Syndromes of clouding of consciousness, abnormalities in brain function

29 Jun 2021 at 12:16 MRI of the head in Tushino 7415

If you often find yourself forgetting things and becoming too suspicious of others, you may need medical advice. Dementia is often perceived as analogous to memory loss. However, this disease, even in its acute form, is a common symptom of age-related dementia, the development of which can be stopped.

Stunned or lethargic

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

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

Treatment

Since confusion is only a syndrome of general pathological conditions of the body, treatment is aimed at relieving the underlying disease. In case of acute intoxication, measures are taken aimed at removing toxic substances from the body and maintaining breathing and cardiac activity.

The reception is conducted by specialists

Tagirov Akram Karamovich

neurologist, reflexologist

Delirium (hallucinations)

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

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

Oneiric state (“waking dream”)

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

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

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

Stun

Accompanied by partial difficulty in mental activity. Adequate behavior remains, but the train of thought slows down and signs of disorientation appear. The patient answers questions in monosyllables, but correctly, but if they talk to him loudly, sometimes the phrase has to be repeated several times. Sensitivity to painful stimuli is reduced, the patient does not notice discomfort (for example, wet clothes, uncomfortable posture, etc.). Depending on the severity of clinical symptoms, mild, moderate and severe degrees of stunning are distinguished. Subsequently, partial memories are retained.

Amentive clouding of consciousness (amentia)

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

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

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

Twilight stupefaction

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

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

Twilight state of consciousness and its types

Stupefaction (twilight) occurs with hysteria, organic diseases of the central nervous system, epilepsy and traumatic brain injury. This type of disorder of consciousness is called transient, that is, it occurs unexpectedly and passes quickly.

Long-term stupefactions (up to several days) are possible mainly in epileptics. This condition may be accompanied by fear, anxiety, 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:

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.
Brad . The patient's behavior does not always change. This state is characterized by silence and an absent gaze. The patient may show aggression.
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.
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.

Glossary of terms

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

Amentive clouding of consciousness (amentia)

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

Hallucination

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

Delirium

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

True hallucinations

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

Comatose state (coma)

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

Oneiric state (oneiroid, schizophrenic delirium)

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

Schizophrenic delirium

– the same as
oneiric state (oneiroid)
.

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, stupor (somnolence) and stupor. Qualitative ones include twilight stupefaction, ambulatory automatism, delirium, oneiric stupefaction, fugue and some other disorders of brain activity.

Main types of disturbance and/or clouding of consciousness:

Stupor (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.
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.
Locked-in syndrome . This is the name of a condition in which the patient completely loses the ability to speak, move, express emotions, etc. People around him mistakenly believe that the patient is in a vegetative state 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 his entire body, he is unable to even express emotions. Only the eyes remain mobile, through the movement of which the patient communicates with others.
Akinetic mutism . This is a condition in which the patient is conscious but confused. He retains an understanding of the surrounding reality. 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.
Hypersomnia . Characterized by a constant desire to sleep. 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 a completely healthy person, and the one that is typical for people with mental and other types of disabilities. In the first case, increased sleepiness may be a consequence of chronic fatigue syndrome or stress. In the second case, hypersomnia indicates the presence of a disease.
Stunning (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 a milder form, the patient can carry out the commands given to him, moderate drowsiness and partial disorientation in space are observed. In a 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.
Wakeful coma (apallic syndrome) . Develops after serious traumatic brain injury. 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.
Delirium . A mental disorder that occurs with disturbances of consciousness. The patient suffers from visual hallucinations. He has disorientation in time, and his spatial orientation 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.
Vegetative state . 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.
Dissociative fugue . A type of mental disorder in which the patient completely loses his previous personality and begins a 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 to the psyche: 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.
Amentia . A confusional disorder in which the patient loses the ability to synthesize. For him, the overall picture of the world falls apart 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 the gradual loss of his own personality.
Coma . The patient is in an unconscious state, from which it is impossible to revive him using conventional 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, and muscle atony is observed.
Short-term loss of consciousness (syncope, fainting) . 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 disturbances in the nervous regulation of blood vessels. Syncope is also possible with some neurological diseases.