STRUPOROUS STATES (Latin stupor catalepsy, immovability; synonym stupor) — the oppression of mental activity caused by psychosis and which is shown an obezdvizhennost, a mutism (lack of speech communication with people around), decrease in all types of sensitivity.
Struporous states — one of the heaviest psikhopatol. the frustration arising during the most various mental diseases.
The patients who are in a struporous state are not mobile. They for hours sit, lie or stand without changing a pose. Or do not answer questions absolutely (mutism), or answer slowly, usually after a pause, with interjections, separate words, occasionally short phrases. They, as a rule, do not react to the events around, never ask about anything, independently do not eat, do not watch the outward, often show resistance in any attempt to influence them, napr, during the feeding, washing, clothing, holding medical procedures (negativism). When at patients the condition of an incomplete obezdvizhennost with sharply reduced speech activity is noted, speak about a substupor.
Usually S. are followed by page various positive psikhopatol. symptoms — nonsense (see), hallucinations (see), the changed affect (see. Depressive syndromes , Maniacal syndromes ), stupefaction (see). Less often than S. pages are exhausted only by motive and speech disturbances — a so-called empty stupor. The stupor accompanied with stupefaction, first of all oneiroid (see. A oneiric syndrome), call receptor; the stupor arising against the background of clear consciousness — lyutsid-ny, or effector. Usually the terms «effector stupor» and «lyu-tsidny stupor» use for the characteristic of a catatonic stupor (see. Catatonic syndrome), but they can be used also for other S.' characteristic of page. At S. temporary sharp depletion of mental activity in this connection such patients remind the persons having weak-mindedness (see) a cut actually usually can be observed by page is absent. This fact was noted by psychiatrists in 19 century. At that time S.'s most of page, and first of all those, to-rye arise at endogenous psychoses (see. Maniac-depressive psychosis, Schizophrenia), determined by the term «primary curable, or acute, weak-mindedness» (dementia primaria s. acuta curabilis). Villages of the village are followed by somatic frustration, first of all vegetative. Reminiscence of the patient of what happened to it in the period of a stupor are more often poor, sketchy or absolutely are absent.
Depending on psikhopatol. manifestations or nosological accessory of a mental disease, at a cut there is a stupor, allocate the following its forms: a catatonic stupor, a psychogenic stupor (see. Reactive psychoses), a depressive stupor (a melancholic stupor, or melancholic catalepsy), a hallucinatory stupor, an apathetic stupor (an asthenic stupor, or the awake coma), a maniacal stupor, an alcoholic stupor, a postconvulsive stupor. Most often meet a catatonic and psychogenic stupor, then depressive and hallucinatory.
At a depressive stupor appearance of the patient reflects depressive affect: the pose is crooked, the head and a look are lowered, on a forehead — the horizontal wrinkles delayed up, muscles of the bottom of the person are relaxed, eyes dry and inflamed. Patients usually respond to appeals with separate interjections, words pronounced by footfall or react the elementary movements (the ducking changing the direction a look, etc.). Nek-ry patients against the background of an obezdvizhennost periodically or constantly move with fingers, from time to time publish separate groans that testifies to possibility of a melancholic raptus (see. Depressive syndromes), later to-rogo the stupor appears again. The depressive stupor is followed by the expressed depressive nonsense (see), including Kotar's nonsense (see. Kotara syndrome ). In some cases at a depressive stupor oneiric stupefaction is noted. The depressive stupor is the culmination ideatorny (disorders of thinking) and motor braking at a melancholic depression or develops at height of the alarming agitated depression (see. Depressive syndromes). The depressive stupor proceeds several hours or weeks, rarely longer. It meets at maniac-depressive psychosis, involutional melancholy and Krepelin's disease (see. Presenile psychoses), at schizophrenia (see). The depressive substupor is characteristic of protragirovanny alcoholic gallyutsinoz (see. Alcoholic psychoses ).
The hallucinatory stupor usually is followed by various mimic reactions expressing melancholy, fear, surprise, curiosity, detachment. The mutism can be full, the negativism usually is absent. Most often the hallucinatory stupor arises at height of true polyvocal verbal hallucinosis, is much more rare — at acoustical pseudo-hallucinosis, at Bonnet's hallucinosis (see. Senile psychoses) and at flow of visual hallucinations at height of a delirium (see. Delirious syndrome). The hallucinatory stupor lasts several minutes or hours, rarely longer. It meets at intoksikatsionny psychoses (see) less often at organic (see the Pathopsyhosis).
At an apathetic stupor patients lie on spin in a condition of prostration and full muscular relaxation. The look devastated eyes are widely opened. To surrounding they are indifferent and indifferent. On the simplest questions are capable to give the short and correct answer, on more difficult — answer «I do not know» or are silent. Vague consciousness of a disease at patients is kept. They have correct emotional reactions, napr, at appointments to relatives. At night sleeplessness is observed; in the afternoon drowsiness is absent. Patients are slovenly. The expressed cachexia (see) accompanied with profuse ponosa is always observed. The apathetic stupor proceeds 1 — 4 month. Memories of it extremely scanty. The apathetic stupor arises at protragirovanny symptomatic psychoses (see) and occasionally in a debut of alcoholic encephalopathy of Gayet — Vernike (see. Alcoholic encephalopathies).
At a maniacal stupor motive block does not mention a mimicry. Remaining motionless, patients are capable to look after the interlocutor, to smile, to laugh silently. Do not answer the asked questions and are silent. The negativism is absent or is expressed poorly. The maniacal stupor usually develops upon transition of a maniacal state in depressive or at the mixed states (see. Maniacal syndromes, Depressive syndromes). Meets at schizophrenia and maniac-depressive psychosis.
The alcoholic stupor is observed rather seldom, first of all at the alcoholic oneiroid accompanied with visual pseudo-hallucinosis (see. Alcoholic psychoses). In a condition of a stupor patients look sleepy or released, answer questions in monosyllables, and that only on simple, quite often are silent. The look which stiffened and stupid or appears expression of fear, surprise, concern, interest. Patients passively submit to survey and if show resistance, then do it as the people who are in a light slumber. The muscle tone is usually lowered. The substupor arising at height of development of acute verbal hallucinosis of depressive contents meets more often. Duration of a stupor — from several hours to several days, a substupor — of several minutes till several o'clock. Occasionally at Gayet's encephalopathy — Vernike (see. Alcoholic encephalopathies) there is a deep stupor with the sharp muscular, including oppositional muscular hypertension which is quickly replaced by a hypomyotonia. Patients are often slovenly.
At a postconvulsive stupor the face of the patient not movably with stupid and senseless expression or on it appears mimic reaction of despair, fear, bewilderment, delight. Motive block is followed in one cases by a mutism, in others — spontaneous or appearing after the asked questions the sketchy, deprived of sense speech; verbigeration (see the Speech, alalias can be observed at mental diseases). One patients passively submit to leaving, to lay down. to procedures, etc., others — show negativism. Sometimes for short time there is a katalepsy (see. Catatonic syndrome). The postconvulsive stupor is occasionally exhausted by one motive frustration. Usually it is combined with nonsense, hallucinations, twilight or oneiric stupefaction, contents to-rykh often has frightening character, and in these cases is followed by affects of melancholy and fear. Many patients are slovenly. Sudden change of motive block by frenzied furious excitement with destructive actions is characteristic of a postconvulsive stupor. The postconvulsive stupor seldom arises as independent frustration. As a rule, it appears after various epileptic seizures, especially serial, in connection with the developed twilight stupefaction at height of heavy dysphorias (see). Duration of a postconvulsive stupor — several minutes or days. More often the postconvulsive stupor comes to an end suddenly, after it full amnesia is characteristic (See).
A therapeutic pathomorphism of psychoses (see. Mental diseases, pathomorphism ) and successful treatment of somatopathies, at to-rykh there are S. of page (e.g., tuberculosis, malaria, pernicious anemia), caused easing of weight of almost all S. of page. Most clearly it is observed at a catatonic, depressive and apathetic stupor.
The diagnosis is based on features a wedge, pictures and data of the anamnesis. Differential diagnosis is carried out with an akineziya — conscious delay or the termination of movements, at severe pains and psychopathic reactions (see. Psychopathies ).
As S.'s presence by the village demonstrates existence of psychosis in the heaviest degree, such patients would need the immediate room in psychiatric and vigorous treatment of a basic disease. As a rule, at the same time treatment of the accompanying somatic frustration is necessary. The round-the-clock supervision and the corresponding leaving shall be provided to sick S. with page (see. Mentally sick ).
The forecast concerning life is most adverse at an apathetic stupor. The forecast concerning recovery is caused by a basic disease.
Prevention is reached by early diagnosis of a mental disease and timely begun treatment.
Bibliography: Gulyamov M. G. Epileptic psychoses, Dushanbe, 1971; And with - l and S. G's N. Sketches of clinical psychiatry, M., 1965; Kowalewski P. I. Epilepsy, its treatment and forensic-psychiatric value, page 154, SPb., 1898; Kraft-Ebing R. The textbook of psychiatry, the lane with it., page 655, SPb., 1897; JI at-komsky I. I. Maniac-depressive psychosis, M., 1968; Moro G. V's call. Struporous states, M., 1968; The Guide to psychiatry, under the editorship of. A. V. Snezh-nevsky, t. 1 — 2, M., 1983; Snezhnevsky A. V. About late symptomatic psychoses, Works Ying-that of Gannushkin, century 5, page 237, M., 1940; Eu N., Bernard P. et Brisset Ch. Manuel de psychiatrie, p. 89 e. a., P., 1967; Lexikon der Psychiatrie, hrsg. v. C. Muller, S. 496, B. u. a., 1973.