Amentia (amentive syndrome) - causes, signs and treatment

Amentia is a disorder of consciousness. A variant of the clouding of consciousness syndrome, in which there is a total incoherence of thinking, speech, emotions and volitional impulses. Amentia is accompanied by total disorientation in time and space. E.A. Popov successfully spoke about amentia - this is a person with broken glasses, perceiving the world in pieces, fragmentarily.

Unlike other forms of consciousness disorders (delirium, stupefaction, oneiroid), amentia has the most unfavorable prognosis. The development of amentia syndrome indicates severe disorders in the body, leading to death.

The disorder of consciousness can last from several days to several months. Amentia lasts longer than delirious syndrome, oneiroid and twilight stupefaction.

Causes of amentia

The etiology of amentia lies in the development of a state of acute or chronic exhaustion; therefore, various conditions leading to states of exhaustion of the body and the nervous system in particular can cause the development of this disease. As observations of exhausted, tired and starving individuals show, the disturbances in mental activity that arise in them correspond to the clinical picture of amentive states, namely, during fasting, exhaustion, insomnia, fatigue, familiar verbal combinations begin to appear and acquire a noticeable influence on the content of the stimulus word, on its sound character. With increasing exhaustion, sound associations increase, acquiring at the same time a repeatability, a persevering flow. The resolution of motor drives is greatly facilitated. There appears an accelerated flow and even a whirlwind of ideas, distractibility of attention with difficulty concentrating. There are cases when starving, exhausted people began to hallucinate.

Infectious diseases seem to be one of the most common causes of exhaustion, which is further aggravated by the influence of an infectious toxin. It is often observed that the body, which has successfully fought an infectious toxin and has been safely freed from it, cannot restore its previous state and reacts with mental illness in the form of amentia 1-2 months, and sometimes long periods after the end of the infectious disease, while , when fears of the possibility of psychosis have already disappeared.

Amentia can develop in the postpartum period, during breastfeeding. Postoperative psychoses, especially those associated with significant blood loss during surgery, often occur in the form of amentia. The picture of amentia is often given by prison psychoses, accompanied by abundant development of auditory hallucinations, which is explained by increased hearing stress in conditions of solitary confinement.

In general, all influences that act on the central nervous system in a debilitating manner can cause amentia. The disease occurs at any age, both young and old. Amentia is not one of the most common psychoses. Psychopathic heredity is of undoubted importance, but it is not always possible to establish it.

Causes

Amentia syndrome develops against the background of mental and somatic diseases:

Long-term debilitating infectious pathologies, accompanied by high body temperature, profuse sweating, dehydration, and general intoxication.
Mental disorders: schizophrenia, bipolar affective disorder, severe depression.
A mild form of amentia syndrome develops due to physical or mental exhaustion after exhausting work requiring physical labor or neuropsychic involvement.
Pathological conditions: dehydration, large blood loss, continuous diarrhea.
Drug intoxication, chronic alcoholism.

Symptoms and clinical picture

The clinical picture is quite diverse, but its most significant signs are confusion, a more or less significant disturbance of combination reactions in the form of asthenic associative ataxia and the presence of motor and sensory phenomena of irritation.

Amentia especially often develops after an infectious disease, sometimes after a significant period of time, measured in several months; More often than others, the disease is combined with influenza infection, the postpartum and lactation periods; it is also caused by states of prolonged and severe exhaustion.

The complaints of patients in the period of precursors are rather vague and uncharacteristic: headaches, heaviness in the head, noise and whistling in the head, in the ears, general poor health, insomnia, nightmares, vague anxiety, confusion in thoughts, difficulty thinking, at times attacks of severe fear; There is increased irritability, tearfulness, capricious behavior, and lack of appetite. The period of precursors can be short - it lasts two to three days, but can drag on for two to three weeks; The disease in some cases quickly and continuously increases in its course, in others it gives short-term outbreaks, interrupted by intermissions.

The period of development and flourishing of the disease is expressed in general motor agitation of a chaotic nature and often with aggressive tendencies: patients jump out of bed, throw off the blanket, attack others, nursing staff, doctors, scream, spit. Affects of fear, and sometimes horror, often affects of anger, often episodic depression, and tears are observed. The state of excitement can reach such a degree of frenzy that, in addition to attacks on others, there are also cases of self-harm - patients tear out their hair, scratch their faces, tear their clothes and underwear. The excitement of patients either persists, then gives way to periods of rest, flaring up again from time to time, but there are cases when it is generally weakly expressed. Also, on the part of speech, there is either speech stimulation or not. However, amentia seems to be characterized not by speech arousal or its absence, but by the reflection in speech of the asthenic or adynamic associative ataxia characteristic of these patients, caused by primary damage to the nervous elements of the cerebral cortex. As a result, the combinational processes proceed incorrectly and unevenly, the natural connection between them is disrupted, and individual links of the associative chain drop out. Therefore, the speech of patients is incoherent, often consisting of meaningless phrases, a set of words that do not express anything, and do not give any idea of what the patient wants to express. Patients often scold in the most indecent words; despite the eroticism sometimes observed in them, their speech gives the impression of incessantly shouting the most cynical words.

Often, patients with amentia give the impression of confusion and helplessness, clearly not oriented in the surrounding environment and in time, which is evident from their perplexed facial expressions and questions, as well as from their answers to the questions offered to them. Their combinatorial abilities suffer sharply despite their relatively satisfactory perception of simple stimuli. These patients, determining the position of the hour hands, are not able to say which hour is indicated by this position, or, naming individual coins correctly, cannot determine their amounts; they are not able to name days, dates, months, years; Often they do not understand their own personality so much that they do not give their own name, do not know their age, their loved ones, and are not even able to determine where they are, for example, in the hospital, how and when they were delivered to it. Often, feeding patients is difficult: some of them eat well and enough, others have to be force-fed, and they push the food away, spit it out, scatter it, so they have to resort to feeding through a tube.

The behavior of the patients reveals a more or less severe clouding of consciousness. With the development of a disease process, not only combinatorial and orienting processes suffer, but perception is also greatly hampered, and the limits of concentration are narrowed. Patients perceive only part of a complex stimulus (object), generalizing it fantastically and bizarrely.

Rarely do cases of amentia occur without hallucinations and illusions. On the contrary, both are very abundant, capturing various senses, but mainly visual hallucinations predominate. Auditory hallucinations occupy second place, with the exception of cases of the disease developing in prison, in which, as with prison psychoses in general, there is a predominance of auditory hallucinations. The content of hallucinations is varied, mostly unpleasant, frightening - terrible faces, demons, dead people, simply scary figures, friends and relatives, whose faces are suddenly replaced by faces and muzzles, less often visions of pleasant and religious content, screams, swearing, threats, noise, whistling, funeral singing, funeral march, smells, stench, disgusting taste of food. Hallucinatory images can be motionless or moving, even cinematic. Illusory perceptions lead to an incorrect assessment of the surrounding reality, since people who come into contact with the patient are perceived by him inappropriately to their real appearance and significance. The same applies to objects around the patient.

The mood of patients ranges from quiet and calm to pronounced affective states. Although mixed and asthenic emotions predominate, such as dissatisfaction, irritability, anger, a melancholy, tearful, perplexed mood is still common, and an increased sense of well-being with an affect of joy and exaltation is less common. Stuporous states are also observed.

In the presence of the described phenomena, of course, the development of delirium, which is an indispensable companion of amentive states, is inevitable. Asthenic associative ataxia, disturbance of orienting reactions and confusion, distorted perception of external and internal stimuli - all this, in certain emotional states, is a source of delirium. This includes abundant hallucinations and illusions. Of course, under the specified conditions, only fragmentary, incoherent, meaningless nonsense without any systematization seems possible, more often than not, individual delusional ideas that persist with more or less persistence. The content of delusions is determined by the prevailing mood of the patient, the stimuli acting on him, and the nature of the hallucinations. There are delusional ideas of greatness. Confabulations are also often found in patients, the origin of which under these conditions is quite understandable. Often there is a suspicious, distrustful attitude towards others, hallucinatory-delusional postures and corresponding behavior.

On the physical side, it is noted that patients with amentia are usually exhausted already at the beginning of the disease; as the disease progresses, body weight drops even more, sometimes reaching extreme, dangerous limits. During the period of increasing painful phenomena, subfebrile rises in temperature are possible. The activity of the heart is accelerated, the number of heart contractions fluctuates, increasing due to the increase in the excited state. After strong bouts of excitement, it may weaken and at times slow down. Fainting conditions are also observed, which becomes quite understandable if we take into account that the disease develops in exhausted people and especially often after infections. Dermographism is clearly expressed. In most cases, the pupils are dilated and their reaction to light is lively. The tongue is usually coated, bowel functions are inconsistent. Women often experience menstrual irregularities, including temporary amenorrhea. Disorders of motor innervation are observed: muscle roll, increased neuromuscular excitability, increased tendon reflexes, trembling of the eyelids, facial muscles, tongue, fingers, expressed to varying degrees. Typically, patients suffer from more or less significant insomnia.

Amentia can proceed smoothly, with a gradual and rapid increase in painful manifestations, then a period of stationary state begins, after which the pathological phenomena begin to decrease. But very often the development and course of the disease occurs in outbreaks, jumps - painful symptoms rapidly increase, reach extreme development, and then weaken just as quickly, and often a short-term intermission occurs with a clearing of consciousness, sometimes significant. Intermissions can be repeated several times during the course of the disease, giving way to new exacerbations of the disease. During intermissions, sleep most often is not restored, and its absence makes one expect an imminent relapse. The transition to recovery occurs gradually. Excitement subsides, hallucinatory phenomena weaken and disappear. Gradually, patients begin to understand their surroundings, appetite improves, sleep improves (becomes strong, long-lasting, often patients sleep for days). Women become more regulated. The weight begins to increase. At first, phenomena of irritable weakness and lethargy and a temporary weakening of mental activity may be observed. An improvement in the patient’s physical condition, along with an improvement in mental health, already indicates the onset of recovery, which can be recognized as accomplished along with the complete restoration of the patient’s general nutrition and weight.

Those recovered from amentia find large gaps in the reproduction of their painful experiences, which is explained by their darkened state at the height of the disease.

Diagnosis of amentia

The first thing to do in diagnosing this rather complex condition is to find out the cause. Depending on the cause of the disease, this can be determined in different ways. In case of an infectious disease, physical symptoms with microbiological studies will help, and it is also important to measure the temperature. If the cause is a somatic disease, you need to conduct suitable examinations: ECG, X-ray, ultrasound. If this is an endocrinological problem, you should get tested for hormones. MRI and electroencephalography are suitable for identifying many neurological diseases or areas of brain tissue damage.

A good technique is to collect anamnesis, this way you can find out about suicidal tendencies or information about poisoning, which at this moment cannot be obtained from the patient.

After this, you can begin to work with the patient himself. First, it is important to identify the psychostatus. The patient is conscious, but disoriented both autopsychically and alopsychically. Not available for contact, unable to carry on a conversation. Speech is intermittent, slurred, sometimes the patient whispers some passages very quietly, and then suddenly shouts something. Subjectively, fragments of delusional ideas can be discerned in speeches. You can tell from the patient’s behavior whether he is hallucinating; if he shakes something off, looks around, or hides, it means he is seeing something scary. The mood of such patients changes unpredictably. Due to fragmented thinking, the patient is unable to adequately analyze the surrounding reality.

This disease is quite difficult to diagnose and must be distinguished from other states of clouding of consciousness.

Some forms of amentia are quite similar to catatonia. To distinguish between these conditions, it is important to understand that the manifestations of catatonia during amentia are completely unstable, thus, with little effort, the posture can be changed. With amentia, there is also incoherence and disconnection of speech with psychoproduction. Catatonia is a more severe disease, which has a number of its own, separate symptoms that require different approaches.

Many people believe that amentia and delirium are almost the same thing. And some doctors even classify amentia as a subtype of delirium, but in fact, amentia is a more severe form, which sometimes has delirium in its structure. The main difference is the variability of delirious episodes. With amentia, motor arousal acts within the bed, which cannot be said about classic delirium. With delirium, hallucinations are complete, but with amentia, thinking and hallucinatory images are torn apart. With delirium, there are clearings during daylight hours, but with amentia, there are no moments of clearing.

This condition can also be confused with oneiroid, but with oneiroid the person has a double orientation, and with amentia it is completely absent. In addition, with oneiroid the individual watches a dream-like film, but with amentia the individual is completely torn. Any of these pathologies do not drag on for months, unlike amentia.

Diagnostics

Making a diagnosis of amentia is one of the difficult clinical tasks of psychiatry. This is explained by the fact that states of confusion and stupefaction, the so-called amental states, often occur in other diseases, such as schizophrenic dementia, epileptic equivalents, cyclophrenic seizures, progressive paralysis, acute alcoholic psychoses.

A patient suffering from amentia is almost always pale, exhausted, and exhibits significant symptoms of a general decline in nutrition. There are often indications of an infectious disease in the recent past or other conditions that have had a debilitating effect on the body.

A clouded state of consciousness, a sharp defeat of orienting reactions - in time, in space, in one’s own personality, senseless behavior not motivated by external stimuli, a sharp violation of combinatorial processes, inaccessibility for the patient of relatively simple combinations with relatively preserved perception of individual stimuli, incoherent speech, regardless of the speed of its pace and the absence of distractibility, an abundance of illusory perceptions and hallucinations - these are the main features of the clinical picture of amentia. At the same time, the main asthenic tone of the painful state is preserved, especially prominent with a decrease in excitement: irritability, tearfulness, confusion, fatigue.

Amentia differs from attacks of manic-depressive psychosis by the presence of clouding of consciousness, damage to orienting reactions, characteristic incoherence of combinations and speech, which is fully expressed even in a calm state of patients, therefore, is not caused by the distractibility of attention inherent in the manic phase of manic-depressive psychosis and the observed with amentia only in states of excitement, and then only occasionally. Finally, the recurrence of attacks of manic-depressive psychosis is important.

Excited catatonics and schizophrenics do not show clouding of consciousness at all, or only for a short time at the height of excitement. Their orientation abilities are usually satisfactorily preserved, in addition, their characteristic features appear - autism, negativism, stereotypies, etc. Confusion is possible in the initial stages of schizophrenic dementia if it begins with the development of acute agitation with hallucinations. A patient with amentia is not autistic, he is not separated from the environment and is accessible to external stimuli, as far as possible according to the degree of clouding of his consciousness, according to the degree of disruption of his combinational processes. A schizophrenic person experiences dissociation from the environment with relative preservation of combined reactions and perceptions, while an amentic person maintains relative contact, despite their defeat.

The agitation with confusion in progressive paralysis may closely resemble amentia, but in the latter there are no organic phenomena characteristic of paralysis.

Of the alcoholic forms, delirium delirium and cases of acute alcoholic hallucinosis can cause confusion with amentia. However, in these cases, an alcohol history is important, which, if not reported, in most cases is determined objectively: characteristic alcoholic hallucinations, the absence of confusion in alcoholic hallucinosis, the usual short duration of the disease and a number of objective somatic phenomena characteristic of alcoholism.

Finally, epileptic equivalents and post-epileptic psychoses, occurring with deep stupefaction and confusion, can be mixed with amentia. Both come suddenly. However, there are distinctive features, for example, epileptic psychoses are not associated with either exhaustion or infection; during the equivalent, the epileptic is usually little accessible to external stimuli; recovery occurs after a certain period, after which amnesia of the painful period is detected. More or less prolonged observation allows a diagnosis of epilepsy to be made.

What is amentia?

Amentia is a fairly severe form of twilight stupefaction, which manifests itself with diverse symptoms. In this state, contact with the person is not achievable.

Amentia, not much different from most medical terms, comes from Latin and means madness. And this is not surprising, because amentia is really a severe form of impaired consciousness, the symptoms of which are really nothing other than madness. It is noted that in ancient times, amentia included any manifestations of insanity. Thus, many cases of schizophrenia and other manifestations were attributed to amentia. But with the development of psychiatry as a separate, quite successful science, amentia began to be considered a type of clouding of consciousness, simply more severe than delirium. But this complex pathology also has mild forms that arise as a reaction to transient states of the body. Amentia syndrome was first identified by Meinert and characterized as acute insanity. Thanks to the advancement of research, these conditions were subsequently separated, identifying mental fragmentation as the main manifestation.

Amentia syndrome has several forms. This classification is not decisive and does not need to be reflected in the diagnosis. Just to make it easier to understand what exactly is happening to the patient, forms such as:

• The catatonic form of amentia, from its name, includes catatonic inclusions, for example, this may be waxy flexibility. A person can be in the air cushion position or the fetal position. But these inclusions from stupor are less common; chaotic, motiveless movement is more common. During this, stereotypical repetitions of phrases or movements, echolalia, and echopraxia appear.

• The incoherent form of amentia is the most typical. The personality exhibits associative incoherence and cannot adequately perceive the environment. It is impossible to maintain contact with such individuals.

• In the hallucinatory-paranoid form of amentia, the individual sees hallucinatory images, while his delusional ideas correspond to the content of the hallucinations. It may also be that there is no delusion, but the patient is hallucinating, then we can talk about the hallucinatory form. But in general, drawing these boundaries is very arbitrary; more often a person exhibits symptoms of a few of all types.

Depending on the cause of its occurrence, amentia is also classified into the following subtypes:

• Epileptic amentia occurs in persons with confirmed epileptic disease.

• Pyruvic, or phenylketonuric, amentia occurs in children with phenylketonuria if left untreated.

• The atonic form of amentia manifests itself as a common symptomatology; it is more common in people with atony.

• Meynert's amentia is used in general terminology and refers to any subtype of amentia that accompanies a specific disease.

Treatment

Treatment for amentia involves careful care, proper nutrition, physical therapy, and medications. The home environment is unsuitable for this type of patient due to their agitated state, frequent aggressiveness, untidiness, possible suicide attempts, and the need for emergency measures that are difficult to implement at home. Therefore, they should be immediately placed in a special medical facility.

Careful monitoring of cardiac activity and increased nutrition with light, easily digestible foods are indicated. If you refuse food, you should not hesitate to administer artificial nutrition through a tube. Soothing baths, sleeping pills, strengthening medications, and psychotropic drugs are useful.

Remembering the possibility of relapses during the recovery period, it is necessary at this time to especially protect the patient with amentia from any strong external stimuli; only with the complete restoration of his mental and physical health can he be discharged from the hospital. Then complete rest is recommended under good sanatorium conditions. Only 3-4 months after recovery can the patient be allowed to return to his work, starting it not in its full extent, but gradually getting involved in it.

The information presented in this article is intended for informational purposes only and cannot replace professional advice and qualified medical care. If you have the slightest suspicion that you have this disease, be sure to consult your doctor!

Treatment of amentia

The main emphasis in the treatment of amentia is on developing the most effective treatment regimen for the underlying disease. If amentia syndrome was provoked by a somatic illness, treatment is carried out in a specialized department of a clinical hospital with the participation of a psychiatrist. If the amental state is a consequence of a mental disorder, it is recommended to place the patient in a psychiatric hospital for treatment in a hospital setting.

Sodium thiosulfate (Natrii thiosulfas) is most often used as an antitoxic, desensitizing, and antiparasitic agent.
The mainstay of treatment for amentia is the antipsychotic drug Chlorpromazine. The advantage of this drug is the combination of antipsychotic action with the ability to influence the emotional sphere. This medication eliminates various types of psychomotor agitation, delusions and hallucinations, fear and anxiety.
In some cases, it is advisable to carry out a two-week course of treatment with Diazepam. It shows high sedative, anxiolytic and hypnotic effects.
To improve cognitive functions and memory, nootropic pharmacological agents are most often used, for example: Lucetam. This substance activates brain metabolism and stimulates blood supply to brain tissue. The use of nootropic drugs can improve cognitive abilities, learning ability, attention, memory, and mental performance of the patient.

The prognosis for amentia is favorable in most cases. With timely comprehensive treatment of the underlying illness, the amental state does not pose a threat to the patient’s life. In some cases, death is possible due to the exhaustion of the patient and the rapid development of the underlying disease.

Amentia

Amentia is the deepest form of clouding of consciousness.
Twilight states have several different subtypes, among which amentia is present. This manifestation occurs in severe pathologies and does not go away without a trace. In this case, the individual poses a significant danger to the environment and is not brought into contact. In psychiatry, amentia is just one of many forms of clouding of consciousness.

Among medical practitioners, the occurrence of such a problem is very rare, so not everyone is able to distinguish such a severe form. An important role for a person with amentia is timely sending to a medical institution, because only with the right prescriptions is it possible to provide assistance to the individual.

What is amentia?

Amentia is a fairly severe form of twilight stupefaction, which manifests itself with diverse symptoms. In this state, contact with the person is not achievable.

It is noted that in ancient times, amentia included any manifestations of insanity. Thus, many cases of schizophrenia and other manifestations were attributed to amentia.

But with the development of psychiatry as a separate, quite successful science, amentia began to be considered a type of clouding of consciousness, simply more severe than delirium. But this complex pathology also has mild forms that arise as a reaction to transient states of the body.

Amentia syndrome was first identified by Meinert and characterized as acute insanity. Thanks to the advancement of research, these conditions were subsequently separated, identifying mental fragmentation as the main manifestation.

• The catatonic form of amentia, from its name, includes catatonic inclusions, for example, this may be waxy flexibility.

A person can be in the air cushion position or the fetal position. But these inclusions from stupor are less common; chaotic, motiveless movement is more common.

During this, stereotypical repetitions of phrases or movements, echolalia, and echopraxia appear.

Depending on the cause of its occurrence, amentia is also classified into the following subtypes:

• Epileptic amentia occurs in persons with confirmed epileptic disease.

• Pyruvic, or phenylketonuric, amentia occurs in children with phenylketonuria if left untreated.

• The atonic form of amentia manifests itself as a common symptomatology; it is more common in people with atony.

• Meynert's amentia is used in general terminology and refers to any subtype of amentia that accompanies a specific disease.

Causes of amentia

Amentia develops in various serious diseases. Severe infectious diseases can also lead to similar symptoms.

Now such diseases are not very common, but against the background of typhus, which is transmitted through food and water, this is possible. Complaints appear, like food poisoning, and then hectic fever with amentia is added.

Diseases accompanied by sepsis can also lead to this condition. Some acute infectious diseases such as influenza may also be accompanied by amentia.

Influenza occurs with high fever and severe intoxication with inexpressive symptoms of catarrhal phenomena. Many hepatitis, including Botkin's disease and hepatitis A, also lead to similar symptoms, especially in fulminant forms.

https://www.youtube.com/watch?v=Zlcwo5OKCqk

Amentia syndrome, in general, can develop if the course of somatic pathology is aggravated, for example, with cardiac, pulmonary or renal failure.

Many rheumatological systemic diseases, such as lupus and dermatomyositis, also have a chance of being aggravated by amentia.

The appearance of this condition is greatly influenced by the duration of the pathology, poor nutrition (from hand to mouth), prolonged illness, exhaustion of both body and spirit.

Amentia develops with almost any severe intoxication, so it can be expected with intoxication with poisons, drugs, alcohol and similar products toxic to brain tissue. Such poisons can be gas weapons, poison for rats or insects, some fertilizers and even food.

Anesthesia drugs can be dangerous. After all, there are known cases when a person, coming out of anesthesia, did God knows what. Antiviral, antipsychotic, antiarrhythmic and chemotherapeutic drugs are also dangerous. In severe allergic reactions, this condition is also possible.

Alcoholic or drug amentia may occur if these drugs are abused.

Amentia syndrome does not always manifest itself as a separate psychiatric problem. Most often, amentia accompanies other diseases of the psychiatric spectrum.

In manic-depressive psychosis, there is a subtype with clouding of consciousness, and it is in this subtype that amentia can occur. Amentia develops in schizophrenia, in the context of psychosis.

Often, such symptoms can develop with vascular pathology, as well as with atrophic degenerative changes in the brain in old age.

Mild forms of amentia can develop due to blood loss, fatigue, or prolonged surgical interventions.

Many endocrinological diseases in case of severe decompensation can also lead to an amental state.

Such diseases in particular include Graves' disease, a pathology of the thyroid gland, often found in areas where there is an endemic lack of microelements necessary for this gland.

Symptoms and signs of amentia

Amentia is a very characteristic symptom in psychiatry. Amentia syndrome manifests itself with severe characteristics. This pathology develops in a variety of diseases, so it is important to diagnose them, because they can be fatal.

Amentia syndrome is described as confusion, often adding an affect of surprise or incoherence, in the form of associative incoherence. At the same time, the person is not able to holistically perceive the events happening around him; the relationship between objects and phenomena eludes such individuals and they are not able to hold it.

Patients snatch certain chaotic fragments from the situation, but are unable to connect them together; there is no integrity. The patient's speech is monosyllabic - it is more like an absurd collection of words, and in special cases, sounds. The nature of speech is often everyday, but perseverations may occur.

If delusional ideas appear, they are intermittent, unstable, but more often than not they are completely absent. Sometimes certain sets of words or words may be repeated in the form of echolalia and verbigerations. The affect is mostly unstable, can change or disappear completely.

Human movements are disordered, chaotic, while excitement reaches motor hyperkinesis, and sometimes echopraxia occurs. There is no personal orientation; the individual is also disoriented in the place of stay and in time.

Such a person gives the impression of being absolutely and irrevocably confused; they are unable to say who they are, where they are, or assess the integrity of the situation. Memories during the period of amentive obscuration are completely absent.

After completing this state, the individual will not be able to remember absolutely anything. The duration of the amentive state is generally short-term, but in severe, prognostically negative cases, it may be extended by several weeks or even months.

Attention in patients with amentive syndrome constantly slips, it is unstable and quickly depleted. The patient's attention cannot be kept on anything specific; any new sign or sound completely takes his attention.

Although the person is in motor excitement, the movements do not exceed the boundaries of the bed. In bed, he swings his limbs, says something incoherently or screams, and often arches and spins. If their actions become more purposeful, they defend themselves from something, close themselves off, push something away, you can think about the presence of hallucinations of a frightening composition.

When the excitement reaches such a high level that the patient is unable to tolerate it, he goes into a catatonic type of stupor. You can give him an uncomfortable position and he remains in it, he does not eat, does not fulfill any requests. If the pillow is pulled out from under his head, he will hold it above the bed.

This condition is dangerous if it lasts for a long time and the person is fed through a tube.

Diagnosis of amentia

The first thing to do in diagnosing this rather complex condition is to find out the cause. Depending on the cause of the disease, this can be determined in different ways.

In case of an infectious disease, physical symptoms with microbiological studies will help, and it is also important to measure the temperature. If the cause is a somatic disease, you need to conduct suitable examinations: ECG, X-ray, ultrasound. If this is an endocrinological problem, you should get tested for hormones.

MRI and electroencephalography are suitable for identifying many neurological diseases or areas of brain tissue damage.

A good technique is to collect anamnesis, this way you can find out about suicidal tendencies or information about poisoning, which at this moment cannot be obtained from the patient.

Subjectively, fragments of delusional ideas can be discerned in speeches. You can tell from the patient’s behavior whether he is hallucinating; if he shakes something off, looks around, or hides, it means he is seeing something scary. The mood of such patients changes unpredictably.

Due to fragmented thinking, the patient is unable to adequately analyze the surrounding reality.

This disease is quite difficult to diagnose and must be distinguished from other states of clouding of consciousness.

Some forms of amentia are quite similar to catatonia.

To distinguish between these conditions, it is important to understand that the manifestations of catatonia during amentia are completely unstable, thus, with little effort, the posture can be changed.

With amentia, there is also incoherence and disconnection of speech with psychoproduction. Catatonia is a more severe disease, which has a number of its own, separate symptoms that require different approaches.

With amentia, motor arousal acts within the bed, which cannot be said about classic delirium. With delirium, hallucinations are complete, but with amentia, thinking and hallucinatory images are torn apart.

With delirium, there are clearings during daylight hours, but with amentia, there are no moments of clearing.

Treatment of amentia

To relieve such a complex condition, it is very important to hospitalize the patient, because at home he is dangerous to others, and his condition will worsen and may even lead to death. The most important thing is to understand what disease led to this unfavorable state and begin treating it. For infectious diseases, it is important to treat the cause.

For influenza, antiviral drugs are used, Remantadine. If there are bacterial complications, antibiotics are added, Flemoclav 500,000 units IV, Ciprofloxacin 100 ml. For hepatitis, pegelized interferons Pegentron, Pegasys. For rheumatological diseases, anti-inflammatory drugs and monoclonal antibodies are used.

If there is poisoning, then antidotes and general measures for poisoning are used.

Specific treatment is quite varied; due to the extensive symptoms, many drugs are suitable. It is very important to start administering neuroleptics on time: Aminazine 2.5% 2-5 ml.

In the presence of hallucinatory-delusional excitation, we use Clopixol-acufase 50-150 ml 1-3 ml intramuscularly, Fluanxol-depot 20 mg/ml. Anticonvulsants also work well: Seduxen 0.5% solution 2.0-4.0 ml IM.

Sodium thiosulfate 30% 20 ml IV, Magnesium sulfate 25% 10-15 ml IV, Pantopon 2% 1 ml s.c. are also used.

Also, since the excitement is very expressive, Diazepam 30-50 mg, Elenium 40-50 mg intramuscularly, Phenazepam 5-10 mg orally are used. For subsequent treatment, nootropics are used: Piracetam 6-8 mg to 20 mg, Aminalon 300-1000 mg/day, Acefan 300-1000 mg/day, Pyriditol 0.3-0.4 g for 3-6 months.

These drugs affect energy processes in brain tissue, help improve glucose utilization, affect the thalamo-pituitary system, facilitate energy metabolism, stabilize redox processes and cerebral functions, consciousness, speech memory, and have a mild psychostimulating effect.

Source: https://vlanamed.com/amentsiya/

Amentia - what is it?

We can talk about the described disorder if the individual’s speech is impaired, there is no coherence, and mental activity is disrupted.

In psychiatry, amentia is a syndrome of severe confusion, manifested by a violation of all types of orientation, a disorder of personal self-identification, motor dysfunction, and incoherence of speech and mental activity.

The most important feature of the syndrome in question is the inability to draw conclusions and loss of associative connections. The patient's speech is meaningless and monotonous, does not contain emotional coloring and intonation modifications. Often, a monotonous whisper is replaced by a rather loud speech in a sing-song voice.

In addition, the speech of patients is characterized by inconsistency and reproduction of individual words.

Amentia - what is it? The analyzed term in psychiatric science arose in the 19th century thanks to the research of neuropathologist-psychiatrist T. Meinert, who identified the specific state of foggy consciousness as a separate syndrome.

He described amentive syndrome as a jumble and incoherence of thinking processes.

In addition, I discovered a relationship between the disorder in question and motor activation, the appearance of hallucinatory ideas and delusional states, and loss of orientation.

Modern psychiatry has made the boundaries of this condition clearer, which has significantly simplified diagnosis and made it possible to differentiate the symptoms of a disorder of mental functioning from twilight consciousness or classic delirium.

E. Kraepelin, an eminent figure in psychiatry, studying amentia, concluded that patients’ perceptions are preserved, but they cannot harmonize their own thoughts with each other or with their experience. In addition, patients are not able to combine logic and their own concepts.

At the same time, they try hard to be aware of what is happening, but as a result of being easily distracted, they become incapable of methodical observation.

The perception of individuals suffering from amentia syndrome is characterized by a mixture of disparate passages that do not provide the patient with a holistic vision of what is happening. As a result, negative emotions arise: incomprehensibility, vagueness, helplessness.

Patients do not realize that they are unwell. In addition, patients with amentia also cannot understand what is happening around them.

Diagnosis and treatment of amentia

Since amentia is a disorder of consciousness, which is accompanied by a violation of the ability to generalize, the diagnosis of amentia is, first of all, made by a psychiatrist based on symptoms.

Characteristic signs of a disorder of consciousness are: disorder of coherence of thinking, confusion, all types of disorientation, chaotic changes in emotional moods, motor restlessness, fragmentary delusional ideas, hallucinatory ideas. In order to clarify the nature of the underlying illness that gave rise to amentia, consultations with other specialists are sometimes required, for example, an endocrinologist, a neurosurgeon, an infectious disease specialist, or a traumatologist.

Differential diagnosis is carried out in relation to catatonic agitation and delirium. With amentia syndrome, there is a clear relationship between the essence and emotional tone of the patient’s speech, which distinguishes it from catatonic activity. Catatonic manifestations in the disorder in question are unstable and changeable.

Amentia is characterized by the appearance of episodes of short-term delirium at night in some subjects, while catatonia does not have such manifestations. She is characterized by the presence of depressive affect.

In a state of delirium, delusions and hallucinatory ideas are characterized by coherence. In some cases, for example, if the disorder is caused by the abuse of alcohol-containing liquids, a holistic, complete picture can be formed.

With amentia, delusional experiences and hallucinations are fragmentary, incoherent, and appear exclusively in the form of short episodes. Delirium is characterized by the appearance of short-term periods of clarity of consciousness during the day, while with amentive syndrome this symptom is absent.

Patients suffering from delirium retain the ability to perform purposeful motor operations and interact with the environment; with amentia, the actions of patients are not purposeful, they are meaningless and of the same type, there is no interaction with the environment.

If an amental disorder occurs as a consequence of a mental illness, then hospitalization is indicated in a department with a psychiatric bias; for a somatic disorder, in a department with a specialized focus corresponding to the main pathology. Advantageously, the basic therapeutic strategy consists of the administration of sodium thiosulfate and Aminazine.

If the use of Aminazine is contraindicated for an individual with amentive syndrome, then Pantopon is prescribed. In order to eliminate motor activity, Diazepam and Phenazepam are prescribed. In order to clarify consciousness, systematic drip infusions of Nootropil in saline solution are indicated. Since patients refuse to consume food and water, they are fed artificially.

In addition, it is necessary to carry out therapy for the underlying ailment.

The prognosis for amentia is relatively favorable if the therapeutic strategy is adequate and carried out in a timely manner. Sometimes amentia leads to death due to severe exhaustion of the individual and the unfavorable course of the underlying illness.

Psychoneurologist Hartman N.N.

Doctor of Medical and Psychological

Source: https://psihomed.com/amentsiya/

Symptoms

Amentia has, although nonspecific, a pronounced clinical picture. The main sign of the pathological process is a violation of all elements of consciousness.

In general, the clinical picture is characterized as follows:

the patient cannot identify himself as a person;
does not recognize relatives and friends;
cannot logically answer the questions posed, his speech is generally incoherent;
the patient’s emotions are incoherent and chaotic, without logical confirmation;
a person confuses fictional events with real ones;
symptoms of deep depression are observed;
visual, auditory hallucinations, which can be understood from the patient’s behavior;
speech is incoherent, may be too loud, or, on the contrary, the person says everything in a whisper;
excessive motor activity, with incoherent and chaotic movements;
a clinical picture that resembles catatonia may be present;
stupor may develop.

In general, the patient's condition is characterized as inadequate. In some cases, a person in such a state can be dangerous not only for himself, but also for others, since he is not responsible for his actions and does not realize what he is doing.

The duration of symptoms can be short - up to a day (with neuroses, severe stress) or protracted - up to several months. The latter form, as a rule, manifests itself in severe psychiatric disorders.

If you have the symptoms described above, you should seek medical help and not treat yourself or ignore the problem altogether.

Diagnosis and differential diagnosis

There are no special instrumental studies to confirm the presence of amentia. The diagnosis is made based on a combination of clinical symptoms and medical history. The main characteristics of amentia are difficulties in finding and fixing logical relationships, incoherent speech, and fragmentary mental activity.

Manifestations of amentia may be similar to delirium and catatonia, or be an extreme degree of the latter. To choose the right treatment tactics and further recovery, it is important to distinguish between these diseases.

The following signs will help to distinguish amentia from catatonia: pronounced fragmentation of thinking, incoherence of thinking and speech, while hallucinatory and delusional experiences are reflected in speech. Also, with amentia, nocturnal delirious episodes are often observed, and the signs of catatonia are unstable, posture changes easily.
Amentia is distinguished from delirium by the irregularity and instability of delirious episodes, the limitation of motor arousal to bed, and the abruptness and incoherence of hallucinations and delusions. A pronounced fragmentation of thinking, an affect of confusion, and the absence of episodes of clarity of consciousness will help confirm the diagnosis of “amentia.”
To differentiate from oneiric clouding of consciousness, it is important to remember that amentia is primarily a fragmentation of thinking and general confusion, and oneiroid is a “dream-like” state in which the coherence of judgments is preserved.
An important characteristic of amentia is its duration. The duration of both delirious and catatonic episodes rarely exceeds a few days, while amentia lasts for weeks.

Treatment with traditional methods of amentia

Treatment for this state of consciousness is carried out exclusively in a hospital, but the patient is not transferred to a psychiatric department. Patients receive specific treatment in the same place where they were before, but it is prescribed by an invited psychiatrist. The principles of therapy here are the same as for delirium, but the measures are more intensive.

The patient is administered intravenously through a dropper with drugs that relieve intoxication, drugs that eliminate psychomotor agitation, a vitamin complex, and antipyretics. Comprehensive treatment of disorders of the bloodstream, kidneys and liver is also carried out. If necessary, strong diuretics are administered to eliminate swelling of the brain and lungs.