Distraction of consciousness: what kinds exist

The confusion of consciousness refers to its qualitative disorders and is a sign of serious problems with the functioning of the brain. There are several types of obscuration, differing in depth and content of pathological symptoms. The detection and treatment of such disorders in patients is most relevant for psychiatrists, narcologists, neurologists, toxicologists and resuscitators, but doctors of other specialties may face this problem. About what kinds of types of obscuration of consciousness exist, and this article will be discussed.

What happens when the consciousness is diminished

The confusion of consciousness is its disintegration with a decrease in the level of perception of external stimuli and the filling of the "inner space" of a person with pathologicalpsycho-productive phenomena. This changes the behavior of a person, which is determined by the depth of immersion in their own experiences and the apparent response to them.

The main clinical signs of confusion are:

• detachment from the outside world, while the perception of events is fragmentary and inconsistent, and the analysis of these external stimuli is sharply reduced;
• disorientation in space and time due to immersion of the patient in their experiences, note that the patient partially or completely does not recognize familiar people and the familiar situation;
• disturbance of thinking with its incoherence, inconsistency, amorphousness, fragmentation;
• memory deterioration to varying degrees, right up to the amnesia of everything that happens during a period of darkened consciousness, including their own experiences.

For the diagnosis of obscuration of consciousness, it is necessary to have all 4 of the above characteristics. Often identified and hallucinatory and secondary delusional disorders. Experiences during the period of obscuration of consciousness are perceived by the patient as real. They replace the events of the surrounding world or are perceived as brighter, absorbing the entire attention of the patient. Sometimes this is accompanied by a violation of self-awareness and a sense of alienation.

Individual memories of experiencing experiences can persist for some time, their brightness and detail depends on the type of disorder transferred. In the future, they lose relevance, but criticality to them almost never comes to a sufficient level. But in some cases, the exit from the state of darkened consciousness is accompanied by complete amnesia of this period, the patient can note a failure in the personal perception of time.

Confusion of consciousness: classification of

Qualitative disorders of consciousness are divided into:

• delirium( delirious obscuration or condition), including the so-called professional delirium;
• is an onyroid( oneyroid, or dream-like obscuration of consciousness);
• Affiliation( anomalous obscuration);
• Twilight states of consciousness( twilight), including several varieties;
• special states of consciousness: different types of aura, which is a paroxysmal form of obscuration of consciousness.

It is not always possible to conduct adequate differential diagnosis during a primary examination of the patient with confusion. The primary goal is the elimination of quantitative disorders( stunning, sopor and coma).Specification of the species of obscuration is sometimes carried out on the basis of dynamic observation and retrospective analysis with the patient's self-report.

Delirium

The delirious confusion of consciousness is characterized by the presence of mainly psycho-productive symptoms. They include abundant hallucinatory and illusory disorders and the acute sensual delusions that they determine. At the same time, true visual hallucinations prevail, although tactile and auditory deceptions are also possible. Their content is usually unpleasant to the patient and is of a menacing nature. These can be monsters, predatory beasts, skeletons, small animals and insects, small humanoid creatures. Hallucinations quickly replace each other, characterized by undulating waves of vision.

Behavior is subordinated to experiences, patients are usually restless until they develop psychomotor agitation. Aggression is aimed at hallucinatory images and can affect others. Affect is changeable and is determined by the content of hallucinations. Mostly, anxiety, anger, fear prevail, but transitory states of curiosity and enthusiasm are possible. Absorption by hallucinations leads to complete or partial disorientation, there is often a false orientation in space and time.

Delirium is an undulating current state. For him, typical lucid windows are typical: spontaneous periods of enlightenment, when the patient's perception of the environment and the overall level of brain function improve. Characteristic also deterioration in the afternoon with an increase in hallucinatory influx in the evening and night. Lucid windows most often appear after awakening, the person during them is asthenized, partially oriented and moderately critical. In addition, delirium is characterized by a staged development, with each stage being reversible.

At the first stage of hallucinations is not yet, but there are bursts of vivid memories, strengthening and uncontrollability of associations, distraction of attention. A person is talkative, emotionally unstable, not critical enough and not always clearly oriented. His behavior becomes inconsistent, and sleep is restless and superficial, with disturbing excessively vivid dreams.

In the second stage, there are illusions and pareidolia, attention impairments are aggravated with a difficulty in perceiving the environment. The third stage of delirium is characterized by multiple true hallucinations and associated sensual delirium. Even with the appearance of scenic visual hallucinations, the feeling of their alienation remains. The patient is not involved in imaginary events, but observes them or opposes them to himself. Behavior is subordinated to experiences, orientation deteriorates sharply.

The fourth stage is a heavy disintegration of thinking with complete immersion in experiences and detachment from the world around us. Delirium at this stage is called muttering. The person shakes something off himself, does offensive movements, tugs the bed, mutters for a long time. Verbal activity is almost independent of external factors, strong sound and pain stimuli lead to a temporary increase in the volume of spoken sounds and words.

A special form of delirious obscuration of consciousness is professional delirium, in which hallucinatory-delusional disorders are fragmentary and do not determine behavior. Against the backdrop of deep detachment and the disintegration of thinking, stereotyped repetitive movements appear that are associated with the automation of the patient's professional activity. This can be an imitation of work on the machine, sweeping, the use of bills, knitting. It is also possible to repeat simple gestures and movements typical for a given person.

Oniroid

Oneiroid is a heavier form of obscuration of consciousness. At the same time, the determining sign is the dreamlike delirium of fantastic content, which dramatically unfolds and leads to a violation of the patient's level of self-awareness. Visions are perceived as an inner sight, they absorb almost all the attention of a person and involve him in an illusory world. Scenes are large, fantastic, colorful and dynamic. The patient feels like a different person or being, with unusual abilities and the ability to influence everything that happens. It as though operates world wars, opens new galaxies, collects extraordinary beauty of a plant, meets historical personalities or even becomes them.

Unlike the onyeroid, all these vivid experiences practically do not affect the behavior of an onyroid-staying person. He may look distracted, inhibited, or simply freezes from time to time. His movements are usually artsy, meager, slow. For them and for frozen mimicry, it is almost impossible to guess the content of visions. At the same time, sometimes it is possible to obtain simple answers to questions about the experiences and the imaginary place of the patient's stay.

Such a confusion of consciousness can take place in stages:

1. Another controlled fantasy with an influx of images;
2. Delirium of intermetamorphosis with a sense of unreality and dramatization of events, false recognitions, growing into a sensual delirium of fantastic content;
3. Oriented onyroid, when dreamlike experiences are combined with a partial orientation in the environment;
4. A deep oneieroid with detachment from the real world, when leaving it, there is a complete amnesia of the actual events that have occurred.

Sometimes, the onyroid obscuration of consciousness is diagnosed after its completion. At the same time the patient has a detailed bright description of fantastic experiences combined with the scant memories of what is happening around him and bewilderment about the dissonance regarding the duration of the episode and his personal identity.

Amenia

With this form of obscurity, the person is confused, helpless, he does not comprehend the events happening and is deeply disoriented in place, time and even his own personality. There is marked disintegration of all components of thinking, the process of analysis and synthesis is disrupted, and self-consciousness is disintegrating. Hallucinatory and delusional disorders are fragmentary and in this case do not determine the patient's behavior.

Speech production is enhanced. The statements consist mainly of separate incoherent words, but at the same time their content corresponds to the existing affect. The mood is unstable, the patient has a changing state of enthusiasm and tearfulness. There are quite clearly outlined episodes of a decreased mood with the classic psychomotor signs of a depressive syndrome.

Behavior is characterized by excitation within the bed, which sometimes resembles a catatonic one and for a short time can be replaced by a substupoporous condition. Movements are not purposeful, inconsistent, often sweeping. Revival of fine motor skills is not typical.

Amenic obscuration is a deep consciousness disorder and can last up to several weeks. Periods of enlightenment does not happen, but in the evening and night time, amenity is often replaced by a transient delirium. After leaving the state of confusion, the patient completely amnesizes both his experiences and the events of the surrounding world.

Twilight

Twilight states of consciousness are transient and heterogeneous disorders. They are characterized by intense affect, disruption of orientation and complete amnesia of the period of obscuration. Depending on the type of twilight, the person also has delusions, hallucinations, automated movements or excitement. Isolate delusional, affective( dysphoric), oriented options of the twilight state of consciousness. Separately there is a form with various outpatient automatisms, including trance and fugue.

Surrounding people do not always recognize the onset of a person's twilight state of consciousness. Suspicious signs are an inadequate state of self-absorption, indifference to events, stereotyped movements or ridiculous unexpected actions. And the actions can be criminal, with causing other people physical damage right up to the murder.

Aura

Aura is a special kind of obscuration of consciousness, most often it occurs before the deployment of an epileptic fit. In this case, a person experiences vivid and memorable experiences, and real events are perceived fragmentarily and indistinctly or not at all obsessing the patient's attention. There is a sense of a change in the body scheme, depersonalization and derealization, visual, taste and olfactory hallucinations, canopyric, bright color photopsy, increased contrast and coloring of real objects.

Affect is usually intense, often there are dysphoria or ecstasy. A person during an aura can freeze, experience anxiety, sink into their unusual sensations. Memories of these experiences replace information from the memory of what is happening in the world around them, and they are not subject to amnesia, even with the subsequent deployment of a generalized convulsive fit.

At present, it is believed that the confusion of consciousness arises from the violation of cortical interneuronal connections. Moreover, these changes are not structural but functional, they are associated with an imbalance of the main neurotransmitters. The cause of this can be endogenous mental disorders, various intoxications, ischemic brain disorders and other conditions. And the definition of the type of patient's mental obscuration is an important point of diagnosis, often determining the tactics of further treatment.

Psychiatrist Zhuravlev IV lectures on "Disorders of consciousness and self-awareness":