A group of syndromes in which a violation of mental activity is reflected in disorders of actions, movements — that is, what should be controlled by the psyche and what should be subordinated to. It’s like with an aircraft carrier: you can have a nuclear power plant with herds of power horses, a complex control system for propellers and rudders, thousands of tons of displacement, a TUEV Hooch team and all sorts of deadly toys on Board — but if the captain foolishly decided not to give way to an island lighthouse with two caretakers and a Canary, then the lighthouse team will win. And a Canary.

This group of syndromes includes:

  • arousal syndromes; stuporous syndromes; hyperkinetic syndromes; lucid catatonic syndromes.

Now in order about each of them.

With all their diversity, one thing will be common: expressed psychomotor agitation, that is, both strengthening and accelerating the motor (mainly) and mental activity of the sick person, which even with all his desire, he is not able not to demonstrate.

  • Depressive agitation (melancholic raptus) is a sudden wave of acute melancholy, with clear feelings of how painful and unbearable it is, with despair that this agony will not end, and a desire to end it all as soon as possible-even at the cost of life. Sobs, groans, throwing from side to side, trying to kill yourself with something — all this can be found here.
  • Manic arousal occurs with the opposite degree of mood, and the awl in the ass this time is not present for the purpose of execution, but as a stimulating factor: such an excess of mental and physical strength just needs to be applied somewhere, otherwise it will tear the owner to shreds, like a drop of nicotine explodes a hamster. The activity, though violent, is not very productive, it is more fuss than good. Speech is also more like a logorea than a normal narrative, and is also often uninformative.

Hallucinatory-delusional excitement is caused, respectively, either by what is seen or heard, or by what is thrown into the furnace of the imagination by delusional symptoms. Or that and another together. And depending on the subject of the experience, the patient will either escape, or save, or defend, or attack, or… Yes, there is little reason to run and worry! Another thing is that all actions that a sick person will seem logical to the limit, for others may look like impulsive and unpredictable. Recall, for example, Bulgakov’s Ivan Homeless.

In addition, psychomotor agitation can accompany all States of darkened consciousness (delirium, oneiroid, amentia, twilight of consciousness) and is not strictly specific to one thing, but can occur in any mental illness.

Stupor Syndromes

All these syndromes, regardless of the reason for which they arose, have one thing in common: inhibition. And strong. It is so strong that compared to the hand brake that can be activated when looking at the issued salary, meeting with an empty bag around the corner or a neighbor in a mini-bikini on the landing, THIS brake is stronger than a stop crane and more like a Parking anchor for an aircraft carrier of medium tonnage.

In this case, inhibition applies to all areas of the patient’s activity: motor-up to complete immobility, when he rather goes under himself than to the toilet; mental and speech-up to the inability to get an answer to the most elementary question; volitional-up to the complete refusal to eat and drink, and not for some political, delusional or any other reasons, but simply because During this period, even the sensitivity to pain is dulled. The mimicry freezes, the gaze freezes, and the person himself freezes, if not like a statue, then as if he had fallen into a jelly. All the events around you seem to pass by without touching the patient and without disturbing his detachment.

Here you can select the following main (except for catatonic, we will consider it separately) options for stupor.

Depressive stupor. Melancholy, pain, grief and suffering are so strong that it is reflected in the facial expressions (a mask of grief, a pained expression of the face), and in the pose-when the patient sits motionless or sways slightly, clasping his hands, or holding his chest. What kind of food can be when it’s not just bad — everything just had way, life is over, damnation, sin, serious, her ass full and permanent!

A manic stupor is diametrically different in the sign of mood, and although the patient who is in it also does not differ in mobility and speed, this happens for a completely different reason: he is the BEST of ALL! So great that there are no words — and in the literal sense: it is almost impossible to get an answer to questions, the patient is not up to it. The universe loves him, angels tremble before him and representatives of the opposite sex fall in stacks, the oligarchs of the world fight in hysterics, envying his untold wealth. And the frozen expression of happiness on his face is only a faint reflection of the personal sun that shines specifically for him.

Hallucinatory stupor. The cause of inhibition in it is hallucinations, often auditory and often imperative. In fact, how can you not freeze when a voice yells: “STOP!!! To be AFRAID of!!!»

Delusional stupor. In General, there are some ideas that overshadow the mournful brow, such a property-if it arrived, then as a victorious knockout. Or suddenly there will be a clear understanding that everything around is stuffed with motion sensors, and any movement of everything that is larger than a mouse, from orbit, Psion beams are pummeled! The old woman from the other entrance was so smart-she was so stuck on her head, now she smiles blissfully and never takes off Faraday’s knitted chain mail cap…

Asthenic (he’s apathetic, he’s dinamicheskii) stupor. Usually occurs when the brain is so exhausted and weakened (severe illness, trauma, infection, Narzan, port or rehearsals and cocaine) that the only possible mode of existence and work for it at the moment is a saving protective inhibition. The patient is prostrated, listless, apathetic, and relaxed. Answers questions after a pause and, as a rule, in monosyllables; at the same time, he quickly gets tired, runs out of breath, and has to wait a long time for him to gather his strength and thoughts again (they also need effort!) for future responses.

Post-shock stupor occurs as a manifestation of an affective shock reaction: if an empty bag around the corner turned out to be too large and dusty, or the situation is more extreme and dangerous than anywhere else, with a real threat to life and health. Looks like him.

Hysterical (aka emotional) stupor — it occurs when the patient hysteroid traits in the background of the trauma, which is specifically for him is very important and painful, although not deadly: for example, forms neighbor has surpassed all imaginable expectations, or suddenly it turned out that wild-growing hemp can give the time as for first-class Indian, either spouse is angry at loved Terrier, too, and he was bitten… in these types of stupor, the patient usually lies in bed, often in a fetal position; the facial expression is helpless, frightened.

Epileptic stupor occurs immediately after a seizure and lasts for several minutes, after which it passes. The period of stupor the patient usually forgets (and he’s having a seizure, of course, he amaziree ALWAYS).

Lucid Catatonic Syndromes

Before the reader himself gives a slight psychogenic stupor, trying to understand what it is, I will explain. Lucid is derived from the Latin word lux, meaning “light”, and means in this case a syndrome free of other painful symptoms. In other words, flowing without hallucinations, delusions and (formally) obscuration of consciousness. Catatonic-from the Greek word katateino, which means “to stretch, strain, depress, disrupt the tone” – because the leading disorders visible in these syndromes to an outside observer will be motor ones, and so specific that they are difficult to confuse with anything else. Here, for example, if such motor disorders occurred against the background of an oneiroid — we would be talking about oneiroid catatonia, but these subtleties will happen next time. An important difference: in lucid catatonic syndromes, the patient remembers events that occurred at the height of the disease, but in oneiroid ones-most often not.

Actually lucid catatonic syndromes can be observed in two opposite hypostases: catatonic stupor or catatonic excitement — and no compromise.

Catatonic Stupor

Wash the body. Wipe the coffin. I’m going out on an evening horse.

This stupor has several variants that differ in details, but, nevertheless, the entire group, like the Communist party factions, is United by several fundamental features.

First of all, it is hypokinesia (from Greek. hypo – – little and kynesis-movement) – and in a wide range, from sluggish and sparse movements, like a boa constrictor, escaped from the terrarium on the snowy expanses, to complete immobility in the manner of a Caryatid, propping up a detail of the facade. Mimicry, by the way, is also not striking in diversity and would do credit to the actors who play Indian leaders in films with the participation of Goiko Mitich. With regard to the patient’s eloquence, one could set an example for monks who took a vow of silence if mutism (remember the mute button on the TV remote?) was a conscious and voluntary affair.

Parakinesia (here the Greek prefix para-means “distortion, perversion, wrongness”) is just the feature of motor disorders that will not confuse catatonic stupor with any other. This passive negativism (the song “the district being a tourist, vigilant and excessive initiative and trying to take the Manneken Pis in the nearest branch or at least the corner”), and the negativity of the active (the same district ogrebaet from Manneken Pis for trying to clamp on a causal place), this is an unusual, art and intricate postures in which the patient freezes (that is, less exalted than the sitters of the Kama Sutra, but still impressive), it’s symptoms, accompanied by increased muscle tone: “airbag”, when, removing the pillow from under the patient’s head, you spend an hour agonizing over what he is so comfortably settled on — the head still does not touch the mattress… This is “waxy flexibility”, or catalepsy (from Greek. katalēpsis-grasping), when the hand or leg remains for hours in the position that it was given. This is a symptom of the hood, when the patient tries to cover his head with something-no matter, a shirt, sheet, blanket-just to hide it; this is the fetal position, when a person lies on his side, with his arms, legs and head to his stomach-just to shield himself from the hostile world; this is a symptom of the proboscis (not to be confused with the proboscis reflex!), when the lips stretched out in a tube as if frozen in anticipation of a return kiss from the universe — and it is already a couple of hours late for a date…

Failure in the work of the autonomic nervous system is also necessarily present, and it is noticeably more serious and heavier than some kind of vegetative dystonia. It’s all grown-up: it’s greasy skin, and acne, and acrocyanosis (cyanosis) of the tip of the nose and ears, and low blood pressure, and a rapid heartbeat. Sensitivity to pain is reduced until it disappears, the reflexes of the mucous membranes (for example, blinking in response to touching the eye) are hardly more lively than those of a zombie, but in response to an attempt to test the knee reflex, like other tendons, it is quite possible to get an industrial injury. Appetite in this state is reduced or turned off completely, but it is unlikely that this method of losing weight can be adopted.

Now about the details. There are three variants of catatonic stupor.

“Sluggish” stupor. With it, hypokinesia is not so severe as to cause complete immobility, and manifests itself in a General amoebic lethargy, a kind of unhurried state that will cause the envy of any respectable snail. Attempts to stir up and give acceleration are met with either passive negativism (“Though I will not give you an eye, but I will not add speed”), or passive subordination (“Okay, lead, basurmans!”), but if you stop making efforts, snails can again gnaw their shell out of frustration — they will not succeed so impressively.

Stupor with waxy flexibility. Hypokinesia is stronger with it, up to full identity with the exhibits of the Madame Tussauds Museum, and the poses taken, combined with the patient’s ability to stay in them for hours, will give a head start to any sitter who looks pale against this background, swims shallow and is generally similar to a child with attention deficit hyperactivity disorder. Passive negativism in response to an attempt to get a more active civil position from the sculpture is expressed quite strongly, up to the complete impossibility of changing something without resorting to improvised tools and dynamite, and with more insistence from others, it can suddenly change to active, and then risk getting both critics and well-wishers, as well as citizens from immoderately sympathetic.

Stupor with numbness. This is the moment of transition from a wax sculpture to a mummy-like state, just as motionless and indifferent, with the same wooden muscles, with a complete lack of appetite, thirst and interest in the environment, and with the only difference that archaeologists are less likely to catch in the eye when trying to remove bandages. The negativity here is very active. In addition, mummies do not go under themselves, any Museum caretaker will confirm this to you. And they don’t try to adopt the hood or embryo pose. But both of them clearly demonstrate the airbag syndrome.

Catatonic Arousal

Here you can observe the complete opposite of catatonic stupor — as if someone turned the toggle switch from the “freeze” position to the “die” position, but managed to overdo it. Tellingly, the transition from stupor to arousal and Vice versa can occur just like this-suddenly and without any external reasons.

The main, or obligate, symptoms of catatonic arousal are hyperkinesia (or over-mobility) and parakinesia (or, as already mentioned, perversion, distortion of motor activity).

Hyperkinesia is an understatement, here they are represented by a powerful, chaotic (without any purpose, but working on areas no worse than the Grad installation), destructive, sometimes impulsive (when the patient explodes with a motor storm from within, as if a detonator spontaneously triggered) psychomotor excitation.

Paragenesia are quite rich. This:

Echolalia (from the name of the Greek nymph Echo and the Greek word laleo — “I say”), when the patient arbitrarily does not say a word, but repeats a word or phrase from a speech addressed to him or said in passing, and good, if it is something censored;

Echopraxia (the same nymph and praxis-action), when the patient involuntarily copies the actions and gestures of others (not to be confused with dance karaoke!);

Motor Stereotypies, when the same action is repeated senselessly, unconsciously, involuntarily and repeatedly-slapping hands, swinging, shifting objects. It is better not to involve in washing dishes in this state — it will be of little use, plus there is a high risk of switching from uncontrolled washing to uncontrolled beating, and the latter will be more successful;

Speech Stereotypies (standing turns, a symptom of a gramophone record) – when a single word or phrase is repeated in the same senseless way and repeatedly, and the persistence of repetition can cause a nervous TIC even in a battered parrot-they say, is it mocking?!

This also includes pretentiousness and mannerism of poses, but here, in contrast to stupor, not wax figures will nervously smoke, but the pantomime theater with a full complement, even non-smokers and watchmen.

Active and passive negativism, as well as in stupor, will take place here.

This is also impulsivity, or the ability to suddenly, as if obeying an internal push, move to the position of “Android fighting, gone off the rails”.

From optional, or additional, optional symptoms:

• Homicidalmaniac (“kill All, one will remain»);

• Suicidaire (“will kill itself about a wall, nobody gets them»);

• Self-mutilation (not necessarily in the literal sense);

Coprophagia (I believe you can not translate).

There are three types of catatonic arousal.

Pathetic catatonic arousal. It usually increases gradually and does not reach the destructiveness and power of the impulsive. The patient constantly walks, periodically assuming poses that would do honor to any public leader; speech competes with poses in its pathos, and often is not burdened with a semantic load-except that echolalia are now and then included in him, and not in the audience. Exaltation is enough to charge a small sect of worshippers with sacred fervor, if catatonia could be professed. At times, the performance is interrupted by bursts of laughter-for no reason, which is generally natural and pathognomonic.

Impulsive catatonic arousal. As the name implies, this is an excitement with a sharp, explosive beginning. This is a tornado, this is a hurricane of destructive, senseless and cruel actions, this is a Berserker with a completely shot down sight, a disabled “friend-foe” system, turned into a weapon of mass destruction. Speech is jerky — individual shouts, phrases, with echolalia (as a rule, this is a repetition of offensive epithets heard from others, or fragments of their frightened exclamations). Motor stereotypes, especially if they are from the series “hands are used to the axe”, only add color to the picture of destruction. Most often, impulsive arousal replaces the catatonic stupor, does not last long, and is replaced by a stupor.

Silent catatonic arousal is so named because the patient performs all the destructive actions in complete silence (mutism). Often these actions are directed not only at others, but also at yourself, and all attempts to stop them are met with fierce resistance. This type of arousal is more chaotic and purposeless than impulsive, but it is also quite dangerous.

A little apart from the catatonic is gebefrenica excitation (from the Greek. hebe-youth, phren-mind, mind). The fact is that it can be one of the stages of development of catatonic arousal, or rather — pathetic, and then it can be called gebefreno-catatonic arousal, and may occur in itself, in the framework of exacerbation of the same name (ie, gebefrenicheskoy) form of schizophrenia. The name comes, apparently, from the manner in which certain young men have been observed to make faces, APE and flaunt in every possible way all the bad things that are in them, in the hope that girls who find themselves in the radius of defeat will take this as a sign of exclusivity and consider it worthy of attention.

This excitement is manifested by pretentiousness, grimaces and antics, mannerisms of behavior, grotesque gestures and facial expressions-only they do not occur at the request of the patient and not from a flaw in education, but in spite of his will and due to illness: he would be happy to behave differently, but can not. Speech, too, is full of neologisms, periodically turning into something like childish babble and syusyukanyu (puerilizm), flat jokes and memorized once phrases, with periodic jamming and repetition of one of them (verbigeratsii). This is what concerns obligate symptoms.

As for electives, they can be represented by episodes of hallucinations, usually auditory, as well as fragments of delusions.