patient is disoriented: he does not understand where he is, does not recognize the people around him, cannot name the day, month, year, does not remember his name and the names of people close to him. The speech of such patients is coherent, grammatically correct, but at the same time it is impossible to talk with them. They do not answer questions, they themselves do not wait for an answer to their statements. They speak to no one, as if to themselves.

Twilight disturbances of consciousness occur in epilepsy, brain tumors, pathological intoxication, in the acute period of traumatic brain injury, in vascular, intoxication psychoses.

Allocate the following types twilight clouding of consciousness:

1. Delusional

2. Hallucinatory

3. Dysphoric

4. Ambulatory automatism (sonambulism, speech automatism, walking automatism)

5. Psychogenic conditioned

Delusional.

Delusional ideas prevail, delusional behavior takes place. Amnesia here is incomplete - when questioned, patients report individual details about the delusional experiences that arose during the period of impaired consciousness.

hallucinatory.

Characterized by the dominance of frightening illusions, auditory and visual hallucinations, a state of hallucinatory arousal, sometimes partial or delayed amnesia. In childhood, some types of night fears can proceed according to this type.

Dysphoric.

Affective disturbances prevail in the form of anger, rage, fear with a relatively mild clouding of consciousness. Dromomanic tendencies may also appear.

Clinical case (a patient who was under examination at the Serbsky Institute):

The officer of the ship, being on vacation on the shore, behaves as usual: he walks, communicates with people, talks to them, his mood is even, but after a while it catches the eye of others that he becomes more silent, concentrated, tense, his gaze is absent . Nevertheless, his behavior remains correct: he puts himself in order, shaves, gets into the boat, comes ashore, but there he moves away from his comrades, which was not characteristic of him before. He lags behind his comrades and disappears. In the future, according to witnesses, it turns out that he wanders around the city, he is seen first at one end, then at the other. Then he enters the rest house, hides there in the back streets and suddenly attacks one of the vacationers and kills him. He is arrested and taken to the police. There he very inconsistently reports about himself, calls his last name, confuses his age, quickly sinks into a deep sleep. When he wakes up, he does not remember anything about what happened.

An even more tragic example, where a patient is described who, in a similar condition, killed her child, cut open her stomach, pulled out the entire intestine and hung it in the form of linen on clotheslines. Then she suddenly came to her senses, saw with horror that her child had been killed and mutilated. She did not remember anything and was not able to imagine that she could do it.

Ambulatory automation.

Paroxysms of a disorder of consciousness with outwardly ordered behavior such as aimless and fairly long wanderings (walking automatisms) in the absence of delirium, hallucinations, affective disorders. Patients suffering from this disorder, having left the house for a specific purpose, suddenly, unexpectedly and incomprehensibly to themselves, find themselves at the other end of the city. During this unconscious journey, they mechanically cross the streets, ride in vehicles and give the impression of people immersed in their thoughts. Seizures of ambulatory automatism can be timed to coincide with the period of sleep - somnambulism (sleepwalking). Sleeping is close to somnambulism - speech automatisms in a dream. In most cases, sleepwalking and sleep-talking are neurotic in nature and are associated with dissociated sleep disorders. In contrast to neurotic epileptic sleepwalking (meaning the actual seizures; neurotic forms of somnambulism can also be observed in patients with epilepsy) are characterized by a certain (like seizures) rhythm of appearance, develop on average much less frequently and usually without connection with the impressions of the past day. It is impossible to wake up an epileptic somnambulist: persistent attempts to do this may contribute to the development of a convulsive attack. Sleepwalking paroxysms are observed at a strictly defined time of the night and are reproduced in a stereotypical form. In the morning, patients feel overwhelmed, as after a normal seizure, and, as a rule, they do not remember the fact of sleepwalking. It should be noted that the difference between epileptic sleepwalking and neurotic sleepwalking has long been known: if a wet rag is laid in front of the door or by the bed for the night, the neurotic, stepping on it, will wake up, while the epileptic somnambulist will not.

Psychogenic conditioned.

It is characterized by turning off the patient from the real situation and transferring to a hallucinatory, replacing a traumatic situation for him. The environment is perceived incompletely, in accordance with painful experiences. The behavior of patients is bright, expressive, maybe even demonstrative. Possible partial amnesia, mostly affecting external events. There may be psychogenic episodes of ambulatory automatism, in particular, somnambulism (an example from fiction is Lady Macbeth). Hysterical twilight clouding of consciousness is observed in reactive psychoses, as well as low-progressive schizophrenia with hysterical dissociative manifestations.

Urgent care .

It is necessary to provide conditions that prevent the possibility of an accident. When using means of fixation, it should be remembered that an excited patient, if he is armed with some kind of tool (fragments of furniture, etc.), should be approached by several people from different sides at the same time, holding mattresses, pillows, blankets in front of him. Approaching the patient closely, fix his limbs. Then the patient is laid on the bed, injected with drugs and kept until the end of the attack, if it is short-lived, or until evacuation to a psychiatric hospital.

When excited, chlorpromazine or tizercin is prescribed, 2-3 ml of a 2.5% solution intramuscularly (repeated injections are possible). A rather quick sedative effect is achieved by introducing into an enema 1-2 g of chloral hydrate and 0.1 g of caffeine in 50-60 ml of starchy mucus. If the excitation is very pronounced, hexenal or thiopental sodium (0.5-0.6 g) is administered intramuscularly, having prepared an ex tempore 5% solution. After some sedation, an enema with chloral hydrate, sodium barbital and caffeine is administered.

In more severe and protracted cases, not amenable to the action of chlorpromazine and tizercin, haloperidol is used intramuscularly (1 ml of a 0.5% solution 1-2 times a day). Sometimes excitation is stopped by intramuscular administration of the above doses of chlorpromazine (tisercin) in combination with haloperidol.

The fastest sedative effect is achieved by slow intravenous administration of chlorpromazine (up to 3 ml of 2.5% chlorpromazine solution with 10-20 ml of 40% glucose solution). It is advisable intravenous or intramuscular injection of 10 ml of a 10% solution of calcium gluconate or intravenous administration of calcium chloride. As soon as the excitement decreases, these medications should be administered orally (for example, chlorpromazine or tizercin up to 300 mg) until the twilight state is completely eliminated, in cases where the twilight state becomes protracted, complex therapy is carried out using antiepileptic drugs and antipsychotics in smaller doses.

Hospitalization is necessary in a psychiatric facility in all cases of a twilight state.