Amentia - This is a variation of clouding of consciousness, characterized by a predominance of confusion, randomness of movements, lack of connectedness of speech operations and thought processes. With amentia, the ability to recognize a place is lost, there is a failure in spatial-temporal orientation and a disorder of orientation in the personality. It is often a complication that aggravates the course of the underlying pathology, alcoholism, traumatic injuries, endocrine ailments, infectious processes, and some somatic dysfunctions. Amental syndrome is often born as a result of certain mental disorders.
Amentia - what is it?
It is possible to speak about the described violation, if the individual is disturbed by speech, there is no connectedness, the mental activity is upset.
Amention is a syndrome of severe confusion in psychiatry, manifested by a violation of all types of orientation, personality identity disorder, motor dysfunction, incoherence of speech and mental activity. The most important feature of the considered syndrome is the inability to produce conclusions and the loss of associative links. The patient's speech is meaningless and monotonous, does not contain emotional coloring and intonational modifications. Often monotonous whisper is replaced by a rather loud speech in a singing tone. In addition, the speech of patients is inherent incoherence, the reproduction of individual words.
Amentia - what is it? The analyzed term in psychiatric science originated in the 19th century thanks to the studies of the neuropathologist-psychiatrist T. Meinert, who isolated the specific state of obscured consciousness into a separate syndrome. Amental syndrome, he described as a jumble and incoherence of thought processes. In addition, he discovered the relationship of the violation with motor activation, the emergence of hallucinatory representations and delusional states, loss of orientation.
Modern psychiatry has made the boundaries of this state clearer, which significantly simplified diagnosis and allowed to differentiate the symptoms of mental functioning disorder from twilight consciousness or classical delusions.
E.Krepelin, an eminent figure in psychiatry, studying amentia, deduced that patients' perceptions are saved, but they cannot harmonize their own thoughts with each other or with past experience. In addition, patients can not combine logic and their own concepts. At the same time, they are trying hard to be aware of what is happening, but due to the fact that they are easily distracted, they become incapable of methodological observation. For the perception of individuals suffering from amentive syndrome, there is inherent a mixture of separate fragments that do not provide the patient with a holistic vision of the picture of what is happening. As a result, negative emotions arise: incomprehensibility, vagueness, helplessness. Patients do not realize that they are unwell. In addition, amentia patients cannot understand what is happening around them.
Causes of Amentia
The most common factors causing the described disorder are considered infectious processes affecting the functioning of the brain and nerve structures. Since amentia is in psychiatry, endogenous psychosis, arising from severe mental exhaustion and physical exhaustion, or due to severe intoxication provoked by toxins of exogenous genesis or endogenous nature. Mild forms of the disease can arise from blood loss, due to diarrhea, prolonged fever, vomiting, mild poisoning, due to long-term surgical intervention. For injuries of the skull, characterized by damage to the brain structures, organic lesions of brain tissue, hyperthyroidism, long-term ongoing infectious processes, intoxications caused by the abuse of alcoholic beverages or drug addiction, severe amentia develops.
The most pronounced manifestations of amentative syndrome are observed in sepsis, which accompanies the damage of brain structures. Short amentative episodes are often born on the background of bipolar affective disorder and certain types of schizophrenia. When thyrotoxicosis can also form amentive syndrome.
The described pathological condition is often characterized by a long course. An individual suffering from amentia loses all variations of orientation. He loses all the baggage of life experience. Skills are also lost, and new information is not imprinted in the memory and ceases to be deposited in the mind.
Due to the etiology of amentia, the “superimposition” of the symptoms of the underlying disease, the absence of distinct specific manifestations and the similarity of the symptoms with other ailments, its diagnosis is often difficult.
Symptoms and signs of amentia
In order to diagnose amentative syndrome, it is necessary to base on a set of manifestations.
Amentia is a disorder of consciousness, so it is difficult to recognize and differentiate it from other types of ailments, as stated above. The main characteristics of the violation described are the difficulties in finding and fixing logical interconnections, the lack of connectedness of speech, the fragmentary nature of mental activity.
Symptoms and signs of amentia are often similar to catatonia and delirium. They may also be their extreme degree. Therefore, to select an adequate therapeutic strategy, it is very important to differentiate these ailments.
Diagnosis involves taking into account the totality of manifestations, as separately manifestations may indicate other pathologies.
The main diagnostic signs of amentia include the following. First of all, there should be a complete lack of orientation (spatial, personal, in the surrounding). There is also a pronounced confusion. Patients wonder what is happening. Speech interaction with patients cannot be established. The speech function is preserved, but is characterized by incoherence and fragments. Replicas of patients may indicate a delusional state and the presence of hallucinations. The emotional mood of sick subjects can be judged by his statements.
Due to the lack of communicative interaction, a conclusion about speech disorders is made on fragments of the patient's speech, his motor acts and other indirect signs. Also impaired concentration function. In patients suffering from amentia, attention constantly “skips”, a new object or sound easily distracts it. At the same time, the main sign of amentia is still considered to be fragmentary and incoherent mental operation.
Also characterized by limited physical activity. The patient, while in bed, performs various motor operations of the extremities: swinging them, can bend or rotate. Some movements are characterized by directionality - the patient can grab something, touch, push, which may indicate the presence of delusions and hallucinations.
At the peak of the escalation of symptoms of amentative syndrome, locomotor activity can replace a catatonic stupor. The patient freezes in a certain position and stays in the adopted position without movement. At the same time, a position that artificially attached to the limbs may persist for a long time.
The presence of fragmented, productive symptoms - delusional fantasies and hallucinations are evidenced by replicas of the subject and his movement. The disorder of the connectedness of mental activity with full-fledged hallucinations does not allow development. With amentia, productive symptomatology boils down to individual hallucinatory views.
Amentia is also characterized by a change in the behavioral response (high activity is replaced by absolute apathy) and mood (sick, sometimes merrily, then begin to cry or become indifferent). To cure ailment, patients forget everything that happens during the amentia period. The condition of patients can reach the limit of exhaustion and with a long course of psychotic manifestations. Symptoms of the disease causes an absolute loss of memory during the entire period of the disease.
Amentia is often characterized by duration. The course of the disease is inherent frequency: deterioration is replaced by improvement. Distortion of the interpretation of events is peculiar to this disorder. During the illness, the patient may lose certain abilities, which are often not restored in the future. An individual cannot adequately master new data and cannot acquire new habits after the disease.
Diagnosis and treatment of amentia
Since amentia is a disorder of consciousness, which is accompanied by a violation of the ability to generalize, the diagnosis of amentia is primarily made by a psychiatrist on the basis of symptoms.
The characteristic signs of a disorder of consciousness are: a disorder of connectedness of thinking, confusion, all kinds of disorientation, a chaotic change of emotional moods, motor restlessness, fragmentary delusions, hallucinatory ideas. In order to clarify the nature of the main disease that gave rise to amentia, sometimes consultation of other specialists is required, for example, an endocrinologist, a neurosurgeon, an infectiologist, a traumatologist.
Differential diagnosis is carried out in relation to catatonic arousal and delirium. In amental syndrome, there is a clear relationship between the essence and emotional tone of the patient's speech, which distinguishes it from catatonic activity. Catatonic manifestations at the violation in question are unstable and variable.
Amentia is characterized by the occurrence of episodes of short-term delirium in part of subjects at night, while catatonia does not have such manifestations. She is characterized by the presence of depressive affect.
In a state of delirium, delusions and hallucinatory representations are characterized by coherence. In some cases, for example, if the disorder is caused by the abuse of alcohol-containing liquids, they can form a holistic, complete picture.
With amentia, delusional experiences and hallucinations are fragmentary, incoherent, manifest exclusively in the form of short episodes. Delirium is characterized by the appearance by the day of short periods of clarification of consciousness, whereas this symptom is absent in the amental syndrome.
Patients suffering from delirium, the ability to produce targeted motor operations and interact with the environment retain, when patients' actions are not very targeted, they are meaningless and of the same type, there is no interaction with the environment.
If amentative disorder arises as a result of a mental illness, then hospitalization is indicated in a department with a psychiatric inclination, somatic disorder - in a department with a specific orientation corresponding to the underlying pathology. Advantageously, the basic therapeutic strategy is to administer sodium thiosulfate and Aminazine. If the use of Aminazine is contraindicated to an individual with amentive syndrome, then Pantopon is prescribed. In order to eliminate motor activity prescribed Diazepam, Fenazepam. In order to clarify consciousness, systematic drip infusions of Nootropil in saline are shown. Since the patients refuse to eat food and water, they are artificially nourished. In addition, be sure to conduct therapy of the main disease.
The prognosis of amentia is relatively favorable if the therapeutic strategy is adequate and timely implemented. Sometimes amentia leads to death due to severe depletion of the individual and the unfavorable course of the main disease.