Disorders of consciousness
Disorder of consciousness – full or partial loss of ability to concentration of attention, orientation in the place, time and to own identity and implementation of other processes making the maintenance of consciousness. Disorders of consciousness can be quantitative and qualitative. Result from the violations of activity of a brain caused by injuries and diseases of TsNS, intoxications, mental disorders and somatic diseases. Are diagnosed on the basis of an objective clinical picture, a conversation with the patient (if it is possible), yielded the anamnesis and results of additional researches. Medical tactics depends on the reason and a type of pathology.
Disorders of consciousness
Disorder of consciousness – violation of the mental processes making the maintenance of consciousness (perception, orientation, processing of information, memory). Disorders of consciousness come to light at traumatic and not traumatic injuries of a brain, mental diseases, intoxications, serious somatic and infectious diseases. Expressiveness can vary from insignificant violations before full loss of consciousness. Tactics of treatment and the forecast are defined by the main pathology and weight of disorders of consciousness. Depending on the development reason diagnostics and treatment are performed by experts in the sphere of psychiatry, neurology, neurosurgery, therapy and other fields of medicine.
Reasons and classification of disorders of consciousness
Disorders of consciousness arise owing to violations of normal work of TsNS. Direct damage of brain fabrics as a result of a trauma or indirect damage because of a sdavleniye by an intra cranial hematoma, aneurism, a malignant or benign tumor can become a cause of infringement. Besides, disorders of consciousness develop at schizophrenia, epilepsy and some other mental diseases, at alcoholism, drug addiction and toxicomania.
At last, disorders of consciousness can be provoked by the serious somatic illness which is followed by endogenous intoxication and dysfunction of vitals. Expressiveness and ease of emergence of disorders of consciousness is defined not only the main pathology, but also the general condition of the patient. At physical and mental exhaustion such frustration can be observed even at an insignificant tension (for example, the caused need to concentrate on performance of some actions).
All disorders of consciousness are subdivided into two big groups: qualitative and quantitative. Include an amention in group of high-quality frustration, , deliriya, twilight disorders of consciousness, double orientation, out-patient automatism, the fugue and a trance. In group of quantitative frustration refer devocalization, a sopor and a coma. The Russian Ministry of Health at diagnosis recommends to distinguish two types of devocalization (moderate and deep) and three types of a coma (moderate, deep and terminal).
General symptoms of disorders of consciousness
At violations of consciousness processes of perception, thinking, memory and orientation suffer. Perception surrounding, time and own personality becomes fragmentary, "greased" or at all impossible. In the beginning at disorders of consciousness orientation in time is broken. By the last it is lost and the first restores orientation in own personality. Extent of violations of orientation can significantly vary depending on a type of disorder of consciousness – from easy difficulties in attempt to report time and date to inability to define though some reference points.
Ability to comprehend external events and internal feelings decreases, lost or distorted. The thinking is absent or becomes incoherent. The patient with disorder of consciousness partially or completely loses ability to fix the attention on certain objects and the phenomena, to remember and in the subsequent to reproduce information concerning as the taking place events, and internal experiences. After recovery full or partial amnesia is observed.
When determining a look and weight of disorders of consciousness consider existence or lack of all signs, however, for diagnosis there can be enough one or two symptoms. The clinical picture of disorder of consciousness in each case is defined by weight of the main pathological process, localization of a zone of defeats of brain fabrics, age of the patient and some other factors.
Quantitative disorders of consciousness
Moderate devocalization is followed by unsharp violation of orientation in time. Orientation in the place and own personality is usually not broken. Some drowsiness, slackness, block, deterioration in concentration of attention and judgment of information comes to light. The patient with disorder of consciousness follows instructions slowly, with lateness. Ability to productive contact is kept, however the understanding often arises only after repetition of instructions.
Deep devocalization – disorder of consciousness with violation of orientation in the place and time at preservation of orientation in own personality. The expressed drowsiness comes to light. The contact is complicated, the patient understands only simple phrases and only after several repetitions. The developed answers are impossible, the patient answers in monosyllables ("yes", "no"). The patient with this disorder of consciousness can follow simple instructions (to turn the head, to raise a leg), but reacts with lateness, sometimes – after several repetitions of a request. Weakening of control over functions of pelvic bodies is observed.
Sopor – heavy disorder of consciousness with loss of any activity. The productive contact is impossible, the patient does not react to change of a surrounding situation and to the speech of other people. Reflex activity is kept. The patient with disorder of consciousness changes a look, draws aside an extremity at painful influence. Deep reflexes are oppressed, the tone of muscles is lowered. Control over functions of pelvic bodies at this disorder of consciousness is lost. A short-term exit from a sopor at intensive stimulation (pushes, pinches, painful influences) is possible.
Moderate coma – full loss of consciousness in combination with lack of reaction to external irritants. At intensive painful influence bending and extension of extremities or tonic spasms is possible. Psychomotor excitement is sometimes observed. At this disorder of consciousness oppression of belly reflexes, swallowing violation, positive pathological-foot reflexes and reflexes of oral automatism comes to light. Control over functions of pelvic bodies is lost. Violations of activity of internals (increase of pulse, increase HELL, a hyperthermia), not life-endangering the patient are observed.
The deep coma is shown by the same symptoms, as moderate. A distinctive sign of this disorder of consciousness is lack of motive reactions in response to painful influences. Changes of a muscular tone are very variable – from total decrease to spontaneous tonic spasms. Unevenness of pupillary, corneal, tendinous and skin reflexes comes to light. Disorder of consciousness is followed by gross violation of vegetative reactions. Decrease HELL, disorders of breath and a warm rhythm are observed.
The terminal coma is shown by lack of reflexes, loss of a muscular tone and rough disorders of activity of vitals. Pupils are expanded, eyeballs are not mobile. At this disorder of consciousness vegetative violations become even more expressed. Critical decrease HELL, sharp increase of pulse, periodic breath or lack of independent breath is observed.
High-quality disorders of consciousness
Deliry can arise at alcoholism and organic damages of a brain. Orientation in the place and time is broken, in own personality is kept. Visual hallucinations, other types of hallucinations are observed (acoustical, tactile) meet less often. Patients with this disorder of consciousness usually "see" real-life or fantastic beings, as a rule – frightening, unpleasant, menacing: (dragon, lizards, devils, aliens and t. ). The behavior of patients depends on the maintenance of hallucinations. After recovery patients keep memoirs about occurring during disorder of consciousness.
Oneyroid can develop at catatonic schizophrenia, maniac-depressive psychosis, epilepsy, encephalitis, vascular dementia, senile psychosis, ChMT, a serious somatic illness, alcoholism and toxicomania. Disorder of consciousness is followed by special violation of orientation at which real events are replaced with hallucinatory and snovidny experiences. This picture can join the real people who are allegedly acting in borders of the fantastic world generated by consciousness of the patient.
Amention comes to light at intoxications, infectious and traumatic psychoses. Arises initially or at aggravation a deliriya, is heavier disorder of consciousness. The patient is disoriented in the world around and own personality, constantly, but unsuccessfully carries out search of reference points. The thinking is confused, the synthetic nature of perception is lost. Numerous hallucinations of sketchy, fragmentary character are observed. After recovery the period of a disease amnezirutsya completely.
Twilight disorders of consciousness usually arise at epilepsy and are characterized by sudden violation of orientation in surrounding in combination with pronounced affects: rage, melancholy and fear. Disorder of consciousness is followed by excitement and sudden flows of frightening hallucinations in reddish, yellowish or black-blue tones. The behavior of the patient at this disorder of consciousness is defined by the maintenance of nonsense of prosecution or greatness. The patient shows aggression in relation to surrounding people and inanimate objects. After recovery total amnesia on disease period events develops.
Out-patient automatism – the disorder of consciousness which is usually observed at epilepsy. It is shown by the automated operations performed against the background of full detachment. The patient can rotate on one place, lick lips, smack the lips, chew or to shake something from itself. Sometimes the automatic movements at this disorder of consciousness have more difficult character, for example, the patient consistently undresses. Fugues (attacks of aimless flight) and trances are possible (long migrations or less long "losses from reality" during which patients pass by own house, pass a stop etc.). Sometimes this type of disorder of consciousness is followed by attacks of motive excitement, antisocial or aggressive actions.
Double orientation – the disorder of consciousness arising at crazy conditions, hallucinations, an onirizm, a oneyroida and dissotsiativny disorder of identity. It is characterized by simultaneous existence of two streams of consciousness – psychotic and adequate. At nonsense of greatness patients with this disorder of consciousness can consider themselves great, unusually important person (the savior of people, the emperor of the fantastic Universe) and the ordinary person, at nonsense of a performance – to believe that they at the same time are in real space and a false zone of a performance. "Softer" options of disorder of consciousness at which patients consider the real qualities are possible, but believe that one "I" am a center of advantages, and another – shortcomings.