Amenity

The highest fundamental function of the human brain is consciousness. It is the basis for cognition of the real world of all phenomena in their complex interaction and one's 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 many reasons, it can be disrupted or switched off, and then a person becomes completely helpless. Sometimes one or more types of orientation are disrupted, this often happens to elderly people. They suddenly get lost in time, cannot orient themselves on the terrain and, for example, return home, somehow assess the situation, do not recognize others, cannot identify themselves. Some suddenly stop perceiving the environment or completely lose the ability to reason sensibly, synthesize their thoughts, and formulate them coherently. Memory problems may arise, often nothing is retained in it.

Such qualitative changes in consciousness may concern one of its aspects, or they may be present all together, in which case the patient is diagnosed with one of the syndromes of clouding (disintegration) of consciousness. These include: delirious, oneiroid, amentive and twilight disorder of consciousness. All these syndromes have one common and characteristic feature - productive contact with the patient at the moment of clouding of consciousness is impossible. Among the syndromes of clouding of consciousness, amentive disorder is characterized by the deepest degree of its damage.

Amentia (lack of mind) is a form of psychotic state in psychiatry, acute psychosis, which is characterized by gross and comprehensive disorientation, loss of perception of the surrounding reality and the ability to think synthetically, accompanied by motor and speech agitation, characterized by meaninglessness and chaos, fragmentary hallucinatory experiences and severe confusion.

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Causes amensia

Amentia, in most cases, occurs in people who have suffered for a long time from serious illnesses that lead to degenerative changes in organs and tissues, as well as against the background of rapidly developing effects of external or internal toxic substances.

There are numerous risk factors for the development of this type of disintegration of consciousness. Severe forms of amentia with pronounced symptoms can be caused by sepsis of various origins, head injuries with damage to cerebral structures, their non-traumatic lesions, for example, oncological diseases with metastases to the brain. Amentia can develop against the background of chronic alcohol or drug intoxication, thyrotoxicosis, phenylketonuria, rheumatism, severe infectious diseases and profound metabolic disorders.

Short amentia episodes can be observed in schizophrenics and people suffering from bipolar disorder. Delirium can smoothly turn into amentia syndrome. And the reverse transition, especially at night, is considered confirmation that amentia was caused by external influences.

The mildest forms of amentia develop with electrolyte imbalances, for example, intestinal infections with frequent vomiting and diarrhea, significant blood loss, and severe physical overexertion.

Many of the above-mentioned causal factors can trigger the pathogenesis of amentia. Since this syndrome is an acute psychosis, catecholamines – dopamine, norepinephrine, adrenaline – play a special role in its development from the point of view of modern neurobiology. The exact mechanism of their interaction in amentia has not been established. However, a violation of their balance in the synaptic cleft leads to the development of symptoms of amentia syndrome.

Since amentia develops with various diseases, the exact statistics of its prevalence are unknown. It is a fairly common companion of severe infectious diseases, secondary neoplasms of the brain and tumor intoxications, craniocerebral trauma. The presence of amentia is considered an indicator of a particularly severe course of the underlying disease, often its terminal stage.

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Symptoms amensia

According to experts, with all the variety of symptoms and sudden manifestation of amentive disorder, it is possible to identify the first signs that precede its development. Patients begin to worry, they have signs of a depressed mood, insomnia, they are overwhelmed by unfounded obsessive thoughts of a hypochondriacal nature, which they share with their doctor. In a day or two, sometimes in a few hours, affective disorders become very pronounced.

Symptoms, in most cases, develop in the following sequence: anxiety disorder (depression), somewhat less often – mania → depersonalization and/or delusion → oneiroid → amentia.

Sometimes amentia occurred, bypassing the intermediate stages, from a state of melancholic depression or mania with increasing symptoms of clouding of consciousness.

An amentive patient can be identified by his appearance: his facial expressions are absolutely inconsistent with the surrounding conditions and situation. His face has a frozen expression of confusion and bewilderment, bordering on fear. The patient constantly shifts his absent gaze from one object to another, it seems that he sees nothing, is blind.

The face is pale, the lips are dry, 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 separate words, sounds, interjections, pronounced by the patient repeatedly at different volumes. Sometimes with amentia there is no speech incoherence. The patient constructs grammatically correct sentences, however, they are devoid of any meaning. There are times when the patient can even answer questions, although not always on the merits. With a long course of the syndrome, the severity of the patient's condition is not always the same - sometimes it worsens, sometimes it improves.

The patient has pronounced autopsychic and allopsychic depersonalization - intrapersonal orientation, as well as temporal and spatial orientation, is completely lost. It seems as if he is separated from everyone by an invisible wall.

The emotional state quickly changes to a polar one - the patient is either happy or crying, the behavior is also unstable - activity quickly gives way to apathy, which is immediately interrupted by songs or monologues. Most of them are monotonous and uniform.

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

Thinking is fragmentary, and its fragments are not connected to each other in any way.

Motor agitation is usually limited to the patient's bed; he constantly touches something, moves things, grabs passing medical workers by the hem of their gowns, throws things around. Sometimes patients roll out of bed and crawl or roll on the floor. The movements are chaotic and absurd. Patients can be aggressive towards others and themselves – prone to self-harm.

The lack of ability for coherent thinking is reflected in the fact that hallucinations and delirium are also fragmentary. Full-fledged production does not develop. This is judged by the patient's statements and movements.

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

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

After recovery, patients remember nothing about the disorder (retrograde amnesia).

Based on the predominant symptoms, a distinction is made between catatonic, hallucinatory and delusional forms of amentia.

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Complications and consequences

Mild forms of amentia may pass without a trace, and in severe diseases its development indicates an unfavorable course of the underlying pathology. Sometimes amentia develops in the terminal stage and ends fatally.

Even patients who have recovered from a long illness are in an extremely exhausted state, they lose almost all of their experience and skills that they had before the onset of the disease. With the current level of therapy, amentia (without a period of subsequent asthenia) lasts no more than one or two months

Memory and cognitive abilities suffer. In some patients, they are not restored to their previous level at all. Amentia can result in disability.

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Diagnostics amensia

There are no specific studies, laboratory or instrumental, that could accurately confirm the diagnosis of amentive syndrome. Such studies may be necessary only to determine the extent of damage to the body by the underlying disease. The disorder is diagnosed based on observations of the patient.

The main diagnostic criteria in this case are incoherence and discreteness of speech, motor skills, other mental functions, complete helplessness, as well as the patient’s appearance, the confused and perplexed expression on his face.

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Differential diagnosis

Manifestations of amentia can be confused with other disorders related to clouding of consciousness. They have many common features, and productive contact with the patient in all cases is not possible. It is necessary to distinguish these syndromes in order to choose the necessary treatment tactics.

Catatonic amentia is characterized by instability and rapid changes of posture, episodic attacks of delirium at night, and fragmentary speech, reflecting this feature of amentia.

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

Oneiroid (dreams, daydreams) – in this state, the ability to form coherent thoughts and judgments corresponding to the unfolding of the oneiroid scenario is preserved.

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

An important diagnostic criterion is also the prolonged course of amentia compared to all other variants of clouded consciousness. Episodes of delirium, oneiroid and catatonia, as a rule, do not exceed several days, twilight disorder of consciousness – hours. Amenia lasts for weeks.

Amentia and dementia – both of these concepts mean the absence of mind, madness. However, dementia occurs gradually, a person experiences a steady decline in his cognitive abilities, loss of existing skills and accumulated knowledge. Such a breakdown of mental activity occurs most often in old age (senile dementia), less often – in younger people, in people who have been abusing alcohol or drugs for a long time and regularly.

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

Treatment amensia

The development of amentia is considered an unfavorable prognostic sign and requires urgent measures and constant medical supervision. Hospitalization of the patient is desirable. Outpatient treatment is possible only in the case of a mild course of the syndrome (asthenic confusion).

Considering that the patient is often in an exhausted state even before the onset of amentia, and during the period of disorder begins to refuse food and water, he must be force-fed.

Treatment is aimed primarily at stabilizing the condition of the underlying somatic disease, as well as relieving amentia syndrome with the help of psychotropic drugs.

Medicines designed to stabilize the mental state are selected taking into account the patient's somatic disease and the predominant symptoms of the syndrome.

Aminazine is most often used to relieve symptoms of amentia. The first antipsychotic is still relevant due to its pronounced dose-dependent sedative effect. Against the background of sedation, conditioned reflexes are suppressed: primarily motor reflexes - offensive and defensive, involuntary motor activity is generally reduced by a relaxing effect on skeletal muscles. The patient stops actively reacting to hallucinogenic stimuli, imaginary danger. The drug significantly reduces productive symptoms - delirium, hallucinations, relieves anxiety and tension, and over time completely eliminates these manifestations.

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

In addition, Aminazine has antiemetic, antipyretic, moderate anti-inflammatory, angioprotective and antihistamine effects.

The drug is indicated for patients with hallucinations, delirium, catatonia, mania, increased motor agitation associated with anxiety and fear, increased muscle tone. It is effective for severe pain in combination with painkillers. In persistent insomnia, it is used simultaneously with tranquilizers and sleeping pills. It is indicated for patients with neoplasms during chemotherapy and radiotherapy. It can be used for dermatoses accompanied by excruciating itching.

At the same time, as a side effect, Aminazine can cause urticaria and edema of allergic genesis, as well as sensitization to ultraviolet rays. This drug quite often causes neuroleptic syndrome or depressive disorder, such effects are stopped by reducing the dose of the drug and taking it in combination with anticholinergics. For example, Trihexyphenidyl hydrochloride can be prescribed, which is able to prevent or stop extrapyramidal disorders that occur when taking antipsychotics.

During Aminazin therapy, it is necessary to monitor blood counts, liver and kidney indices. This drug is not used in acute brain injuries, liver and kidney dysfunction, hematopoiesis pathologies, decompensated organic heart pathologies and hypothyroidism, malignant processes affecting the brain and spinal cord, and is also not prescribed to patients in a comatose state.

Aminazine is prescribed as intramuscular injections three times a day, the initial dose is 100-150 mg. It is diluted in 2-5 ml of physiological solution or novocaine solution (0.25-0.5%). Dilution is necessary to prevent the occurrence of painful infiltrates. The injection is recommended to be performed in the deep muscle layer.

To relieve acute symptoms, the drug can be administered intravenously: 25 or 50 mg of Aminazine is dissolved in 10-20 ml of dextrose solution (5%). Administered over five minutes. These are approximate dosages, since dosing is individualized based on the patient's age and underlying disease. Sometimes Aminazine may be contraindicated.

Then intravenous injections of 30% sodium thiosulfate solution are prescribed, which is sometimes used 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.

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

Sometimes such patients are prescribed intravenously or intramuscularly Diazepam - a powerful benzodiazepine anxiolytic that has the ability to stop convulsions, relax muscles, and provide a hypnotic effect. The action of this drug is based on its ability to enhance the central inhibition function, which is provided by γ-aminobutyric acid, due to which agitation, nervous tension, anxiety and fear, obsessive thoughts of hypochondriacal content, depressed or hysterical state are reduced. Delirium and hallucinations are not eliminated with this drug. Therefore, it is not prescribed to patients with such leading symptoms.

In addition, Diazepam has a relaxing effect on muscles (relieves cramps), increases the pain threshold, has an antihistamine effect, and reduces blood pressure. The effects of the drug depend on the dose taken: low-dose (up to 15 mg per day) intake provides stimulation of the central nervous system, high-dose - calms. Diazepam is incompatible with alcohol and other benzodiazepines. When taking this drug, do not bring down a high temperature with paracetamol, since in such a combination the elimination of Diazepam slows down and there is a high probability of overdose. When taken simultaneously with painkillers and antispasmodics, these effects are potentiated, which can lead to respiratory arrest. A long course of the drug requires gradual withdrawal, abrupt cessation of intake can 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 prescribed therapy with another benzodiazepine - Phenazepam, which effectively eliminates anxiety and mental pain. When taking this drug, the symptoms usually disappear in the following sequence - internal mental stress and anxiety disappear, then the symptoms of somatopsychic depersonalization disappear, and later - autopsychic signs. Phenazepam, like other drugs in its group, acts on benzodiazepine receptors, reduces the likelihood of convulsions, ensures rapid falling asleep and a good night's rest. It enhances the effect of other sedatives and anticonvulsants. Short-term use of the drug practically does not lead to withdrawal syndrome when stopping the drug. It is prescribed at 5-8 mg orally per day.

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

Prevention

Amentia develops rarely and is a companion of serious diseases. Special preventive measures to prevent the development of this syndrome of clouding of consciousness are not provided, 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 that cause clouding of consciousness.

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Forecast

Amentia is an unfavorable sign of the development of the underlying disease, however, with modern methods of treatment, in most cases the patient can be brought out of this condition.

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

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