Consciousness, violation . The criteria for impaired consciousness are: 1) the patient’s detachment from the environment with difficulty, fragmentary and indistinct perception; 2) various types and degrees of disorientation (in place, time, self, etc.); 3) one or another degree of incoherence of thinking, accompanied by weakness or impossibility of judgments and speech disorders; 4) complete or partial amnesia for the period of impaired consciousness. Only a combination of all four signs makes the diagnosis of impaired consciousness legitimate.
Nonpsychotic forms. Fainting is a short-term loss of consciousness as a result of transient brain ischemia. Stunning is characterized by two main signs: an increase in the threshold for all stimuli and a depletion of mental activity. In this regard, patients answer questions asked only persistently and in a loud voice. Their answers are usually monosyllables, but correct. Patients do not complain of noise, an uncomfortable, wet bed, do not respond to other inconveniences. The stun period is usually fully or partially amnesized. Sopor - a more serious condition ("pathological sleep"), in which simple mental reactions to external influences are preserved: pulling the arm away at an injection, opening his eyes to a loud sound; pupillary, corneal, and conjunctival reactions persist. Coma is characterized by complete oppression of mental activity, the absence of pupillary and other reflexes, and dysfunction of the pelvic organs. All degrees of stupidity are signs of severe brain damage and are observed with intoxications, traumatic brain injuries, metabolic disorders (uremia, diabetes), with volumetric processes, vascular and other organic diseases of the central nervous system.
Psychotic forms. Twilight stupefaction - a sudden onset and suddenly ceasing stupefaction with subsequent amnesia, in which the patient performs sequential actions due to delusional or hallucinatory experiences, affects of fear or anger. The criteria are: paroxysmality of the onset and termination of the disorder, the safety of automated activity, complete subsequent amnesia . Partial contact with the patient is possible. Twilight states of consciousness are observed in epilepsy, organic brain diseases.
Delirium is an illusory-hallucinatory confusion, characterized (as opposed to being stunned) by lowering the threshold to all irritants and rich psychopathological symptoms. Oneiroid (oneiric syndrome) - confusion with an influx of vivid and fantastic, like-like representations in the form of finished paintings in content that follow in a certain sequence. If the patient’s inappropriate behavior in delirium immediately becomes apparent to everyone, then the oneiroid state is often seen due to the patient’s inactivity (“with delirium, the patient is a participant in imaginary events, and with oniroid, the viewer”). Catatonic frustration are constant, more often proceeding with lethargy (see. Catatonia). Patients are usually silent, almost motionless, with a frozen expression on their face, and only a look in which alternately rapture, detachment, fear, amazement indicates that something unusual is happening in their minds.
Onyroid can last several weeks and the patient usually has fantastic experiences in his memory when he forgot what really happened at that time. It is observed, as a rule, in acute attacks of schizophrenia. The condition requires emergency care, can temporarily be stopped by intramuscular injection of antipsychotics (chlorpromazine - 2.5% solution up to 4 ml, tizercin - up to 2 ml); course treatment is carried out only in a psychiatric hospital. Amentia (amentic syndrome) is the most profound degree of confusion, characterized by confusion with the affect of bewilderment and incoherent speech-motor agitation. Disorientation in place and time, self-identity, disordered thinking up to incoherence, unsystematic delusional expressions, motor excitement within the bed, lack of productive contact with others, refusal of food and subsequent amnesia are characteristic . Patients quickly become exhausted and become silent for a while, while motor excitement also disappears. Memories of the period of amentia are not preserved. It occurs mainly in connection with long-term, depleting diseases, infections and intoxications. It lasts several weeks or months.
The treatment of most disorders of consciousness requires close attention to the patient, hospitalization in a psychiatric hospital or intensive care unit. When transporting such a patient, a paramedic and a nurse should always be around him, carrying the necessary set of drugs (administered intramuscularly) that stimulate the cardiovascular system and respiration. Outpatient treatment can be carried out with fainting, simple forms of twilight stupefaction, which usually pass before hospitalization.