Disorder of consciousness Different disorders of consciousness are often the first clinical expression of somatic conditions of high risk for the life of the patient, and in other cases they can be the consequence of life situations with notable anxiety-producing potential.
Disorder of consciousness
The relative precocity of alterations in consciousness, which in the first group precede neurological ones, allows the early diagnosis of conditions such as tumors, abscesses, aneurysms or brain hematomas, as well as endocrine, metabolic or infectious processes that seriously affect metabolism cerebral.
Classification of disorders of consciousness according to the affectation of its field , its clarity or its veracity.
This condition, also called narrowing of consciousness, is typically psychogenic in nature, and is characterized by the focus of consciousness on a theme, which can sometimes express the conflict faced by the patient and at other times, evade it through amnesic mechanisms. The most characteristic expression is the exclusion from the field of consciousness of a highly significant experience.
Other times it is manifested by a persevering theme along with disorganized behavior. The narrowing of consciousness can also be expressed under hypnotic influence in the trance state, and it can be the mechanism that serves as the basis for the so-called second states or cases of double or triple personality.
Sharpness of consciousness disorders: It expresses the reduction of the level of wakefulness that can go from dullness or lightheadedness, to coma, passing through drowsiness, drowsiness and drowsiness.
Clouding : It means seeing through a cloud and in it the reflection of objective and subjective reality becomes increasingly difficult, as if the activation threshold of the sense organs was raised, which requires increasingly intense stimuli to be appreciated. It should be noted that in these disorders of consciousness distortions of reality such as illusions, hallucinations and metamorphoses are not evidenced , but only difficulty in reflecting it.
The clouded patient decreases his chances of noticing what is happening in his environment and only responds to more intense stimuli than usual; his thinking is slow and somewhat persevering, but without serious distortions in its content , the affectivity is dull and the movements slow and slow.
Its manifestations:
- General description. Calm, hypomimic patient, with careless habits if not helped.
- Integration function. Low wakefulness; distractile attention; decreased memory and very rude orientation.
- Relationship function. Globally affected.
- Electual intellectual capacities. Decreased.
- Cognitive functions. No productive symptoms; the most significant is the need to use strong stimuli to achieve communication; slow thinking.
- Affective function. Indifference.
- Behavior: apathy and hypokinesia.
These manifestations were classically described in typhoid fever , but they can be seen in other conditions or in meningoencephalic pictures and brain tumors. When the comatose level is reached, the relational functions of the nervous system are completely abolished, and only those aimed at homeostatic regulation remain.
Disorders of the veracity of conscience
In these, the reflection of objective and subjective reality is distorted to a greater or lesser degree with serious sensory-perception disorders. We will study the delirium, the dreamlike state, the twilight state and the confusional state.
Delirium. Its name etymologically implies deformation or deviation from reality, and it is a very productive picture, in which the patient runs a significant risk of accidents if he is not protected. Its evolution in the elderly leads to 25% mortality. In this syndrome, wakefulness is greater and there are, in addition, important sensory-perceptual disorders, especially visual and tactile, whose usually unpleasant or terrifying content determines the affective state and the frequently defensive or escape behavior that implies agitation to large spaces or dangers like defenestration. One of its manifestations of greatest diagnostic value is fluctuating false orientation, expressed by moments of orientation immediately followed by total disorientation.
- Overview Overview. Agitated, sweaty, and shaky patient.
- Synthesis function Synthesis function. Low wakefulness, distractile attention, diminished memory with residual evocation after passing the picture, diminished comprehension, fluctuating orientation that occasionally allows him to locate himself in space and person, although moments later he appears totally disoriented.
- Relationship function. Globally affected.
- Intelectual skills. Decreased.
- Cognitive functions. Remarkable hallucinatory richness, especially visual and tactile, whose most frequent themes are the disgusting animals that are superimposed on it or the cosmic or catastrophic themes in which the patient feels at risk of death or aggression, sometimes the hallucinations are pleasant and in miniature form, the thought is fragmented and persevering and its theme is related to hallucinations.
- Affective functions affective anointing. There is often anxiety and terror .
- Agitation in large spaces, generally defensive of its alleged aggressors and determinant of risks, such as jumping into the void or hitting oneself in flight, if it is not protected, the tremors are very significant, especially in the alcoholic delirium that is the most characteristic. This syndrome can occur in other external intoxications, as well as in severe infectious processes or cranial trauma.
Oneiroid state . This painting, etymologically linked to daydreaming, has as its most relevant characteristics the contemplative and peaceful attitude of the patient in the face of its hallucinatory richness of a visual and scenic nature, that is, hallucinations in two dimensions as if he were witnessing a movie. In this syndrome, affectivity and behavior are little affected, except in relation to passivity as a result of the generally neutral nature of their sensorial-perceptual disorders.
- General description. Patient in contemplative, hypomimic attitude, with neglect of habits if there is no tutoring.
- Integration function. Low wakefulness . Attention is distractible, except in relation to his hallucinatory experiences on which, in general, he appears to be hyper-focused.
The memory is diminished, when overcoming the frame there are partial memories. In the orientation the allopsychic predominates as taken, the autopsychic preserved.
- Intelectual skills. Decreased.
- Cognitive functions. Remarkable visual hallucinatory richness of a scenic type with non-distressing themes that explain his passivity in the face of experiences. Thought is disjointed, rambling and slow.
- Affective functions. Beatific complacency.
- Behavior . Contemplative and immobile. Upon overcoming the painting, experiences of derealization and memories of some experiences that occurred in the episode are expressed. It can be seen in toxic and septic pictures and after cranial trauma
Twilight state . Its name refers essentially to the affectation of consciousness, clinically expressed by the disorientation maintained and the total amnesia of the experiences once the picture has been overcome.
There are two modes: passive or orderly and disorderly or agitated, which is precisely the most frequent, and that is why it will be the object of our fundamental description. The passive form is the one that makes epileptic or psychogenic escapes feasible, in which the patient is automatically capable of moving up to thousands of kilometers from home on trips without voluntary purpose, after having behaved in an apparently organized way. It is of sudden installation and termination.
The disorganized form constitutes one of the most important psychiatric emergencies due to its frequent aggressive and destructive character, in which the patient faces his hallucinations of threatening content.
- General description. Sick agitated, sweaty and aggressive.
- Synthesis function anointing of synthesis. Very low level of wakefulness. Attention is distracting for subjects unrelated to his hallucinatory experiences. In memory, total amnesia predominates at the end of the picture, unlike delirium and the onyroid state in which the norm is the possibility of fragmenting what happened. Comprehension is impaired and orientation is totally disoriented and without fluctuations.
- Cognitive functions. Hallucinations
This syndrome can also manifest itself with the ingestion of alcohol – even in small amounts – in subjects with dysrhythmic terrain.
State of mental confusion . It is characterized by a high degree of brain dysfunction; it is also called amencia, a term that highlights the almost total absence of psyche. This is the expressive syndrome of the highest degree of awareness, after the compulsive attack syndrome in its posictal stage or the comatose syndrome. The affectation of the psychic phenomenon is of such magnitude that only by clinical inference the presence of visual illusions is presumed. the thoughtIt shows a high degree of incoherence that prevents communication, and the behavior becomes very rudimentary, although generally limited to the space of the bed, unlike that which occurs in delirium. Perplexity is a first-order element for diagnosis
- General description. The patient is described as in agitation limited to his bed, with movements without purpose – such as rolling the sheet – which are called carfolic movements, of high diagnostic value. The facial expression is puzzled.
- Synthesis function. Vigil about to be abolished. Attention is very distractible and memory is abolished. Comprehension is also abolished, and orientation is dominated by total disorientation without fluctuations.
- Relationship function. Abolished.
- Intelectual skills. Virtually nil.
- Cognitive functions. Predominance of visual illusions inferred by the observation of the patient. Thought is incoherent.
- Affective functions. Indifference. The behavior is marked by agitation sometimes limited to professional characteristics, in which the patient repeats movements typical of his usual work.
This syndrome is common in poisonings, infections and severe traumas, as well as in cerebrovascular accidents and systemic metabolic imbalances.
