Confusion or disorder of consciousness is a distorted perception of the real world. This pathology is a whole complex of different syndromes, among which the following are considered particularly striking and significant:

• Disorientation in time and space;
• incoherent thinking;
• complete or almost complete amnesia.

The disease has varying degrees of severity and can manifest itself as simple stupor, stupor or coma. Depending on the severity of the syndromes, emergency psychiatric care is provided and the person is hospitalized for subsequent inpatient treatment. Treatment can be carried out either in a psychiatric hospital (pronounced clouding syndrome) or in the intensive care unit of a hospital.

Description of the disease

Bewildering is a form of pathological condition that is characterized by a short-term but sharp (sudden) loss of clarity and clarity of consciousness.

Such an inadequate state can also manifest itself in the form of self-isolation from the outside world, detachment and asociality. In this case, a person exhibits outwardly ordered behavior that is similar to automatic. In some cases, with disorders of a twilight nature, a state of fear, apprehension, melancholy may be observed, or attacks of anger and rage may appear. The peculiarity of the condition is that it goes away as suddenly as it begins.

All a person’s memories of the “experienced” state are completely erased. Although, sometimes a person still remembers fragmentarily both the actions he performed and the events occurring at that moment. But this is rather an exception to the rule of total amnesia.

The duration of the twilight type disorder can last from several minutes to several days.

It is believed that the main causes of this condition are pathologies that arise in the brain. The disorder also occurs during hysterical psychosis or other pathological condition. To confirm the diagnosis, you need not only an anamnesis, but also the testimony of eyewitnesses who observed clinical manifestations of human behavior.

The most correct thing to do in such a situation is to ensure the safety of both the person and others through emergency hospitalization. As for treatment, taking into account the patient’s initial condition, drug therapy is prescribed.

Treatment is carried out only by specialists from the field of psychiatry.

Reasons for appearance

Professionals from the field of psychiatry identify two sets of reasons that can give impetus to the development of twilight disorder of consciousness.

There are functional and organic reasons.

The most common and widespread causes of organic nature include classical epilepsy. The group of organic causes, in addition to the already mentioned epilepsy, includes lesions of the temporal region (its medial sections), provoked by:

1. Neoplasms (tumors);
2. TBI (traumatic brain injury);
3. Other pathological processes.

Functional reasons that provoke twilight disorder of consciousness include stress, difficult situations of a traumatic nature, and hysterical psychosis.

Types of pathology

Based on clinical symptoms, psychotic and non-psychotic disorders of consciousness are distinguished. The psychotic group includes the following types:

1. , which is accompanied by vivid manifestations of fear and fear, sadness and melancholy, or expressed rage and anger;
2. Delusional disorder, during which the patient develops obsessive delusional ideas that determine his behavior;
3. Hallucinatory disorder accompanied by visual and auditory hallucinations. During this type of state, the appearance of obsessive illusions is observed, the content of which determines his behavior. Behavior is also influenced by the content of the hallucinations that arise.

Separately, experts identify this type of psychotic twilight disorder as oneiric, which is accompanied by the appearance of fantastic colorful hallucinations adjacent to the patient’s weak external activity.

Manifestations of catatonia (a syndrome of a psychopathological nature, which is accompanied by motor disturbances in the form of hyperexcitation or, conversely, complete stupor) may be observed.
The group of non-psychotic twilight disorders of consciousness includes:

1. Trances, which are distinguished by a fairly long period, and during which a person can “automatically” perform any action. As practice shows, the most common activity of the patient is moving to an unfamiliar city;
2. Automatisms are outpatient, which are characterized by automatic short-term actions;
3. Somniloquy, accompanied by;
4. Somnambulism, the main indicator of which is.

Main features

Symptoms of twilight disorder depend on the type and type of condition.

Dysphoric disorder

The patient has, first of all, a visual orderliness of his activity and actions. At the same time, the patient becomes immersed in himself and appears isolated from the events occurring around him. An angry or gloomy grimace appears on the face. In rare cases, a person appears wary.

Since the patient does not show any reactions to contact with him, it is not possible to establish contact with the person.

Most of the time he is silent. Sometimes he can answer using standard phrases that have nothing to do with the sentences or questions addressed to him. A person can recognize his surroundings and recognize people who are familiar to him.

This “recognition” is very limited, because the patient completely loses the ability to critically evaluate his own behavior. As a result, the patient performs actions that are completely inadequate for the specific situation.

If fragmentary hallucinations occur, the patient’s perception of time and his body is disrupted, and an “obsessive” feeling of death or the presence of a double appears.

If hallucinations progress, then either aggression directed at the outside world or auto-aggression directed at oneself appears.

Hallucinatory type

Illusions appear, turning into auditory and visual hallucinations. It becomes impossible to establish productive contact with the patient, because he completely isolates himself from reality and ceases to perceive words and actions addressed to him. As a result of the impact of hallucinations, which, as a rule, are frightening in nature, a person becomes aggressive and embittered. Therefore, cases of extreme cruelty towards others are not uncommon. A patient in this condition can cause severe injuries to people nearby, and even kill with his bare hands.

Delusional type disorder

The patient has an obsessive idea that he is being persecuted. The person looks absolutely “normal” and collected. Perhaps he looks overly cautious and scared. But it is impossible to establish contact with him in this state, since he is trying to “protect himself” and can commit inappropriate, atypical and asocial actions.

Delusional disorder is a rare case when, after emerging from a pathological state, the patient can retain memories of his experiences and emotions.

Outpatient automatism

The patient performs actions automatically (on autopilot). Outwardly, such a person looks absent-minded or thoughtful. In fact, during such a state, the patient can leave the apartment and “find himself” in a neighboring city. In this case, exit from the state is accompanied by . As with trances, the patient has no hallucinations, no delusions, no dysphoria. At the same time, trances last for a longer period, so a person may find himself at a greater distance from home.

Hysterical psychosis

There is a lesser degree of self-isolation from reality, which allows, at least partially, to maintain contact with the person. Thanks to contact, it is possible to determine the reasons or circumstances that provoked the development of hysterical psychosis and resulted in a twilight disorder of consciousness.

To clarify the picture of what is happening, you can put the patient into a hypnotic sleep.

First aid

Based on the nature and type of disorder, certain priority actions are taken.

The main task is to protect a person from himself as quickly as possible. The patient must be isolated so that he does not cause harm to himself or others.

In case of dysphoric delusional or hallucinatory disorder, the patient must be isolated until doctors arrive. To protect a person from self-injury, his hands need to be secured. Upon arrival of the ambulance, a team of professionals performs comprehensive fixation of the patient and also administers diazepam (2-4 ml.). If the excitement does not go away 10 minutes after the injection, the drug should be re-administered in the amount of half the first dose. Drugs such as seduxen, sibazon or relanium have a similar effect.

If a psychotic type is affected, the patient must be immediately taken to a psychiatric ward and antipsychotic drugs and medications with tranquilizer properties must be used to normalize the condition.

Upon recovery from the pathological condition, individual psychotherapy is prescribed.

If the twilight disorder is non-psychotic in nature, then emergency care is not needed, but treatment of the underlying pathology should be carried out. In this case, the further prognosis is influenced by the course of the chronic disease and its features.

Treatment Options

To diagnose disorders of consciousness of the twilight type, it is necessary to evaluate the clinical picture and analyze the testimony of eyewitnesses. To confirm the diagnosis, EEG, CG and MRI of the brain are performed (we advise you to read); a consultation with a neurologist is also indicated.

If a crime was committed during a pathological condition, then a forensic psychiatric examination should be carried out.

Depending on the type of disorder, treatment is prescribed. If we are talking about a non-psychotic type, then the main emphasis in treatment is aimed at the root cause, that is, the pathology that provoked the disorder. If we are talking about the psychotic type, then, first of all, it is necessary to bring the patient out of the state of “inadequacy”, and based on the results of all examinations, prescribe treatment, including both drug therapy and individual psychotherapy.

Conclusion

Conclusion

At this stage, the researchers agreed that the cause of the twilight disorder of consciousness lies in the disruption of connections between neurons. Failures in cortical connections are not structural, but functional in nature, and are provoked by the development of an imbalance of neural mediators that occurs during various intoxications, endogenous mental disorders, ischemic disruptions in the functioning of the brain, etc.

The main task of specialists is not just to identify the disorder, but to determine its type, which allows them to determine subsequent treatment tactics and achieve positive results.

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- a pathological condition characterized by a sudden short-term loss of clarity of consciousness and detachment from the outside world, combined with apparently ordered automatic behavior or attacks of rage, melancholy or fear. As a rule, it ends suddenly, and memories of the period of twilight disorder of consciousness are completely lost. Occurs with brain pathology, hysterical psychosis and some other conditions. The diagnosis is established on the basis of anamnesis, clinical manifestations and eyewitness accounts. Treatment – ​​ensuring the safety of the patient and others, pharmacotherapy.

General information

Causes and classification of twilight disorders of consciousness

There are two groups of causes for the development of disorders of consciousness: organic and functional. The most common organic cause of twilight disorder is epilepsy. It is also possible that the medial parts of the temporal regions may be damaged as a result of TBI and other pathological processes. The group of functional causes of twilight disorders of consciousness includes hysterical psychoses and sudden severe psychotraumatic situations.

Disorders of consciousness can be psychotic or non-psychotic. Depending on the clinical symptoms, three types of psychotic twilight disorders of consciousness are distinguished:

• dysphoric– accompanied by expressed anger, melancholy or fear
• delusional– formation of delusional ideas is observed, behavior is determined by the content of delirium
• hallucinatory– accompanied by illusions, visual and auditory hallucinations, behavior is determined by the content of hallucinations.

Some experts also distinguish the oneiric type of psychotic twilight disorder of consciousness. With this variant, colorful fantastic hallucinations prevail in combination with minor external activity and manifestations of catatonia.

Non-psychotic twilight disorders of consciousness are divided into:

• shemales– long-term states of confusion, during which the patient automatically performs some actions, usually leaving for another city
• ambulatory automatisms– short-term automatic actions
• somnambulism - sleepwalking
• somniloquy- talking in your sleep

Symptoms of twilight disorders of consciousness

Dysphoric twilight disorder of consciousness is characterized by external orderliness of actions. The patient looks detached from what is happening, immersed in himself. The facial expression is often angry or sullen, sometimes wary. Establishing contact is impossible - the patient does not react to speech addressed to him and either remains silent or utters stereotypical remarks that are in no way related to the words of the interlocutor. In some cases, patients with twilight disorder of consciousness have limited recognition of familiar surroundings and people they know, but they lose the ability to critically evaluate their own behavior and act inappropriately to the situation. Fleeting fragmentary hallucinations may occur: disturbances in the perception of time, disturbances in the body diagram, a feeling of a double, a feeling of death and birth, etc. As hallucinations progress, aggression and auto-aggression are possible.

Hallucinatory twilight disorder of consciousness is accompanied by the formation of illusions, which are subsequently joined by auditory and visual hallucinations, usually of a frightening nature. Productive contact is impossible - patients with twilight disorder of consciousness are completely isolated from reality, do not perceive speech addressed to them, pronounce abrupt phrases or individual words, sometimes hum or shout out something inarticulate. Hallucinatory experiences provoke aggressive behavior. There are frequent outbursts of aggression, during which patients with twilight disorder of consciousness commit acts of terrifying force and cruelty: they inflict multiple wounds on other people using sharp objects, severely beat and beat to death with their bare hands, etc.

Delusional twilight disorder of consciousness is accompanied by the development of delusions of persecution. It seems to the patient that someone is trying to harm him, has intentions and commits actions that should entail his suffering or death. The behavior is outwardly orderly, from the side of the patient it looks focused and purposeful, but productive contact, as in previous cases, is impossible. A patient with a twilight disorder of consciousness often commits antisocial acts determined by the content of delirium and aimed at “protecting himself from a threat.” After normalization of the condition, many patients retain memories of their own experiences.

Outpatient automatisms are characterized by the performance of automatic actions. The patient can get on a tram, travel a few stops, and then suddenly find himself in an unfamiliar place, he can get dressed, close the door, leave the house and come to his senses on the street, not understanding how he got there. From the outside, patients with twilight disorder of consciousness look thoughtful, somewhat confused, immersed in their thoughts. Delusions, hallucinations and dysphoria are absent. After exiting this state, complete amnesia for events during the illness occurs. A similar clinical picture is observed during trances, but in this case the disorder of consciousness is longer lasting and, as a rule, is accompanied by moving long distances.

Twilight disorders of consciousness in hysterical psychoses are characterized by a lesser degree of detachment from what is happening. Contact with the patient is partially preserved; from the patient’s behavior and remarks one can understand what circumstances provoked the development of psychosis. After normalization of the condition, partial memories of events and experiences during the illness are retained. When immersed in hypnotic sleep, memories come to life, the picture becomes more coherent and complete.

Diagnosis and treatment of twilight disorders of consciousness

The diagnosis is made based on the clinical picture and eyewitness accounts. When crimes are committed, a forensic psychiatric examination is carried out. Psychiatrists who are members of the commission talk with the patient, study the testimony of witnesses and representatives of law enforcement agencies, reports of forensic experts, etc. If a twilight disorder of consciousness of organic origin is suspected, the patient is referred for a consultation with a neurologist, an EEG, MRI of the brain, CT scan of the brain are performed brain and other studies.

Patients with dysphoric, hallucinatory and delusional twilight disorders are isolated until the ambulance arrives so that they cannot harm themselves or other people. In case of psychomotor agitation, a specialized team performs fixation, and the emergency doctor administers 2-4 ml of diazepam intravenously to the patient. If arousal persists within 5-10 minutes from the moment of administration, the injection is repeated using half the initial dose of the drug.

Patients with psychotic twilight disorder of consciousness are urgently taken to a psychiatric department, fixation is continued, and tranquilizers and antipsychotics are prescribed. After exiting the psychotic state, individual psychotherapy is carried out (especially important when committing actions that resulted in the death of other people or causing serious harm to the health and property of others). For non-psychotic twilight disorders of consciousness, the underlying pathology is treated. The prognosis is determined by the characteristics of the underlying disease.

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 of reality.

Why does consciousness disappear?

The main causes of disturbances of consciousness include:

• without visible structural changes in the 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 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.
4. . This is a condition in which the patient is conscious but confused. He has 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 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 drowsiness may be a consequence of chronic fatigue syndrome 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 a milder form, the patient can carry out 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.
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. He has 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 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 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: 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. 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.
12. 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, 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 disturbances in the nervous regulation of blood vessels. Syncope is also possible with some neurological diseases.

Twilight state of consciousness and its types

Stupefaction (twilight) occurs with, and. 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, 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 must take urgent measures. If consciousness is completely lost, you need to try to bring the person back to his senses: give him a sniff of ammonia, put a napkin soaked in cold water on his head.

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

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

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.

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 clouding of consciousness, 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 soporous 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 excruciating delirium;

Amentia is characterized by confusion and incoherence (incoherence). The latter consists in 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, 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.

All types of clouding of consciousness have a number of common features:

• 1) detachment from the outside world;
• 2) disorientation in place, time and surrounding persons, sometimes in one’s own personality;
• 3) incoherence of thinking along with weakness or impossibility of judgment;
• 4) complete or partial amnesia during the period of stupefaction.
• 1. Stunned state of consciousness (drowsy, somnolent). Orientation in the environment is incomplete, in one’s own personality it can be preserved, but in time it is disrupted. Slowness of movements, silence, and indifference to surrounding stimuli are noted. The condition is characterized by a sharp increase in the threshold for all external stimuli and difficulty in forming associations. The person answers questions as if “awake”. The depth of stun can be different (light, medium, deep). Deep stun is dangerous because it can turn into sopor.

: often this state of consciousness can occur both after intense mental trauma (sudden intense enemy shelling, hostage taking, etc.) and physical (traumatic brain injury).

In addition, such a disturbance of consciousness can occur during intoxication stages of somatic diseases (infection, poisoning, diabetes, peritonitis, typhus, anemia).

2. Delirious stupefaction. In such a state of consciousness, a person can be completely disoriented in place, time and self. In contrast to stupor, a person in this state is fussy, mobile, talkative at random, facial expressions do not correspond to the situation: he expresses fear, then joy, laughter or curiosity. Not always, but the appearance may change: there is severe redness of the face, sweating, trembling of the limbs against a background of high temperature, sloppiness. With targeted questioning, you can identify visual and auditory deceptions (hallucinations), and delusional ideas. That is, a person sees, hears and feels what others do not see or hear, and comes into contact with the invisible world (answers questions, performs actions under the influence of “voices” heard only by him). In this state, he can commit auto- and hetero-aggressive actions. At the same time, at times he can answer questions correctly, but then attention and orientation in the environment are disrupted again.

In the practice of a clinical psychologist: this state of consciousness can develop in persons who have consumed alcohol, drugs or their substitutes, against the background of intense stress, after traumatic brain injuries and infections.

3. Oneiric (dreaming) state of consciousness. This state is characterized by influxes of fantastic experiences, often intertwining pictures of reality. Fantastic experiences have the nature of vivid dreams, without motor excitement, since the person himself is not always an active participant in the events he experiences. Often all experiences are perceived as if from the outside, while he has a double orientation. Often a person sees himself on other continents, planets, lives in other historical eras, participates in atomic wars, and is present at the death of the Universe. Although very dynamic events may unfold before your eyes, behavior may remain inhibited. Upon recovery from this state, amnesia, as a rule, does not occur. A person can draw or describe in sufficient detail what he saw, but at the same time he will have difficulty remembering the real situation around him.

Sometimes oneiroid can be in the form of excitement or stupor, expansive or depressive.

In the practice of a clinical psychologist: oneiroid can occur against the background of intense exposure to psychotraumatic factors in persons predisposed to psychosis or who have previously had sluggish, latent forms of disorders: with schizophrenia, epileptic disease, organic diseases of the brain, tumors, etc.

4. Twilight state of consciousness (TSC). In this state, disorientation in the environment is combined with the development of hallucinosis and acute sensory delirium with an affect of melancholy, anger and fear, frantic excitement or, very rarely, outwardly ordered behavior. CVS develops suddenly and ends just as suddenly; its duration varies - from several hours to several days or more. In this state, a person can show aggressiveness, characterized by extreme cruelty, due to anxious and angry affect and the presence of hallucinations or delusions. Depending on their predominance in the structure of impaired consciousness, CVS has three clinical variants: delusional, hallucinatory, dysphoric. With the latter option, amnesia of experienced events can be delayed: immediately after the resolution of the SSS, the person, although indistinctly, for several minutes or hours, remembers the events and his behavior during a period of darkened consciousness, and amnesia subsequently develops. CVS occurs in epilepsy, organic brain diseases, and tumors.

Also in the structure of the cardiovascular system, mention should be made of such disorders as obnibulation, pseudodementia, depersonalization and derealization, and states of ambulatory automatism.

Obnibulation - consciousness seems to become foggy for a few seconds, covered with a light cloud, while all types of orientation are preserved, amnesia does not occur.

Pseudo-dementia characterized by a short-term impairment of intellectual-mnestic abilities in literate people (for example, a person cannot answer the question of how many fingers or toes he has, but at the same time he can correctly answer a complex question).

Depersonalization characterized by a feeling of alienation or splitting of one’s own “I”, a violation of the “body diagram” (for example, a person thinks that one leg reaches the size of a two-story building, the size of the stomach extends to the whole body, etc.).

Derealization- a state in which the surrounding world and environment are perceived indistinctly, unclearly, as something unreal. Often a person can perceive a familiar environment as “never seen”, and an unfamiliar one as “already seen” (“ja mé vu” and “de ja vu”).

Amentia - confusion of consciousness with a predominance of incoherent speech-motor excitation against a background of confusion, affect of anger and fear, followed by complete amnesia.

In the practice of a clinical psychologist: such conditions can develop in persons who have suffered severe head injuries, stress, predisposition to mental illness, after severe intoxication and infectious diseases.

5. State of ambulatory automatism. This condition is characterized by automated forms of behavior (somnambulism, sleepwalking, trance). In these states, a person can perform purposeful actions without being aware of what is happening (travelling by transport, leaving his place of residence); when leaving it, he cannot understand how he found himself in this or that situation.

In the practice of a clinical psychologist: this condition develops in many people after hysterical and epileptic seizures - those predisposed to vascular and other psychoses, those who have suffered traumatic brain injuries, as well as against the background of exposure to intense stress factors (crisis situations of a socio-political nature, emergency situations of a man-made, environmental and natural nature, emergency incidents of a criminal nature).