The symptoms of impaired consciousness have already been discussed. Now let’s talk about syndromes. Perhaps, and even most likely, different occult schools would offer their own versions of their classification, but who are we to deviate from dialectical materialism?
So, all the syndromes of impaired consciousness can be divided into quantitative (they are not psychotic) is off consciousness: it was — did not, or considerably diminished; and the quality (or psychotic) is an aberration: it was clear and untroubled, and then mingled such that Mama do not cry!
In addition, both quantitative and qualitative syndromes can develop or suddenly and immediately reach their peak, and then it will be paroxysmal (from Greek. paroxysmos-irritation, excitement) violations, or gradually and consistently, and then they can be attributed to non-paroxysmal violations. As a result, four groups of syndromes are formed:
1) Non-paroxysmal shutdowns of consciousness: stun, SOPOR, coma;
2) Non-paroxysmal obscurations of consciousness: delirium, oneiroid, amentia;
3) Paroxysmal shutdowns of consciousness: large and small convulsive seizures (they are now studied by neurologists, not psychiatrists);
4) Paroxysmal obscurations of consciousness: twilight obscurations of consciousness, special States of consciousness and the aura of consciousness.
Stun. It is the most easy and relatively quickly reversible, compared with SOPOR and coma, but it also does not promise anything good for the psyche, and it is better to study it in theory than in practice. Three of its degrees — light, medium and deep — are allocated conditionally, because, unlike computer characters, the real patient will not light up a colored strip of his current state over his head. All by themselves. So.
A slight degree of stun, aka obnubilation (from lat. obnubilatio-cover with clouds, obscure). The patient can be confused with a person who is a little drunk: not to the extent that it is very stormy, but enough to upset the wife. Disorientation concerns mainly time, space, and one’s own personality. And if the month and year are correct, you may get confused about the date and approximate time. In addition, it is unlikely that the patient will be able to correctly remember what and in what order he did today and when the trouble happened to him. After a little conversation, you may find that he has already forgotten what you just said — the memory of such a patient does not record current events, they simply do not stay in it. It is not possible to attract the attention of the stunned person immediately, so you have to make some effort to make him listen and respond. All his movements are slowed down, the answers follow after a pause, absent-mindedness would please any novice pickpocket. Eloquence is hardly to be expected — for it, as for any subtle action, you need a coordinated work of the entire psyche: not to aerobatics, when the plane is shot down. In emotions, indifference prevails — after all, they take a lot of effort and attention to detail. The state itself can flicker, from time to time slightly brightening, giving the so-called lucid Windows (from lat. lux-light).
With an average degree of deafness, disorientation concerns not only time, but also space. It is useless to ask the patient who is in it where he is, what day it is, and what time it is. It is good if he gives you his last name, first name and patronymic. Year of birth-excellent. The address … it’s unlikely. There is no interest in the surrounding environment and people in this state-it doesn’t matter whether special forces are chasing terrorists around or naked beauties are dancing the cancan. Even a Letka-Yankee performed by special forces will not surprise you. Even in the arms of terrorists. On the face-an expression of confusion and perplexity. It is extremely difficult to attract the attention of such a patient, for this you either need to shout in the ear, or shake something large-caliber in front of his nose. If you leave such a patient alone, he lies down and seems to doze, indifferent to everything, often with his eyes open.
A deep degree of deafness, aka somnolence (from lat. somnus-dream). With it, disorientation is already complete — in time, space, your own personality (that is, even what your name is-will not tell). What is happening around the patient is not able to understand. What they try to tell him, explain, shout in his ear, or show him with gestures-too. The only way to attract a faint semblance of attention is to inflict pain — physical, of course: a slap on the face, a prick, or a good pinch — not out of personal antipathy, but to understand how much the situation is running. Even in this case, the reaction will be sluggish-well, he will open his eyes, well, look without meaning — and that’s it. Most of the time, the patient is motionless, lying down and once again does not remind you of yourself.
As it should be when switching off consciousness, after coming out of this state, the memory will erase some of the memories for the painful period itself (congradnaya amnesia), if the stun was light, or will not leave them at all (meaning, for the period of the stun itself), if the stun was medium or deep.
If the condition improves, the stun passes (regresses), if it worsens, it deepens (progresses) and goes into SOPOR.
SOPOR, or status soporosus (from lat. sopor — numbness, lethargy). This condition is almost a step away from a coma (sometimes called a precoma). Disorientation at SOPOR is complete, that is, to ask what time-day-month-year and try to get acquainted with the same success, you can go to the monument. Only the reaction of others will be slightly different in the latter case. Even on a prick or a pinch, the patient will react, but sluggishly and purposefully-twitch, shudder, but the offender will not look for. Reflexes of the mucous membranes (sneezing in response to an attempt to tickle a feather in the nose — and do not look so disapproving, this is a diagnostic procedure, not a mockery!) and no skin. Tendon reflexes (hammer — knee — kick from the toe) are weakened. Protective reflexes are preserved: corneal, when the eyelids close on an attempt to touch the cornea with cotton wool, coughing, vomiting, swallowing. The reaction of the pupils to light is sluggish. The patient lies motionless and can only occasionally toss around in the bed.
If the condition improves, then first the consciousness passes through the stun to normal, while the memory for the SOPOR period is completely lost. If the condition deepens, a coma occurs.
Coma. The name comes from the Greek word koma, which means “deep sleep”. The psyche in a coma completely resigns all its powers. Most reflexes, including defensive ones, are suppressed. Only those unconditioned ones that allow life to warm in the body are preserved-those that support breathing, heartbeat, thermoregulation, and vascular tone. Deepening the coma leads to death. If the situation is favorable, there is a gradual exit from the coma in the reverse sequence: coma-SOPOR — three degrees of stun-return to clear consciousness. Memory for events that occurred in a coma, as well as for the period of recovery, up to the state of light stun, is lost.
We have already touched briefly on the concepts of delirium and oneiroid, now let’s look at them in more detail, adding to them amentia. Delirium and its stages of development have already been discussed in the section “Intoxicating psychoses”. It should be said that intoxication (most often it is, and it is alcohol) is not the only reason for the development of events in such an interesting scenario. Severe infection (a chronic alcoholic is quite common pneumonia), severe damage of cerebral vessels (hence the delirium in octogenarian grannies who forgot the smell of alcohol, excluding the part of valokordin), severe somatic (bodily, in other words) disease — here is a partial but basic list of possible causes, the rest is out of the realm of casuistry, and stories among colleagues for a saucer of brandy.
Oneiroid, aka oneiroid syndrome (from Greek. oneiros-a dream). It got its name from a dream-like state, similar to the brightest dream, absolutely incredible and fantastic in the content of the nature of the experiences and visions that patients experience. Does it remind you of Alice? However, all in order. The main symptoms of oneiroid are:
Disorientation. Not a loss of orientation in time, space, in what is happening around and in your own personality, as in the case of disconnections of consciousness, and not a desperate attempt to find it again, as in the case of Amenti, but a change. “Time? I’m going to ask that fairy over there, fluttering among the sparkling pollen. You know, the position of the two local moons makes it difficult for me to answer offhand. What of the city? Oh, I was told by the guards at the gate, it completely slipped my mind — a beautiful name… What’s going on? They’re in the middle of a festival, and there’s going to be champagne spouting from all the fountains in the square, so let’s get this over with as soon as possible. Who am I? Elf. Level thirty-one. Well, everyone who goes where, and I-to go to the festival.” Tellingly, the” I ” of the patient in oneiroid does not hesitate to change, to become multiple, fragmented, to envelop entire cities with fog, to become the atmosphere for planets, to inhabit animals, birds, trees and stones, or even to transform into an abstract concept — like universal love or no less universal law of meanness.
Complete detachment from real events — it is still necessary to find out which ones are more real for whom — and the deepest immersion in vivid scene — like (not in fragments, not in snatches, and not single characters, but with a full set of actors and scenery) pseudo-hallucinations: visual, auditory, olfactory, tactile, and gustatory-a complete set in order for the new reality to be more palpable than the one from which the patient fell. And since the consciousness must somehow come to terms with new sensations and situations, these pseudo-hallucinations are accompanied by a fantastic dream-like sensory (that is, not the one that took on itself, but stems from what was seen and felt in hallucinations) delirium. “Coven of witches? Well, that’s right, I was always infernal at heart and looked with interest at all sorts of brooms and mops. The Apocalypse? Oh, my God, I’m the one who screwed him up, and now I’m getting paid for it! I fly in a pack of pterodactyls? Well, I fly myself and fly, I’ve always been very good at snapping my beak, and flapping my wings-it’s so natural, as long as my fingers are spread wide!”Less specific disorders of the autonomic nervous system: greasy skin and hair, sweating (hyperhidrosis), fever, nausea, constipation, fluctuations in blood pressure — both in one direction and in the other; but they also often occur. And, of course, insomnia (dreams and so show, and in reality) and lack of appetite (popcorn in this auditorium is either local, or not provided at all). Oneiroid syndrome most often has one of three types: a pure, classic type — a type of oniric syndrome (aka onirism, aka oniric delirium), which in most cases occurs with severe infectious diseases and is characterized by lethargy with constant drowsiness. The patient, falling asleep, sees such vivid dreams that when he wakes up, he continues to consider them part of his real experiences. He may well be outraged about why the bikini-clad beauties were chased away and his pirate chest was hidden somewhere. And anyway, you can’t see the masts of his personal frigate outside the window, who dared to drive him to a distant roadstead? However, such a patient may not make claims, but the sediment in the soul will remain…
Another type of oneiroid syndrome is one of the stages in the development of an oneiroid-catatonic attack (in the vast majority of cases — in schizophrenia). Unlike pure oneiroid, there will also be elements of catatonic syndrome, most often in the form of catatonic stupor.
The classic, expanded oneiroid is divided into seven stages, which were described by T. F. Popadopoulos in 1975. According to S. T. Stoyanov, there are only five of them, but this is for an Amateur.
Phase one. Or the stage of General somatic disorders and fluctuations of affect. There are no delusions or visions yet, but the body is already sending distress signals: the normal work of the autonomic nervous system is disrupted, the mood begins to change quite sharply, in leaps and bounds — and the further, the more noticeable and more often in the direction of the pole that will color the entire attack — either depressive, with anxiety and fears, or manic, with a sense of uplifting, ecstasy.
The second stage, or stage of delusional affect. At this stage, the mind seems to be looking for a logical justification for the changed mood — and finds it. Bad — it means that something is going to happen. Or someone who is planning something bad is about to appear. Good means, again, something has to happen. The gingerbread truck will tip over under the Windows, or the wizard will fly there. Yes, in a blue helicopter. Yes, and show a movie for free. Or the Nobel prize for personal charm is about to arrive.
The third stage, or the stage of affective-delusional derealization and depersonalization. The environment seems more and more mysterious and suspicious. There’s something here for a reason. More precisely, everything. Everything has a double meaning. Yes, and the thinking itself begins to throw up surprises: then some thoughts will float in spite of themselves (mentalism, remember?on the contrary, the process of thinking will stop, as if someone has plugged the neck (sperrung). Gradually, the delirium begins to gain a clearer content, a plot, and gradually the plot begins to emerge: “Aha! That’s what I thought. This is because I loved the temples more than I loved God!”( ©) According to the content of the delusion, the patient’s” I ” is becoming more and more familiar with the new, dual environment: it seems to be still here, IN this reality, but it is already gradually becoming familiar with it THERE. The surrounding people and objects seem only conditionally belonging to this world — in fact, they are like icebergs, here only the tip, and if you look into the depths-and you will discover their true essence: that person seems to be a relative, but in fact … Oh, did not recognize you, Croesus, you will be rich (a symptom of Fregoli)!
The fourth stage, or the stage of fantastic affective-delusional derealization and depersonalization. The delirium that appeared at the previous stage acquires fantastic, paraphrenic features. He is no longer restrained by the framework of boring everyday reality, he needs space-fabulous, cosmic, apocalyptic or divine, and then Peter got bored at the gate, the devils in hell work somehow sluggishly, completely abandoned the service, and on Olympus, the corporate office needs to be revived — a new round of drunkenness or bruising, that’s how it will turn out. After delusions and changes in the ” I ” begin to appear and the first pseudo-hallucinations — you can not deceive expectations, the new reality must match the plan!
The fifth stage, or the stage of illusory-fantastic derealization and depersonalization. Delirium spurred the imagination, and it galloped madly, sweeping away barriers and unleashing an avalanche of pseudo-hallucinations. Auditory, visual, kinesthetic, tactile, olfactory and taste — all set to dive into the world of dreams was as complete as possible, to the new world found paints and began to live his own life — life stage set for a single audience. The patient’s ” I ” is already almost completely transferred to this new world and holds on to the reality from which it came, only with the little finger. Yes, it still remembers the passport details, and perhaps, with a huge effort of will, it will be able to give an answer on what day and from what geographical point it dived here, but what the hell does it matter! “Now we will conduct an orbital bombardment of the planet of the saber-toothed wetheads, and then there will be a landing, and no one will not think enough!”Or, alternatively,” there opens a portal to Olympus, we are also waiting there, the nectar is warming and expiring! And the mammoth license will expire soon, so let’s hurry!»
The sixth stage, or the stage of true oneiroid confusion of consciousness. Another gust of the mental storm, and the last anchor that held consciousness to these shores was lost. Now the patient is completely THERE; the reality that you and I are in no longer exists for him — he is traveling, fighting, or just contemplating Grand colorful pictures. At the same time, you can observe how the patient’s gaze wanders, stopping at anything but the surrounding environment, how the patient experiences or enjoys. It is useless to call him, to stop him, to try to attract attention — he is too far away! He rides among the horsemen of the Apocalypse, it is repeatedly burnt at the stake, he contemplates the garden of Eden, he steals fire from the gods and apples from the garden of the Hesperides… Yes there! It is he who is the universe, and it is he who watches with detachment everything that happens in it! Everything would be fine, but only the suffering brain gives birth to visions and experiences, and its resources are not unlimited. If the condition worsens, the next stage occurs.
The seventh stage, or stage of the Amen-like (from lat. amentia-insanity) obscuration of consciousness with fragmentation of oneiroid experiences. Consciousness is no longer able to maintain the whole picture in its entirety, and it falls apart into fragments of dreams, individual pseudo-hallucinations. The patient is confused, he tries to make sense of what is happening, where he is, who he is and when he is, but in vain. Thinking is incoherent, speech is slurred. Sometimes at this stage, the General physical well-being worsens, the body temperature increases, and the patient may fall into a coma. More often, after the sixth stage (and sometimes not reaching it), the patient leaves the oneiroid-smoothly or critically. The memories of the experience are most often preserved, with the exception of the seventh stage.
Oneiroid can most often occur in schizophrenia, infections (especially neuroinfections) and in the postpartum period (as part of postpartum psychosis).
The term originated from the Latin word amentia, which means “madness”. Of all the obscurations of consciousness, this is the most profound and serious. It cannot occur on its own, and a powerful artillery preparation is needed — for example, severe infectious or somatic diseases, encephalitis, or neuroleptic malignant syndrome.
Mandatory, or obligate, symptoms of amentia:
Deep disorder of consciousness with complete disorientation in time, place, and self. Therefore, if you suddenly decided to find out what date, day of the week, time of year, how to get to the library, or at least what the patient’s first name is, then you have chosen an inappropriate person to talk to. He would have liked to find out now, but the agonizing attempts to remember and collect himself in a heap do not bear fruit, and tips and even a simple statement of his own passport data do not give anything but even more confusion and weak attempts to somehow digest the information that has fallen on him;
- Incoherent or incoherent thinking. Attempts to operate with the available information are no more successful than in a patient with cerebellar disorders to juggle ten working chainsaws. If, for example, for most people, the combination of a full white beard, a staff, a red hat and a bag of gifts adds up to a famous character, then for a patient with amentia it is an unsolvable puzzle. For him, putting together a complete image of the characteristic features is like a first-grade student who does not know German, reading and comprehending “Faust” in the original: there are familiar letters of the alphabet, but that’s all. Speech, like thinking, is also confused and incoherent in amentia. This confusion is asthenic: the brain simply does not have the strength for more complex integrating processes. This asthenic confusion of thinking and speech is the main sign by which amentia is determined;
• Congrega amnesia. This is when the entire period during which the patient was in a state of amentia, memory mercifully erases. Yes, and not before it the brain — to stay with her!.. Additional, or optional, symptoms: perception disorders-fragments of illusions, hallucinations, senestopathies that do not make up any single picture, but appear in separate strokes: something was heard there, something was seen here, something inside cracked, gurgled, or felt hot…
- Disorders of thinking — again in fragments, without a clear coherent system and logical completion: fragments of delusional thoughts, paranoid inclusions;
• Affective disorder. They are present more often and can be very different: the affect of anxiety, fear, confusion, and much less often — euphoria.
When the General condition becomes heavier, amentia can change to a coma and end in death. Exit from amentia occurs with a sharp weakening, asthenization of the psyche, up to the formation of a psycho-organic syndrome (we are still talking about it).
Now about the paroxysmal obscurations of consciousness.
As the name implies (from Greek. paroxysmos-irritation, arousal), they develop quickly, acutely and immediately reach the peak of symptoms. The memory of events occurring during the blackout is lost completely or, as in the case of hysterical twilight, fugiform reactions or pseudo — dementia, partially.
Now in order. There are the following types of paroxysmal confusion of consciousness:
- Twilight clouding of consciousness (organic and hysterical);
- Ambulatory automatisms (actually ambulatory automatisms, fugues and trances, as well as — in the case of hysterical origin — fugiform reactions);
- Aura of consciousness;
• Exceptional state of pathological affect, pathological intoxication, proselochnoy condition and the reaction of the short circuit.
A twilight blurring of consciousness, organic. Its main prerequisite is the defeat and weakening of the brain as an organ — not by Psychotrauma, but by a more tangible and tangible factor (trauma, infection, intoxication, vascular damage). It starts and ends abruptly, as if it was turned on and then turned off.
Leading, obligate symptoms — deep disorientation (except in some cases, more often with a dysphoric, with a predominance of dark and evil mood, variant) in time, the environment and your own personality, which does not prevent, however, to operate in a very dangerous autopilot mode. The second obligate symptom is total amnesia during the entire twilight period. Sometimes this amnesia is delayed, retarded, that is, the patient in the first hours and days may remember some of these events of the painful period, but then the memory will erase them completely. Moreover, this amnesia is so complete that it is useless to convince a person, to provide him with eyewitness accounts and recordings from surveillance cameras — for him, this period of time DID not EXIST AT all. No, it’s not he uprooted three of the ATM. And the chase with a chainsaw for cash collectors, too, is not stored in the memory. And the police Department simply could not have been harmed by his hands, feet, and tools. What kind of witnesses? What kind of video? No, it just couldn’t be! For this reason, twilight States of consciousness in forensic psychiatric practice are included in the list of exceptional States (more on them later), that is, those that exclude sanity at the time when such a state took place. The third is a deep, restless sleep that occurs when you come out of the twilight state.
Depending on which of the additional, optional symptoms prevail, it is customary to distinguish between delusional, hallucinatory and dysphoric (aka oriented) versions of “twilight”.
• If delusional variant behavior of the patient will largely determine the content of acute-onset (and lasting exactly as long as twilight lasts themselves) delusions: no — to hide, to escape or wait for his pursuers into his own ambush, if the end of the world will either be saved, or to save others, or to off last.
• In the hallucinatory version, everything will depend on what the patient sees or hears, what the devils tell them, who will be looming among ordinary passers-by, what will be the orders of the inner voice.
- In the dysphoric (oriented) version, the patient may recognize some of the people around him, remember where he is and what time it is, but anger, longing, rage and aggression will gradually boil inside, Shrouding everything in a bloody fog — and an explosion will follow, in the best traditions of true Berserkers. Then, of course, everything will be forgotten. What are the shields? Who’s been eating? Where are the axes from? Yes, there was nothing!
• In the case of hysterical twilight obscuration of consciousness, the crucial prerequisite for its occurrence is the personality warehouse, of course, hysteroid. The state itself is not so much a blurring as a narrowing of consciousness, with the exception of what the patient does not want to see, hear, or be aware of. Moreover, from the current situation, where all the thorns, generously unavozhennaya territory and only points after the letter “e”, the consciousness is quite capable of mercifully transferring the patient to pink childhood (puerilism) or to portray pseudo — dementia-they say, why should the intellect overwork, dear master? Nevertheless, selective contact with such a patient is quite possible, especially on neutral or pleasant topics for him. And amnesia after leaving the twilight is often not complete, but partial.
Outpatient automatics (from lat. ambulo-take a walk). They are more common in epilepsy or organic brain damage. Memory for a painful period of time is also completely absent.
In fact, outpatient automatics usually do not differ in any kind of purposefulness: the patient can spin like a dervish, Crouch or jump, dress or undress many times, suddenly brew tea on beer instead of water, or disassemble a computer — and then wonder: why is it that they look at him so strangely today and collectively frown?
Trances. In contrast to previous States, in a trance, a person behaves quite orderly and seemingly purposeful, so from the outside, in addition to a certain detachment, drowsiness and confusion (not very noticeable, however), it will be difficult to detect any oddities-until the very moment when the person suddenly wakes up and sincerely wonders: what am I doing in this city (in this bed, this country, among recruits)? Even to cope with the official duties of the person during the trance sometimes quite capable (as long as it’s not running the country, by ship, by plane or bus), that’s just coming out of the trance, he completely loses all period of time (days, weeks, and even months) and will be a long time to figure out where a piece of my life.
The Fugue flows more rapidly and briefly. The patient suddenly picks up and runs somewhere, leaves the house, tries to get out of the car, train (well, if not on the move) or plane (what causes a chain reaction among other passengers on Board) — and so for a few seconds or minutes, and then suddenly comes to himself and wonders: why am I in the middle of the highway? Or at a distant station, grass up to your waist, a stopcock in your hand? Or with a parachute at the emergency exit?
In the case of hysterical trances and fugiform reactions, despite their similarity to organic ones, three distinctive features of these States are noticeable: theatricality and emotional saturation, the possible (though not always reasonable) benefit of such behavior for the patient, and partial, rather than complete, amnesia of events. As well as initially hysteroid character traits and personality warehouse.
The aura of consciousness. More often observed in epilepsy, before an approaching seizure; less common in organic brain damage. An interesting and characteristic feature is that the memory of the sensations experienced in the aura is not erased. This allowed F. M. Dostoevsky to describe it in detail in the novel “Idiot”. Why, the prophet Mohammad himself probably experienced this state more than once!
Which symptoms do not occur during aura: this is a dazzling, beautiful, colorful hallucinations, it feels as if the body transformered into something so… so… It’s deja vu and jamais vu, this is an unusual body sensations and change in the course of time, until it stops. And then comes the epileptic attack.
Exceptional condition. The causes of these conditions are different, but there are, nevertheless, criteria that unite them:
- Sudden development;
- Conditionality by an external cause;
- Short duration (minutes, hours, less often days);
- Accompanied by a clouded consciousness;
- On exit-full or partial amnesia.
The presence of such a condition can serve as a basis for declaring a person insane if, while in this state, he has committed an offense. Now briefly about what these States are.
- Pathological affect. There are three phases of it. First, or preparatory: in connection with a Psychotrauma (offense, insult), emotional tension increases, the ability to critically assess the environment and their condition is lost, attention and consciousness itself is narrowed and fixed on the Psychotrauma, from which everything else loses importance and only the offense, experiences are aggravated and inflated to the limit. The second phase, or explosion phase, follows the first, which is called, without warning, sharply, explosively, can be accompanied by illusions and hallucinations. This person is unresponsive and not distracted, he completely dominated outbursts of passion: he excited up to the rampage, senselessly aggressive and destructive, shows no mercy and acts like a machine. The third and final phase-just as suddenly the strength leaves the person, he falls into prostration or falls into a deep sleep.
- Pathological intoxication. It can occur from both small and large doses of alcohol. At a certain stage of intoxication, consciousness changes sharply, hallucinatory and delusional experiences occur, as well as a pronounced affect: fear, anger, which leads to the corresponding aggressive behavior, with a complete separation from reality, although the behavior may resemble an ordered one: a person can drive a car, perform complex purposeful actions. This state also ends abruptly, often passing into a deep sleep.
• Pathological prooecia state. Previously, they were described as” sleep intoxication”: a person does not fully Wake up from a deep sleep: he continues to dream while awake. And if the dream is frightening, heavy, and carries a threat, then the person begins to defend himself and shows aggression, sometimes very dangerous for others. So, the household he may well take for burglars who broke into the house, neighbors in the tent – for bears-perverts — Yes, you never know! And the body, unlike the mind, is already awake and ready for action! After a period of arousal, the patient usually wakes up completely, but either does not remember his dream, or can only partially remember it.
• “Short circuit” reaction. Occurs when the stressful situation lasts long, day after day — whether old-timers picking on poor rookie, itchy if my wife to quit drinking, pass the bottle and buy her a mink coat. At the same time, nothing foreshadows a denouement, and the patient certainly does not prepare or plan for such a development of events, everything happens suddenly, vividly, with a powerful outburst of emotions, aggression (which is called “jumped”), after which sleep or exhaustion with detachment occurs.
As a rule, this is followed by a forensic psychiatric examination, recognition of the patient as insane, and compulsory psychiatric treatment, thoughtful and serious.
Since exceptional States occur suddenly and are not often repeated and characteristic of a particular person, it is extremely difficult to predict their occurrence, almost impossible. Have to deal with a fait accompli when only uncontrollable, senseless and destructive aggression, coupled with a glass eye and changed complexion (crimson or, on the contrary, livid), as well as dedication homing missiles — “I see the goal, I do not see obstacles” — suggest that the situation is extremely dangerous, and should save himself or save others.