Psychopathology of consciousness (II/III)

Qualitative disorders

• Delusional states
• Twilight states
  • Pathological intoxication
  • Night terrors/sleepwalking
  • psychogenic twilight states, fugues, and dissociative states
• Confusional states
  • Confusion
  • Asthenic/apathetic state
  • Delirium
• Disorientation
• Secondary states: multiple personality, false identifications…

Some authors included twilight and confusional states under the heading of delirious statesbecause they considered that, to some extent, these altered states of consciousness exhibited activity close to delirium. This term is no longer used.

Twilight states

It consists of a narrowing of the field of consciousness. This becomes primarily focused on internal experiences with a clear decrease in attention to the external environment. The flow of thought is often confused. These symptoms are accompanied by mood swings that may manifest as... anxious or happy mood.

During twilight, the following may appear automatisms Chewing, verbal, stereotypies, ambulatory, gestural… This is an involuntary activity. Likewise, although less frequently, the following may appear: impulsive behaviors short circuit (opposition – flight). It is common post-episodic amnesia.

Some authors include the following in the twilight states: pathological intoxication (A twilight state accompanies the characteristic symptoms of intoxication.) Others often include the night terrors and somnambulism.

Twilight states can have a organic origin (epilepsy, head trauma, vascular disorders, hypoxia and toxic substances) or psychogenic (soldiers in combat situations, hypnotic states, panic, emotional shock, hysteria…).

Confusional states

They are psychopathologically determined by the confusion or confusional syndromeSemiologically, it consists of the individual's inability to distinguish between reality and imagination. Phenomenologically, it can be identified with the adream activity and delirium as the highest expression.

Currently, depending on the intensity of the confusion, several stages are usually described. From least to most severe, we would have: a prodromal situation called neurasthenic which may or may not evolve into asthenic-apathetic stage (fatigue, emotional lability, attentional fluctuation, hyperesthesia, and insomnia), which would be followed by confusional state, properly speaking.

The most relevant semiological aspects of confusional state, would:

1. Occupational jargonDisorganized, chaotic activity, although they usually identify the workplace.
2. IncoherenceInability to establish and maintain a comprehensible conversation.
3. Paramnesia. Distortion of memory, of recollection.
4. Error propagationParamnesia extends to all areas of memory.
5. DysgraphiaInability to develop comprehensible writing.
6. Inattention. He is unable to respond to environmental stimuli.
7. Post-confusional amnesia. People often lose memory of what happened during the confusional state.
8. When the frontal lobe is affected, the following symptoms usually occur disinhibited behaviors

If the situation progresses, it could lead to deliriumalthough this can also occur suddenly or acute deliriumIt is characterized by: 1) dreamlike state or altered consciousness; 2) visual hallucinations; 3) psychomotor agitation; 4) chaotic delusions.

Disorientation

Disorientation is a symptom that can be included in both qualitative and quantitative disorders of consciousness. Disorientation results from the subject's inability to correctly grasp and process incoming information, whether from the environment or about themselves.

Normally, one usually distinguishes information about time, space, and peopleWhen time processing fails, it is called temporal disorientationIf this failure occurs in the perception of space, it is called spatial disorientationIf it's about people, it's called allopsychic disorientationWhen the problem lies in the correct processing of information related to oneself, it is called autopsychic disorientation.

Second States

"These are transient pathological states characterized by a particular alteration of consciousness that allows the patient to engage in coordinated activity, which, however, remains foreign to his personality and is not integrated into it" (Higueras Aranda et al.).

Several situations have been described that would fall under this heading: alternating personality, split personality, hypnotic dissociation (the subject obeys the hypnotist), dual or multiple personality (existence of two or more personalities with amnesia about one of the states) and the phenomena of reduplication or false identification.

Most of these states are expressed in dissociative disorders.

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