From Big Medical Encyclopedia

TWILIGHT STUPEFACTION (synonym twilight consciousness) — loss of clarity of consciousness with full detachment from surrounding or with his sketchy and distorted perception at preservation of the usual automated actions.

On features a wedge, S.'s manifestations the item of page can allocate simple form S. of the item of page with productive frustration. A clear boundary between them does not exist.

The simple form develops suddenly. Perception surrounding at the same time is interrupted completely; it is impossible to enter communication with patients. The spontaneous speech is absent or is limited to stereotypic repetition of separate interjections, words, short phrases. The movements of patients are grown poor and slowed down, up to development of short-term struporous states (see), or there are episodes of chaotic excitement. Sometimes consecutive externally purposeful actions remain. When they are followed by involuntary wandering, speak about out-patient automatism. The short-term out-patient automatism lasting several minutes is called the fugue, longer — a trance; the out-patient automatism arising during sleep — noctambulation (see), or lunacy. Recovery of clarity of consciousness happens usually gradually and can pass through the period of a stupidnost — passing sharp depletion of mental, in particular intellectual, activity in this connection patients make a false impression of feeble-minded. The simple form C. of the item of page lasts usually several minutes or hours and is followed by the subsequent full amnesia (see). In some cases there comes the dream.

The page of the item of page with productive frustration arises rather gradually. The attack is followed by emergence of hallucinations (see), nonsense (see) and affective frustration. Perception by patients of surrounding is distorted. Verbal communication with them to some extent remains. Statements and acts are defined by the arising frustration. Visual hallucinations of frightening contents, as a rule, mobile restricting — the approaching group of people or the separate figure rushing on the patient the car, the airplane, the train, the rising water, the collapsing buildings, a pursuit, etc. prevail. Quite often hallucinations are sensually bright, stsenopodobna, are painted in different colors or sparkle. Auditory hallucinations in the form of phonemes (see. Hallucinations ) often oglushitelna — a thunder, footfall, explosions; olfactory hallucinations are usually unpleasant — a smell of smoke, urine, sulfur, something burned. Prevail hallucinatory, figurative nonsense (see. Nonsense ) with the ideas of prosecution, physical destruction, greatness, Messianizm; often religious and mystical crazy statements meet. The figurative nonsense often is followed by false recognitions (see Kapg-r a symptom). Affective frustration are intensive and differ in tension. Most often it is fear, horror (superhorror according to nek-ry patients), frenzied rage or rage, ecstasy. Motive frustration are shown by excitement, is frequent in the form of the senseless destructive actions directed to inanimate objects, surrounding people or there are short conditions of an obezdvizhennost. S.'s current of the item of page with productive frustration can be continuous and alternating (spontaneous disappearance for a short time many and even all symptoms with their subsequent repeated emergence). Duration of this form C. of the item of page fluctuates of several hours to 1 — 2 week. Disappearance of painful frustration quite often happens suddenly — the patient as if wakes up after a dreadful dream. Amnesia can be partial (in consciousness for different terms there is most often a maintenance of visual hallucinations and the affect accompanying them), retardirovanny or full (see. Amnesia ). The relation to the dangerous actions made by them (e.g., murder) as to alien, made by someone another is characteristic of patients with S. of the item of page even with incomplete amnesia.

Versions C. of the item of page with productive frustration are the oriented twilight stupefaction, at Krom patients in the most general terms know where they are and who surrounds them, and a morbid prosonochny condition (or intoxication a dream). Approximate twilight stupefaction usually develops against the background of heavy dysphorias (see). The morbid prosonochny condition arises at the slowed-down awakening from a deep sleep. It is followed by bright dreams of dreadful contents. Motor functions while the highest mental functions and among them consciousness remain in a varying degree slowed down first of all are exempted from sleepy braking. At the semi-wakened person the dreams perceived by it as reality proceed. They intertwine with the wrong perception of surrounding, can be followed by fear and are capable to cause motive excitement with aggressive actions. Such state comes to an end with a dream. In memory scraps of the former dreams can remain.

The page of the item of page meets most often at epilepsies (see) and traumatic damages of a brain; more rare — at symptomatic psychoses (see) and reactive psychoses (see). The morbid prosonochny condition can arise at alcoholic intoxication and hron. alcoholism (see an alcoholism).

The diagnosis is based on a wedge, data. Differential diagnosis is carried out with a delirium (see. Delirious syndrome ) and oneiroid (see. Oneiric syndrome ).

It is possible to stop S. to the item of page intramuscular introduction of 5 — 7 ml of 10% of solution of hexenal and the subsequent enema from 5% solution of Chlorali hydras (15 — 20 ml). From psikhofarmakol. means use the aminazine and a haloperidol entered parenterally.

The forecast depends on a basic disease.

Bibliography: Questions of clinic, pathogeny and forensic-psychiatric assessment of mental diseases, under the editorship of G. V. Morozov, page 95, M., 1967; Gordova T. N. The remote period of the closed cherepnomozgovy injury in forensic-psychiatric aspect, page 69, M., 1973; Kerbi-k about in O. V., etc. Psychiatry, page 83, etc., M., 1968; Krasnushkin E. K. Chosen works, page 341, M., 1960; Le-xikon der Psychiatrie, hrsg. v. C. Muller, S. 61, B. u. a., 1973; P about r about t A. Manuel alphabetique de psychiatrie clinique et therapentique, p. 228, P., 1969.

H. G. Shumsky.