Symptoms of catatonic stupor and photos of the types of manifestations of the disease

Stupor

Stupor

(from Latin stupor “numbness, stupor”) - in psychiatry, one of the types of movement disorder, which is complete immobility with mutism and weakened reactions to irritation, including pain. There are various types of stuporous states: catatonic, reactive, depressive stupor. Catatonic stupor is the most common; it develops as a manifestation of the catatonic syndrome and is characterized by passive negativism or waxy flexibility or (in the most severe form) severe muscle hypertension with numbness of the patient in a pose with bent limbs.

Being in a stupor, patients do not come into contact with others, do not react to current events, various inconveniences, noise, wet and dirty bed. They may not move if there is a fire, earthquake or some other extreme event. Patients usually lie in one position, the muscles are tense, the tension often begins with the masticatory muscles, then goes down to the neck, and later spreads to the back, arms and legs. In this state, there is no emotional or pupillary response to pain. Bumke's syndrome—dilation of the pupils in response to pain—is absent.

Manifestations of hysterical psychopathy

There is a personality disorder, extreme egocentrism, infantilism, lack of naturalness, and demonstrative behavior. Patients urgently need the attention of people nearby, and their proximity and relationship to the patient is unimportant. The opinion is incorrectly spread that hysterical psychopathy is mainly observed in the female sex, from the perspective of recent statistical generalizations, such a reaction is distributed in half.

Hysterical mental instability does not mean the inability to build a career; many individuals with such manifestations are actively making progress in creativity , for example, fine arts or applied technologies. But it should be noted that in other, more mundane areas of activity, the inability to adequately respond to criticism and an increased ability to suggest leads psychopaths to the severance of employment relationships, the collapse of the earned image, and damage to relationships with partners.

Perfect recovery is called into question, but stable and reasonable behavior can be achieved in standard situations developed with the help of a psychologist.

Causes of stupor

Women are much more likely than men to fall into emotional stupor. This condition usually occurs due to intense mental shocks (fear, horror, grief, disappointment). In this case, motor activity and affective activity are blocked, and mental activity also slows down. This condition can go away without treatment and without any special consequences, or it can lead to a panic state, during which the sick person will rush to perform chaotic actions (run, scream). The consequence of this may be depression. A state of stupor of this type can appear in a woman who has witnessed a catastrophe, an accident, or someone else's suffering. It can occur in soldiers during combat, and also in children, for example, during exams.

Catatonia

The disease was first studied and described by the German psychiatrist Kahlbaum . The doctor separated catatonia from other diseases and considered it as an independent mental illness. His colleague later clarified that the syndrome is a companion to schizophrenia, and a connection was later discovered between affective bipolar disorders, depression, manic-depressive psychosis and other mental disorders. Treatment of the disease is in the psychiatric field , patients are advised by oncologists, neurologists, narcologists, and other medical specialties are involved as necessary.

How does catatonia occur?

A catatonic state of stupor or agitation can be observed in a number of diseases:

psychoses of organic, intoxication, withdrawal, infectious, somatic origin;
autism;
injuries and tumors of the brain, skull;
infectious diseases;
epilepsy;
thrombocytopenia;
drug addiction;
prescribing treatment with psychotropic substances;
acute mental changes after childbirth.

The immediate prerequisites for the appearance of catatonic stupor have not yet been determined, despite extensive research in this area. But working hypotheses exist and the causes of the disease are considered to be:

metabolic changes in the brain;
the cessation of motor activity in catatonia may be based on a lack of GABA in the cerebral cortex, which appears due to top-down modulation, developing in the basal ganglia;
effective action of the therapeutic plan of benzodiazepines affecting the activity of GABA;
high activity of monosodium glutamate;
the effect of antipsychotics designed to block dopamine can be harmful in case of catatonia, without bringing any benefit, since stupor and agitation can occur due to a sudden stop in the flow of dopamine;
activation of the serotonergic and cholinergic systems after clozapine withdrawal;
disturbances on both sides of metabolism in the frontal lobes and thalamus can cause chronic catatonia;
stupor can be a manifestation of a response to a feeling of approaching mortal danger, a typical reaction in many somatic and mental disorders.

Types of stupor

Stupor with waxy flexibility

In case of stupor with waxy flexibility, in addition to mutism and immobility, the patient maintains the given position for a long time, freezes with a raised leg or arm in an uncomfortable position. Pavlov's symptom is often observed: the patient does not respond to questions asked in a normal voice, but responds to whispered speech. At night, such patients can get up, walk, put themselves in order, sometimes eat and answer questions.

Negativistic stupor

Negativistic stupor is characterized by the fact that with complete immobility and mutism, any attempt to change the patient’s position, lift him or move him causes resistance or opposition. It is difficult to get such a patient out of bed, but once raised, it is impossible to put him back down. When trying to be brought into the office, the patient resists and does not sit down on the chair, but the seated person does not get up and actively resists. Sometimes active negativism is added to passive negativism. If the doctor extends his hand, he hides his hand behind his back, grabs food when it is about to be taken away, closes his eyes when asked to open, turns away from the doctor when asking him a question, turns and tries to speak when the doctor leaves, etc.

Stupor with muscle numbness

Stupor with muscle numbness is characterized by the fact that patients lie in the intrauterine position, muscles are tense, eyes are closed, lips are pulled forward (proboscis symptom). Patients usually refuse to eat and have to be fed through a tube or undergo amytalcaffeine disinhibition and feed at a time when the manifestations of muscle numbness decrease or disappear.

Depressive stupor

With depressive stupor with almost complete immobility, patients are characterized by a depressed, pained expression on their face. It is possible to make contact with them. get a one-word answer. Patients in a depressive stupor are rarely untidy in bed. Such a stupor can suddenly give way to an acute state of excitement - melancholic raptus, in which patients jump up and injure themselves, can tear their mouths, tear out an eye, break their heads, tear their underwear, and can roll on the floor howling. Depressive stupor is observed in severe endogenous depression.

Apathetic stupor

With apathetic stupor, patients usually lie on their backs, do not react to what is happening, and muscle tone is reduced. Questions are answered in monosyllables with a long delay. When contacting relatives, the reaction is adequate emotional. Sleep and appetite are disturbed. They are untidy in bed. Apathetic stupor is observed with prolonged symptomatic psychoses, with Gaye-Wernicke encephalopathy.

Catatonic stupor

Catatonic stupor is understood as freezing in fear, fright and helplessness during the severe suffering of the Self - consciousness in its various dimensions. Anyone who does not know whether he is still alive, whether he is able to act, is not sure of the unity and separation of his personality from the environment, is capable of freezing in a stupor. Therefore, everything that leads to the restoration of the authenticity of the self-experience can be of therapeutic value for catatonic stupor. So, if the I-identity is lost, sometimes calling by name is enough to improve the patient’s condition. Another patient can be helped to regain the feeling of his activity by doing physical exercises, breathing exercises, etc. with him.

It is clear that in severe cases a purely verbal therapeutic approach is often insufficient. But purely neuroleptic therapy or ECT is not sufficient; the patient must be perceived as an individual. Some patients can only be brought out of their stupor with great difficulty. But even if they are not objectively responding, it is still useful not to leave them alone in this state, but to stay and talk to them. Sometimes it is possible to take a couple of steps with them - and this is the first therapeutic success on the road to a generally meaningful world. Other types of catatonic stupor occur when loaded with hallucinatory and delusional experiences, for example, in ecstasy.

How to get out of a stupor

Only specialists—psychotherapists, psychologists, psychiatrists—know exactly how to overcome stupor. But if you see that a person close to you is in this state how to get out of the stupor, he definitely needs help, here are a few ways:

Massaging special points that are located above the pupils of the eyes, exactly in the middle, equidistant from the eyebrows and the beginning of the hairline, can help; these points need to be massaged with the pads of the fingers, index and thumb;
you can try to evoke any strong emotions in the patient, even negative ones - tell him something in a clear and confident voice, sometimes even a slap in the face helps;
stupor can go away if you bend the person’s fingers and press them forcefully against the palms, the thumbs should remain straight.

How to identify catatonia?

For a psychiatrist, at the stage of establishing a diagnosis, it is important to compare the symptoms of catatonic stupor and determine the causes that serve as a catalyst for the condition. The doctor interviews relatives and finds out the pathological reasons that led to the development of the disease. If the patient is able to respond to the doctor, then his answers are also taken into account.

The diagnosis of a catatonic state is made if in the last two weeks the patient has observed:

intense excitement, stupor;
signs of negativism;
waxy flexibility and rigidity;
automatic submission to caregivers.

Intoxication, bacterial and viral infections should be identified through questioning and laboratory tests . The use of psychotropic drugs is established from the words of loved ones. The list of mandatory tests includes:

urine testing for traces of psychotropic drugs;
biochemical blood test;
blood sugar test;
establishing hormonal levels in the thyroid gland.

At the same time, computed tomography of the brain and magnetic tomography are prescribed. They do electroencephalography, spinal cord puncture, and determine the level of antibodies in the blood serum. The patient takes a blood test for AIDS and syphilis, and does a bacterial culture from urine and blood.

Emergency care for stupor

Emergency care for stupor comes down to preventing dangerous actions and ensuring the safety of the patient. With catatonic stupor, this is a readiness to stop sudden impulsive excitement. In case of depressive stupor - preventing the possibility of sudden development of depressive agitation with a desire for suicide, as well as eliminating refusal to eat. It should be borne in mind that psychogenic stupor can be replaced by psychogenic agitation. Emergency care for catatonic stupor in out-of-hospital conditions does not make sense, since attempts to disinhibit the patient can cause agitation and thereby create additional difficulties.

Treatment for stupor

In a hospital setting, thanks to barbamyl-caffeine disinhibition, it is possible to identify the characteristics of the patient’s experiences and thereby determine the nature of the stupor. It also serves as a method of treatment and helps with persistent refusal to eat. At the beginning, 1-2 ml of a 20% caffeine solution is administered, and after 3-5 minutes, 5-10 ml of a 510% barbamyl solution is administered slowly intravenously, monitoring the patient’s condition, and at the first signs of disinhibition, the infusion is stopped so as not to exceed the individual disinhibition dose for this patient and do not induce normal sleep. The administration of barbamyl is stopped at the moment when the patient opens his eyes or when facial, motor or vegetative reactions (in the form of paleness or redness of the face, sweating, etc.) begin to appear; in this case, it is necessary to stimulate the patient’s disinhibition in every possible way: contact him with questions, slow him down, lightly pat on the cheek, etc.

In a psychiatric hospital, catatonic stupor is treated with intramuscular administration of frenolone at a dose of 5-15 mg/day; for lucid stupor, mazeptil is prescribed orally up to 60 mg/day; Barbamilcaffeine disinhibition is also effective. The psychostimulant sydnocarb up to 30-50 mg/day orally is also effective. For stupor with delusions and hallucinations, stelazine (triftazine), haloperidol, and trisedal are used according to the same principles as the treatment of delusional and hallucinatory states.

For depressive stupor, barbamyl-caffeine disinhibition is carried out, melipramine is used up to 200-300 mg/day orally or intramuscularly. For psychogenic stupor, use diazepam (Seduxen, Relanium) up to 30 mg/day orally, preferably intramuscularly; elennium up to 50 mg/day orally, preferably intramuscularly; phenazepam - 3-5 mg/day orally. Stupor in severe somatic diseases requires intensive treatment of the underlying disease. Hospitalization is necessary in a psychiatric hospital for all types of stupor, except for somatogenic stupor, the treatment of which is carried out in the same department where the patient is diagnosed with a somatic disease.

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