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Psycology » Psychiatry and psychotherapy » Pathology of consciousness » Twilight state (dizziness) consciousness

Feature of this type can be considered a stupefaction suddenness of its occurrence and the same suddenness resolution that characterizes the disorder as twilight paroxysmal manifestation of "off" consciousness. Unlike delirious stupefaction, profound disorientation observed here, the duration of which is most often from several minutes to several hours. Arousal disorder in the twilight of consciousness expressed much sharper than when delirious, while there may be a seemingly orderly behavior. There may be massive hallucinatory disorders of various kinds (visual, auditory), very often marked affects anguish or fear, anger. In patients with epilepsy in some cases, the duration of twilight consciousness disorders can be significant (up to several days).

After the resolution of psychosis with clouded state patients noted a total amnesia, only very rarely occur manifestations described below retardirovannoy amnesia when, after permission for psychosis in a short period of time (minutes, hours) memories of the psychotic symptoms persist, then disappear.

In the clinic, there are several types of twilight stupefaction: simple, hallucinatory, delusional.

Typical or simple variant is characterized in that the external behavior of patients looks orderly and generally correct. However, objectively observed detachment or otherworldly gloom with a vicious expression. Many patients have a complete loss of speech: they are silent, tense or stereotypically expressed. This may manifest some signs of wariness and suspicion, as well as occasional and transient delusional disorder, delusional mood symptoms. Resolution psychosis critical, with total amnesia, often with deep sleep.

Hallucinatory version is a different type of twilight stupefaction. It most often occurs in practice in patients with epilepsy. Psychosis in such cases begins with the appearance of illusions, then join hallucinations: visual, auditory, and a general sense. Patients see sparks, red, blood, often taking awesome nature experience, patients are terrified, forcing trot out all defenses and attack. May appear hallucinatory confusion with a riot, a desire to kill, to tear to pieces, tear. In this state, committed the most heinous crimes, the sick strike blows crushing force, can not keep their few strong, healthy people (Gilyarovskii, 1935). Depth clouded state may vary considerably. In more severe cases, there are confusion, incoherence, patients hardly pronounce the words, something mooing.

In other cases, an elementary orientation persists, patients can learn some people close to them, they saved fragments of consciousness. Hallucinations fleeting, insignificant prevails affect anger and fear. This type of stupefaction sometimes referred to as oriented (dysphoric) twilight (AB Snezhnevsky, 1983).

In some patients there is a change in the experience of his own body sensations: they cease to distinguish between right and left, can not answer the most basic questions. Frequent phenomena double vision or sensation that may be associated with a disorder of the optical and tactile "body schema." May disappear measure of time: a long period of time seems to instantly concise. Along with sexual explosions in such twilight states experienced a sense of death and rebirth, physical shock "I" or, as Karl Wernicke (1900), "mutation somatopsychic sphere." Auditory hallucinations can be quite bright: voice, singing, threats, hissing, squeaking, howling terrible monsters, ready to destroy the patient may appear sulfur smell of burning flesh, etc. This type of clouded state also is developing very quickly and irresistibly growing up degree riot, uncontrolled behavior, there are suicide attempts.

Delusional option clouded state that stands some psychiatrists, characterized externally as if orderly behavior, but the attention is drawn to a faraway look sick, some special concentration and silence that gives shade patient behaviors "awareness" and "purposeful

the uncertainties. " In clarifying the consciousness that, as the emergence of his disorder, occurs usually sudden, patients relate to their actions (often antisocial) as completely alien to them. Many of them later on questioning can get information about the delusional experiences in a period of disordered consciousness. This gives reason to forensic psychiatrists describe twilight disorders of consciousness with the absence of amnesia.

Twilight states without delusions, hallucinations and spitefully treated as dreary affect vigilambulism. Such patients develop automated movements and actions. They can, for example, out of the house with a purpose, and then suddenly and wonder to themselves are in a totally unfamiliar place, often very far from home, and sometimes in another city (known so-called journey from Bombay to Calcutta, perfect patients in a state of psychic automatism). During such unexplained "travel" patients impress some aloof, confused, lost in thought people who then suddenly "come to life" and do not remember anything about what happened.

Fugues - Very short-term state of ambulatory automatism (from Lat. Fuga - running out, running away). Patient suddenly to others, not knowing what was happening to him, for no reason takes off running, or stops and starts to take off her clothes, or spinning like a top. All this "action" takes one to two minutes and stopped as suddenly as it had begun. When he regained consciousness, the patient does not understand what happened to him, looks puzzled. At the same patient suffering from, for example, epilepsy, there can be various types clouded state.

Example twilight stupefaction caused by indomethacin intoxication results in their work Sotskov VG (1991).

"Patient T., 55 years, laborer, admitted to inpatient forensic psychiatric examination in 1987. As a child, no sick, graduated 11 classes at night school.

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