Amenition

The highest fundamental function of the human brain is consciousness. It is based on the knowledge of the real world of all phenomena in their complex interaction and their own personality, it allows a person to integrate into the world around him. However, the state of our consciousness is not always clear. Under the influence of a variety of reasons, it can be disrupted or disconnected, and then the person becomes completely helpless. Sometimes there is a violation of one or more types of orientation, this often happens to people of advanced age. They suddenly get lost in time, can not navigate the terrain and, for example, return home, at least somehow assess the situation created, do not recognize others, can not identify themselves. Some suddenly cease to perceive the surroundings or completely lose the ability to reason rationally, synthesize their thoughts, coherently formulate them. There may be memory problems, often nothing is delayed in it.

Such qualitative changes of consciousness can concern one of its sides, and can be present all together, then the patient is diagnosed with one of the syndromes of confusion (disintegration) of consciousness. These include: delirious, onyroid, amenious and twilight consciousness disorder. All these syndromes have one common and characteristic feature - productive contact with the patient at the moment of obscuration of consciousness is impossible. Among the syndromes of obscuration of consciousness, the most profound degree of its damage is characterized by an amenious disorder.

Amenia (absence of mind) is in psychiatry such a form of psychotic state, acute psychosis that is characterized by gross and comprehensive disorientation, loss of perception of the surrounding reality and ability to synthetic thinking, accompanied by motor and speech excitement, differing senselessness and chaos, fragmentary hallucinatory experiences and strong confusion.

[1]

Causes of the amplification

Amenia, in most cases, occurs in people who suffer from severe illness for a long time, leading to dystrophic changes in organs and tissues, and also against the background of the rapidly developing effect of external or internal toxic substances.

Risk factors for the development of this type of disintegration of consciousness are numerous. Severe forms of amenia with severe symptoms are caused by sepsis of various genesis, head injuries with damage to the cerebral structures, their nontraumatic damage, for example, oncological diseases with metastases to the brain. Amenia can develop against a background of chronic alcoholic or narcotic intoxication, thyrotoxicosis, phenylketonuria, rheumatism, severe infectious diseases and profound metabolic disorders.

Short episode episodes can be observed in schizophrenics, persons suffering from bipolar outbreak. In the amenitary syndrome, delirium can smoothly migrate. A reverse transition, especially at night, is considered a confirmation that the amenation was caused by external influences.

The easiest forms of amenia develop when electrolyte balance disorders occur, for example, intestinal infections with frequent vomiting and diarrhea, significant blood loss, and severe physical overstrain.

Many of the above causative factors can trigger the pathogenesis of amenia. Since this syndrome is an acute psychosis, in its development, catecholamines - dopamine, norepinephrine, adrenaline - are of particular importance from the point of view of modern neurobiology. The exact mechanism of their interaction with amenations is not established. However, a violation of their equilibrium in the synaptic cleft and leads to the development of symptoms of the aminic syndrome.

Since amenia develops in different diseases, the exact statistics of its prevalence are not known. It is quite frequent companions of severe infectious diseases, secondary neoplasms of the brain and tumorous intoxications, craniocerebral trauma. The presence of amenia is considered an indicator of an especially severe course of the underlying disease, often its terminal stage.

[2], [3], [6], [7], [8],

Symptoms of the amplification

According to specialists, for all the variety of symptoms and sudden manifestation of an amnesic disorder, it is possible to determine the first signs preceding its development. Patients begin to worry, they have signs of depressed mood, insomnia, they are obsessed with unreasonable obsessive thoughts hypochondriacal character, which they share with the attending physician. For a day or two, sometimes for several hours, affective disorders become very pronounced.

Symptoms, in most cases develop in this order: anxiety disorder (depression), somewhat less often - mania → depersonalization and / or delusion → onyroid → amenia.

Sometimes, amenity advances, bypassing the intermediate stages, from the state of melancholic depression or mania with the growing symptoms of obscuration of consciousness.

An amenable patient can be identified by appearance: his facial expressions absolutely do not correspond to the surrounding conditions and situations. On his face he has a frozen expression of bewilderment and bewilderment, bordering on fear. The patient constantly translates the missing sight from one object to another, it seems that he does not see anything, he is blind.

The face is pale, the lips are parched, cracked, sometimes with herpetic or purulent crusts. Speech is absolutely incoherent and not burdened with meaning, which reflects the incoherence of thinking. It often consists of individual words, sounds, interjections, pronounced by the patient repeatedly with varying loudness. Sometimes, when there is an amputation, there is no speech rupture. The patient grammatically correctly builds phrases, however, they are devoid of any meaning. There are times when the patient can even answer questions, though not always, in essence. With prolonged course of the syndrome, the severity of the patient's condition is not always the same - it worsens, then improves.

The patient expressed autopsychic and allopsychic depersonalization - completely lost intrapersonal orientation, as well as temporally-spatial. It seems that he is separated from all by an invisible wall.

Emotional state quickly changes to polar - the patient is having fun, then crying, behavior is also unstable - activity is quickly replaced by apathy, which is immediately interrupted by songs or monologues. In the majority they are monotonous and monotonous.

The emotional state is reflected in his statements, but verbal contact with the patient is not established. The patient can not concentrate on anything, constantly switching attention to different objects.

Thinking is fragmentary, and its fragments are in no way connected with each other.

Motor excitement is usually limited to the bedside of the patient, he always touches something, shifts, grabs the passing medical workers for the gowns of the robe, flings things. Sometimes the patients slide off the bed and crawl or roll on the floor. The movements are chaotic and ridiculous. Patients are aggressive to others and to themselves - are prone to self-harm.

The lack of ability to coherent thinking affects the fact that hallucinations and delusions also have a fragmentary nature. Full-value products do not develop. This is judged by the statements and movements of the patient.

Elements of confused consciousness are sometimes combined with elements of delirium, which occurs at night.

As the patient loses his appetite and refuses food and drink all the time, with a prolonged course of the disorder, he reaches an extreme degree of exhaustion, both physical and mental.

After recovery, patients do not remember anything about the disorder (retrograde amnesia).

According to the prevailing symptoms, a catatonic, hallucinatory and delusional form of amenia are distinguished.

[13], [14]

Complications and consequences

Light forms of amenations can pass without a trace, and in severe diseases, its development indicates an unfavorable course of the underlying pathology. Sometimes, amenia develops in the terminal stage and ends lethal.

Even those who recover after a long illness are extremely exhausted, they lose almost all of their experience and skills that they had before the onset of the disease. At the current level of therapy, amenia (without the period of subsequent asthenia) lasts no more than one to two months

Memory suffers, cognitive abilities. In some patients, they do not recover at the same level at all. The consequence of an amputation can be disability.

[16], [17], [18], [19], [21], [22], [23],

Diagnostics of the amplification

Specific studies, laboratory or instrumental, that could accurately confirm the diagnosis of the aminic syndrome does not exist. Such studies may be necessary only to determine the extent of the body's damage to the underlying disease. Diagnose the disorder, based on observations of the patient.

The main diagnostic criteria in this case is incoherence and discreteness of speech, motor skills, other mental functions, complete helplessness, as well as the appearance of the patient, the confused and puzzled look on his face.

[26], [27], [28],

Differential diagnosis

Manifestations of amenia can be confused with other disorders related to confusion. They have many common features, and productive contact with the patient in all cases is not possible. Distinguish these same syndromes is necessary to select the necessary treatment tactics.

Catatonic amenia is characterized by instability and rapid change of postures, episodic delirious attacks at night. Fragmentary speech reflecting this feature of amenity.

Delirium is characterized by pronounced mobility, the development of full-fledged hallucinations and the corresponding delusional interpretation of non-existent visions. Nevertheless, the patient basically retains an orientation in his own personality.

Onyeroid (dreams, waking) - in this state, the ability of connected thoughts and judgments, corresponding to the deployment of the one-game scenario, remains.

Twilight consciousness disorder is characterized by a sudden and short-term detachment from the surrounding reality, as well as the safety of the usual actions performed automatically and paroxysmally. Such seizures may be equivalent to epileptic and develop often in persons suffering from epilepsy or hysteria.

An important diagnostic criterion is also the prolonged course of amenations in comparison with all other variants of the darkened consciousness. Episodes of delirium, onyeroid and catatonia, as a rule, do not exceed several days, twilight consciousness disorder - hours. Amenity lasts for weeks.

Amenia and dementia - both these concepts mean lack of mind, insanity. However, dementia occurs gradually, a person has a steady decline in his cognitive abilities, loss of existing skills and accumulated knowledge. Such disintegration of mental activity occurs most often in old age (senile dementia), less often in younger people, in people who have long and regularly abused alcohol or narcotic substances.

Asthenic confusion is essentially a very weakly expressed amenia, its mild form, which is characterized by the effect of confusion and the absence of coherent thinking, severe fatigue. Episodes are short-lived and not deep, more often detected in childhood. In adults, can be observed with poisoning and blood loss, other causes of disturbance of water-electrolyte balance.

Treatment of the amplification

Development of amenia is considered an unfavorable prognostic sign and requires urgent action, constant medical control. Hospitalization of the patient is desirable. Out-patient treatment is possible only with mild syndrome (asthenic confusion).

Given that the patient is often in an exhausted state and, before the onset of amenia, starts to refuse food and water during the period of the disorder, it must be forcibly fed.

Treatment is directed, first of all, to stabilization of the state in terms of the main somatic disease, as well as to the removal of the amenia syndrome with the help of psychotropic medications.

Medications designed to stabilize the mental state are selected taking into account the patient's physical illness and the prevailing symptomatology of the syndrome.

Aminazine is most often used to relieve the symptoms of amenia. The first antipsychotic is still relevant due to its pronounced dose-dependent sedation. Against the background of sedation, suppression of conditioned reflexes takes place: first of all, motor - offensive and defensive, in general involuntary motor activity decreases by relaxing effect on skeletal musculature. The patient ceases to react actively to the hallucinogenic stimuli, a fictional danger. The drug significantly reduces productive symptoms - nonsense, hallucinations, alleviates anxiety and stress, and eventually completely eliminates these manifestations.

An important quality of Aminazine is its ability to block dopaminergic and adrenergic receptors in the brain. The drug reduces the release of adrenaline, reduces, and sometimes quite quickly completely eliminates many of the effects caused by its overabundance, except for hyperglycemic.

In addition, Aminazine has antiemetic, anti-pyretic, moderate anti-inflammatory, angioprotective and antihistamine action.

The drug is shown to patients with hallucinations, delirium, catatonia, mania, with increased motor excitement, associated with anxiety and fear, increased muscle tone. It is effective for severe pain in combination with pain medication. With persistent insomnia, it is used simultaneously with tranquilizers and hypnotics. It is indicated to patients with neoplasms during the course of chemotherapy and radiotherapy. It can be used for dermatoses accompanied by painful itching.

In this case, as a side effect, Aminazine can cause hives and swelling of allergic genesis, as well as sensitization to ultraviolet rays. This drug often causes neuroleptic syndrome or a depressive disorder, such effects are reduced by a decrease in the dose of the drug and a reception in combination with anticholinergics. For example, Trihexyphenidyl hydrochloride, which is capable of preventing or arresting extrapyramidal disorders arising from the administration of antipsychotics, can be prescribed.

When Aminazine is used, it is necessary to monitor blood counts, hepatic and renal indices. This drug is not used for acute cerebral trauma, liver and kidney dysfunction, hematopoietic pathologies, decompensated organic pathologies of the heart and hypothyroidism, malignant processes affecting the brain and spinal cord, and are not assigned to patients in a coma.

Aminazine is prescribed as intramuscular injections three times a day, the initial dose is 100-150 mg. It is bred in 2-5 ml of saline or novocain solution (0.25-0.5%). Breeding is necessary in order to prevent the occurrence of painful infiltrates. Injection is recommended to perform in the deep muscle layer.

For relief of acute symptoms, the drug can be administered intravenously: 25 or 50 mg of aminazine are dissolved in 10-20 ml of a dextrose solution (5%). Enter for five minutes. These are approximate dosages, since dosing is performed individually from the patient's age and underlying disease. Sometimes, aminazine can be contraindicated.

Then appoint intravenous injection of 30% solution of sodium thiosulfate, which is sometimes used and in combination with Aminazine. The drug has a pronounced antitoxic effect against internal and external toxins, in addition, it has the ability to reduce the symptoms of inflammation and sensitization reactions.

Assign 20ml in combination with Aminazine, without the latter - 30ml simultaneously with 5ml of magnesium sulfate (25%), which calms and has a hypnotic effect, in addition, relieves spasms and moderately reduces blood pressure. In the absence of Aminazine, together with the administration of magnesium and sodium sulfate, Omnupon (2%), subcutaneously 1 ml, is prescribed as an analgesic.

Sometimes such patients are prescribed intravenously or intramuscularly. Diazepam is a potent benzodiazepine anxiolytic with the ability to cramp seizures, relax the muscles, and provide a hypnotic effect. The effect of this drug is based on its ability to enhance the central function of inhibition, which is provided by γ-aminobutyric acid, thereby reducing excitation, nervous tension, feeling anxiety and fear, obsessive thoughts of hypochondriacal content, oppressed or hysterical state. Delusions and hallucinations with the help of this drug are not eliminated. Therefore, it is not assigned to patients with such leading symptoms.

In addition, Diazepam has a relaxing effect on the musculature (relieves convulsions), increases the pain threshold, has antihistamine action, reduces blood pressure. Effects of the drug depend on the dose: a low-dose (up to 15 mg / day) reception provides stimulation of the central nervous system, high-dose - soothes. Diazepam is not compatible with alcohol and other benzodiazepines. Taking this drug, you do not need to bring down the heat with paracetamol, because in this combination the elimination of Diazepam slows and the likelihood of an overdose is high. With simultaneous reception with painkillers and antispasmodics, these effects are potentiated, which can lead to the stopping of breathing. The long course of the drug requires a gradual cancellation, a sudden discontinuation of reception may cause depersonalization. Paradoxical side effects are possible. The average single dose is 20-30 mg.

Patients with severe anxiety and without a hallucinatory-delusional component may be treated with another benzodiazepine, phenazepam, which alleviates anxiety and mental pain. When taking this drug, the symptoms usually disappear in such a sequence - the internal mental tension and anxiety disappear, then the symptoms of somatic psychic depersonalization disappear, and later autopsychic symptoms. Phenazepam, like other drugs of his group, acts on benzodiazepine receptors, reduces the likelihood of convulsions, provides a quick sleep and a full night's rest. It enhances the action of other soothing and anticonvulsants. Short-term use of the drug does not lead to a withdrawal syndrome when discontinuing admission. It is prescribed 5-8 mg per day.

Patients with organic lesions of the central nervous system are prescribed nootropics, which very effectively eliminate the confusion of consciousness. The most effective are dropwise infusions of Pyracetam. The drug acts directly on the brain, improving neuronal metabolism through the normalization of synaptic conductivity, balancing the processes of excitation and inhibition, normalizing the rheological properties of the blood (providing antiaggregant and erythropoietic action), thereby improving its circulation in the vessels of the brain. Thanks to such properties, when taking the drug, the ability to intellectual activity is restored. The patient begins to remember, learn, learn, acquire lost skills. Pyracetam does not expand the lumen of blood vessels, protects them from the effects of intoxication and oxygen starvation. Patients with impaired renal function require dose adjustment. Side effects can increase nervousness, hyperkinesis, depressed mood, drowsiness, asthenia and other paradoxical effects, as well as allergic reactions of various kinds and weight gain, which in our case is even good. The drug is prescribed at 6-8 g per day, and the heavy dose can be increased by 2-2.5 times.

Prevention

Amenia develops rarely and is a companion of serious diseases. Special preventive measures to prevent the development of this syndrome of obscuration of consciousness are not foreseen, however, maintaining a healthy lifestyle, timely detection and treatment of diseases can increase the likelihood that it will be possible to avoid conditions of severe intoxication causing confusion.

[30], [32], [33], [34], [35], [36]

Forecast

Amenia is an unfavorable sign of the development of the underlying disease, however, in modern methods of treatment the patient in most cases can be removed from this state.

The prognosis depends entirely on the disease, against which the syndrome arose.

[37], [38]