LETHARGY (grech, lethargia; from lethe oblivion + argia inaction; synonym: hysterical dream, lethargical sleep, «small life», imaginary death) — a condition of a pathological dream with more or less expressed weakening of physical manifestations of life, with an obezdvizhennost, considerable decrease in exchange and easing or lack of reaction to sound, tactile and pain stimulations. Origins of L. are definitely not established.
In the heavy, seldom found cases of L. there is really a picture of imaginary death: skin cold and pale, pupils do not react, it is difficult to find breath and pulse, strong pain stimulations do not cause reaction. The hypomyotonia, an areflexia, decrease in the ABP are expressed. Within several days patients do not drink, do not eat, release of urine and a calla stops, there comes the weight loss, dehydration. In mild cases of L. the immovability, relaxation of muscles, even breathing, sometimes start a century, rolling of eyeglobes are observed. The possibility of swallowing remains. In response to irritations the chewing or deglutitory movements follow. Perception of surrounding can be partially kept.
Attacks of L. arise suddenly and suddenly come to an end. Chances with harbingers and disturbance of health and behavior after awakening.
Duration of L. — from several hours to several days and even weeks. Separate observations of a long-term lethargical sleep with the remaining possibilities of meal and departures of others fiziol, acts are described. At measurement of temperature in a rectum and a vagina its decrease is noted; neuromuscular excitability at action by a current is also lowered.
Attacks of L. it is necessary to distinguish from a long dream at encephalitis (see. Ekonomo lethargic encephalitis ), narcolepsies (see), an epileptic paroxysm of drowsiness (see. Epilepsy ), the expressed catatonic stupor (see. Catatonic syndrome ), a syndrome Klein — Levina (see. Dream, frustration ).
Treatment: rest, pure air, easy, vitamin-rich food. At the expressed decrease in the ABP — an injection of caffeine 2 — 3 times a day. At impossibility to feed the patient parenteral food can be applied, intravenously enter 40 — 60 ml of 20% of solution of glucose and subcutaneously to 100 ml of isotonic solution of sodium chloride.
Dangers to life of L. does not represent.
A lethargy in the medicolegal relation
Court. - medical examination can meet need of establishment or an exception of L. at survey of a corpse on site incidents. At suspicion on L. it would be necessary to take measures for rendering the first medical aid and to direct the victim in.
If L. timely it is not established, that perhaps wrong research of «corpse» of the seeming dead person that is observed in court. - medical practice it is extremely rare. The wrong ascertaining of approach of true death owing to insufficient inspection seeming dead can lead to non-rendering of medical aid that under the conditions provided by the criminal legislation there is a prof. an offense. The existing «Rules of a medicolegal research of corpses» specify that opening shall not be made at the slightest doubt actually of death, and in such cases it is necessary to take all measures to revival.
A question of danger of burial alive the persons which are in a condition of L., lost the value since burial is usually made in 1 — 2 days after death when the reliable cadaveric phenomena are already well-marked.
Arising at L. state helplessness (see) it can be used in criminal intents (a robbery, drawing damages, rape and other crimes against the personality). If court. - is established by medical examination that the victim was in a condition of L. during commission over it of a crime, it is important for investigation authorities and court as the circumstance aggravating responsibility for criminal acts and increasing their punishability.
Along with cases true L. its simulation is possible. Establishment or exception of simulation of L. also the wedge, observations is proved on the basis of careful inspection, and sometimes.
Bibliography: Astvatsaturov M. I. Epidemic encephalitis, its symptomatology and clinical picture, Pg., 1923; In e y A. M N. Sleep disorders and wakefulnesses, M., 1974, bibliogr.; r and shch e of N to about in N. I. and With t of e p and V.P's N. The pathophysiological analysis of patients with periodic attacks of a long dream, Zhurn, a neuropath, and psikhiat., t. 54, No. 1, page 48, 1954; Forensic medicine, under the editorship of V. M. Smolyaninov, page 85, M., 1975; To 1 e i n e W. Periodische Schlafsucht, Mschr. Psychiat. Neurol., Bd 57, S. 285. 1925; R o h t B. Hypersomnie, B., 1962.
B. H. Favorina; K. I. Hizhnyakova (court.).