Amention – the heavy obscuring of consciousness which is followed by violation of orientation in the place, time and own personality, loss of the ability to synthetic perception expressed by confusion, incoherence of thinking, the speech and movements. Can arise against the background of some mental disorders, alcoholism, crushing traumatic defeats, infectious, endocrine and somatic diseases, confirms deterioration in a course of the main disease. The diagnosis is exposed on the basis of characteristic clinical signs. Intensive therapy and treatment of the main pathology is required.
Amention – the heavy disorder of consciousness which is followed by violation of ability to synthesis. The world for the patient with an amention as if breaks into a set of small pieces which cannot be collected in a uniform picture. All types of orientation suffer, including – in own personality. The productive contact is impossible. The condition of the patient is aggravated with fragmentary hallucinatory experiences, an emotional randomness and motive concern. Tendency to a long current is noted, duration of an amention can make several weeks or even months.
In the past an amention called all mental diseases with sharp violation of intellectual activity, senseless behavior, the incoherent speech and sketchy hallucinations. After the researches Krepelina and Bleyera the interpretation of an amention was narrowed. Now understand the psychopathological syndrome described by the German psychiatrist Theodor Meynert and including the expressed confusion, incoherence of mental processes and physical actions as an amention. Treatment of an amention is performed by experts in the field of psychiatry in cooperation with therapists, endocrinologists, traumatologists and doctors of other specialties (depending on the nature of the main pathology).
Reasons of development of an amention
Amention – the endogenous psychosis arising against the background of heavy physical and mental exhaustion or against the background of the expressed intoxication endogenous or exogenous toxins. Easy forms of an amention can develop as a result of diarrhea, slight poisoning, blood loss or long surgery. The heavy amention can be observed at the opened and closed craniocereberal injuries with injury of a brain, organic damages of a brain, a gipertireoza, infectious diseases (usually – it is long flowing), sharp and chronic intoxications at alcoholism and drug addiction.
The brightest manifestations of an amention come to light at the sepsis which is followed by damage of a brain. Short amentivny episodes can arise at bipolar affective disorder and some forms of schizophrenia. The amention Polietiologichnost, lack of accurately expressed specific symptomatology, "imposing" of symptoms of the main disease and various degrees of expressiveness of endogenous psychosis can become the reason of diagnostic difficulties, especially – at a stage of the pre-hospital help.
The main symptom of an amention is frustration of all elements of consciousness. The patient does not know who is he, does not understand where he is and what happens to him. He does not recognize close people, does not distinguish sense of the questions turned to it and is not capable to productive speech contact. Confusion of the patient is aggravated with fragmentary deception of feelings, elements of nonsense and sketchy hallucinatory experiences. Because of violation of ability to all types of synthesis of the patient ceases to see communications between events and objects.
Emotions of the patient are incoherent and chaotic, his attention extremely quickly distracts. He smiles, cries, shows indifference to surrounding. Prevalence of depressive reactions is often observed, but even at height of affect of the patient continues to be in a condition of a deep disorientation, his experiences are not connected with external irritants and real events in any way. At night development short-term a deliriya is possible. Words and behavior of the patient confirm existence of deception of feelings, elements of nonsense and fragmentary hallucinatory experiences. At the same time the nonsense and hallucinations never crystallize in a uniform coherent picture.
The productive contact with the patient is impossible. The patient does not answer questions, his speech consists of the separate words which are not connected among themselves phrases and scraps of offers. According to statements of the patient sometimes it is possible to understand that he feels confused and helpless. Maintenance and emotional coloring of the speech correspond to the current affect. Being in high spirits, the patient pronounces the words and phrases expressing joy, pleasure and other pleasant emotions, at decrease in mood maintenance and coloring of the speech undergo corresponding changes. Words can be cried out or said by whisper, sound roughly or gently, to be followed by laughter or crying.
Motive excitement is noted. Motive reactions are sketchy and are not purposeful. The patient waves hands, is bent, shudders or turns in a bed. Some movements demonstrate existence of elements of nonsense and hallucinations. The patient can make the hvatatelny movements, to touch something or to push away. At aggravation of an amention horeinformny giperkineza or the clinical picture reminding a catatonia are sometimes observed. Development of a stupor is possible.
Depending on prevalence of these or those clinical manifestations allocate three forms of an amention: crazy (the sketchy crazy ideas prevail), hallucinatory (hallucinatory experiences prevail) and catatonic (the stupor prevails). Amention duration at adults can significantly vary – from short episodes lasting less than a day at easy forms of psychosis owing to a physical overstrain or a mental disease before disorder of consciousness lasting several weeks or several months at is long the current progressing infectious diseases and other states which are followed by the expressed organism exhaustion.
At children the amention is, as a rule, superficial and short. Full disorder of consciousness does not come. The child is uneasy, confused, badly is guided in the events. The contact is possible, but is very unstable. The kid distracts, badly understands sense of the speech turned to it. Even if the doctor or the loved one manage to enter productive dialogue with the child, the contact quickly is interrupted owing to exhaustion and incoherence of thinking of the patient.
Diagnostics and differential diagnostics
The diagnosis an amention is exposed by the psychiatrist on the basis of characteristic clinical symptoms: confusions, incoherence of thinking, violation of all types of orientation, chaotic change of emotions, motive concern, fragmentary crazy ideas and hallucinatory experiences. For specification of nature of the main pathology consultations of the therapist, the infectiologist, the endocrinologist, the traumatologist, the neurologist, the neurosurgeon and other experts can be required.
The differential diagnosis is carried out with deliriy and catatonic excitement. Unlike catatonic excitement at an amention accurate correlation between maintenance and emotional coloring of the speech of the patient is observed. Catatonic symptomatology at an amention unstable, changeable and very changeable. At an amention at many patients short-term deliriya develop at night, at a catatonia deliriozny episodes are absent. Existence of depressive affect is not characteristic of a catatonia.
The nonsense and hallucinatory experiences at a deliriozny state have coherent character and in some cases, for example, at alcoholic deliriya, can form the integral, finished picture. The crazy ideas and hallucinations at an amention are fragmentary, incoherent and can be shown only in the form of short-term episodes. At a deliriya the consciousness clearing moments are quite often observed in the afternoon, at an amention this symptom is absent. Patients with deliriy keep ability to make purposeful actions and to contact to people around, at an amention of the movement of patients are not purposeful, senseless and monotonous, the contact with people around is absent.
Treatment and the forecast at an amention
At a mental disease hospitalization in psychiatric office is shown, at somatic pathology – in the profile office corresponding to the main disease. To the patient enter 30% solution of thiosulphate of sodium and 2,5% solution of a hlorpromazin. In the presence of contraindications to a hlorpromazin use the combined medicine containing morphine. For elimination of motive excitement appoint diazepam or to fenazepa. For consciousness clearing regularly perform drop infusions of piracetam in salt solution.
Patients refuse water and food therefore they are transferred to artificial nutrition. Perform therapy of the main disease. The forecast is rather favorable. At timely adequate treatment the amention usually does not pose hazard to life, however the lethal outcome in some cases can be caused by exhaustion of the patient and the adverse course of the main disease. After an exit from an amention the expressed adynamy and full amnesia is observed.