A disorder of consciousness is a complex of mental and neurological changes in which the relationship between a person and the outside world is disrupted or completely absent.
There are key signs of impaired consciousness:
- Impaired perception. Sensory cognition turns off, visual, auditory or tactile deceptions of perception occur, which distort the picture of the external world.
- Disorientation in place, time or self. The patient may not know the location and time. In other cases, he is falsely, distortedly aware of himself, imagining an unreal environment.
- Impaired rational cognition. A person with impaired consciousness does not understand the connections between objects and phenomena due to the inability to make judgments.
- Difficulty remembering. Typically, a patient with impaired consciousness loses memory of events and his actions after emerging from an unconscious episode. This manifests itself as congrade amnesia. Sometimes memories are fragmentary and unclear.
Why does consciousness disappear?
The main causes of disturbances of consciousness include:
- psychological disorders without visible structural changes in the brain;
- disorders of cerebral circulation and electrical activity of the brain;
- infectious, metabolic and mental diseases;
- drug addiction, alcoholism, substance abuse;
- concussions and traumatic brain injuries.
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.
Diagnostics
If all 4 of the above signs are present, this indicates darkness or disturbance of consciousness. This condition can affect people of any gender, age and race. Confirmation of the diagnosis does not require confirmation of amnesia or the end of acute psychosis. It is worth noting that consciousness can be only slightly impaired, then the person does not lose the ability to make specific judgments and does not get lost in place.
Sometimes the diagnosis is made retrospectively (that is, after the person has already experienced a violation of consciousness and restored it). Then you need to focus on the amnesia that was noted at that time, and on the remaining memories, which differ depending on the form of confusion. But the type of consciousness disorder is not always clearly defined due to mixed manifestations. Then, when forming a diagnosis, the form is not indicated, just about.
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.
Treatment
If a person is in a coma, it is necessary to take preventive measures and eliminate disturbances in vital functions. It is necessary to ensure the supply of oxygen to the patient’s body. They perform artificial ventilation or use other methods. Next, you need to normalize blood circulation in the body. For this purpose, vasopressors or antihypertensive drugs can be used.
If there is a suspicion that impaired consciousness is caused by alcoholic beverages, treatment requires the administration of thiamine in a large dosage. Convulsions in cases of impaired consciousness are eliminated with the help of anticonvulsants. A patient in a coma is given glucose to prevent hypoglycemic brain damage. Next, tests are performed and the dosage is adjusted accordingly.
If the patient is in a state of psychomotor agitation, sedatives may be needed. If the balance of acids and alkalis is not in order, or there are water and electrolyte disturbances, these indicators need to be normalized. Body temperature also needs to be measured and brought back to normal. If the confusion is due to an infection or bacterial disease, antibiotics may be needed. In case of poisoning, detoxification therapy is necessary. After providing first aid, you need to take tests, interview relatives, and do research. The type and degree of impairment of consciousness is determined, and in connection with these data, effective therapy is prescribed.
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.
