Amentia is a severe confusion of consciousness, accompanied by a violation of orientation in place, time and one’s own personality, loss of the ability to synthetic perception, pronounced confusion, incoherent thinking, speech and movements. It can occur against the background of some mental disorders, alcoholism, severe traumatic lesions, infectious, endocrine and somatic diseases, indicates a worsening of the course of the underlying disease. The diagnosis is made on the basis of characteristic clinical signs. Intensive therapy and treatment of the underlying pathology are required.
R41.0 Orientation disorder, unspecified
Amentia is a severe disorder of consciousness, accompanied by a violation of the ability to synthesize. The world for a patient with amentia seems to be broken into many small pieces that cannot be put together into a single picture. All kinds of orientation suffer, including in one’s own personality. Productive contact is impossible. The patient’s condition is aggravated by fragmentary hallucinatory experiences, emotional chaos and motor anxiety. There is a tendency to a long course, the duration of amentia can be several weeks or even months.
In the past, all mental illnesses with acute intellectual disability, senseless behavior, incoherent speech and fragmentary hallucinations were called amentia. After the research of Kraepelin and Bleyer, the interpretation of amentia narrowed. Currently, amentia is understood as a psychopathological syndrome described by the German psychiatrist Theodor Meinert and includes pronounced confusion, incoherence of mental processes and physical actions. Treatment of amentia is carried out by specialists in the field of clinical psychiatry in cooperation with therapists, endocrinologists, traumatologists and doctors of other specialties (depending on the nature of the underlying pathology).
Causes of amentia
Amentia is an endogenous psychosis that occurs against the background of severe physical and mental exhaustion or against the background of severe intoxication with endogenous or exogenous toxins. Mild forms can develop as a result of diarrhea, mild poisoning, blood loss or prolonged surgical intervention. Severe amentia can be observed in open and closed craniocerebral injuries with brain damage, organic brain lesions, hyperthyroidism, infectious diseases (usually long-term), acute and chronic intoxication with alcoholism and drug addiction.
The most striking manifestations of amentia are revealed in sepsis, accompanied by brain damage. Short amenative episodes can occur with bipolar affective disorder and some forms of schizophrenia. Polyethologicity of amentia, the absence of clearly expressed specific symptoms, the “overlap” of the symptoms of the underlying disease and various degrees of severity of endogenous psychosis can cause diagnostic difficulties, especially at the stage of pre-hospital care.
Depending on the predominance of certain clinical manifestations, three forms of amentia are distinguished:
- delusional (fragmentary delusional ideas prevail);
- hallucinatory (hallucinatory experiences prevail);
- catatonic (stupor prevails).
Symptoms of amentia
The main symptom of amentia is a disorder of all elements of consciousness. The patient does not know who he is, does not understand where he is and what is happening to him. He does not recognize close people, does not recognize the meaning of the questions addressed to him and is not capable of productive speech contact. The patient’s confusion is aggravated by fragmentary deceptions of the senses, elements of delirium and fragmentary hallucinatory experiences. Due to a violation of the ability to all types of synthesis, the patient ceases to see connections between events and objects.
The patient’s emotions are incoherent and chaotic, his attention is extremely quickly distracted. He smiles, then cries, then shows indifference to others. Often there is a predominance of depressive reactions, but even at the height of affect, the patient continues to be in a state of deep disorientation, his experiences are in no way connected with external stimuli and real events. At night, short-term delirium may develop. The words and behavior of the patient indicate the presence of deceptions of feelings, elements of delirium and fragmentary hallucinatory experiences. At the same time, delusions and hallucinations never crystallize into a single coherent picture.
Productive contact with the patient is impossible. The patient does not answer questions, his speech consists of separate words, unrelated phrases and fragments of sentences. According to the statements of the patient, it can sometimes be understood that he feels confused and helpless. The content and emotional coloring of speech correspond to the current affect. Being in high spirits, the patient pronounces words and phrases expressing joy, pleasure and other pleasant emotions, with a decrease in mood, the content and color of speech undergo corresponding changes. Words can be shouted out or pronounced in a whisper, sound rude or gentle, accompanied by laughter or crying.
Motor excitement is noted. Motor reactions are fragmentary and purposeless. The patient waves his arms, bends, shudders or twists in bed. Some movements indicate the presence of elements of delirium and hallucinations. The patient can make grasping movements, touch something or push away. With the aggravation of amentia, choreographic hyperkinesis or a clinical picture resembling catatonia are sometimes observed. The development of stupor is possible.
The duration of amentia in adults can vary significantly – from short episodes lasting less than a day with mild forms of psychosis due to physical overstrain or mental illness to a disorder of consciousness lasting several weeks or several months with long-term progressive infectious diseases and other conditions accompanied by severe exhaustion of the body.
Amentia in children
In children, amentia is usually shallow and short-lived. Complete disorder of consciousness does not occur. The child is restless, confused, poorly oriented in what is happening. Contact is possible, but very unstable. The kid is distracted, poorly understands the meaning of the speech addressed to him. Even if the doctor or a loved one manages to enter into a productive dialogue with the child, contact is quickly interrupted due to exhaustion and incoherent thinking of the patient.
The diagnosis of amentia is made by a psychiatrist on the basis of characteristic clinical symptoms: confusion, incoherent thinking, violations of all types of orientation, disorderly change of emotions, motor anxiety, fragmentary delusional ideas and hallucinatory experiences. To clarify the nature of the underlying pathology, consultations of a therapist, an infectious disease specialist, an endocrinologist, a traumatologist, a neurologist, a neurosurgeon and other specialists may be required.
Differential diagnosis is carried out with delirium and catatonic arousal. In contrast to catatonic arousal in amentia, there is a clear correlation between the content and emotional coloring of the patient’s speech. Catatonic symptoms in amentia are unstable, unstable and very changeable. With amentia, many patients develop short-term delirium at night, with catatonia there are no delirious episodes. Catatonia is not characterized by the presence of depressive affect.
Delirium and hallucinatory experiences in a delirious state have a coherent character and in some cases, for example, in alcoholic delirium, they can form a complete, complete picture. Delusions and hallucinations in amentia are fragmentary, incoherent and can manifest themselves only in the form of short-term episodes. With delirium in the daytime, moments of clarity of consciousness are often observed, with amentia this symptom is absent. Patients with delirium retain the ability to perform purposeful actions and contact others, with amentia, the movements of patients are not purposeful, meaningless and monotonous, there is no contact with others.
Treatment of amentia
In case of mental illness, hospitalization in a psychiatric department is indicated, in case of somatic pathology – in a specialized department corresponding to the underlying disease. The patient is injected with antitoxic drugs and neuroleptics. Benzodiazepines are prescribed to eliminate motor arousal. To clarify consciousness, drip infusions of nootropics in saline solution are regularly carried out. Patients refuse water and food, so they are transferred to artificial nutrition. Therapy of the underlying disease is carried out.
The forecast is relatively favorable. With timely and adequate treatment, amentia usually does not pose a danger to life, however, the fatal outcome in some cases may be due to the exhaustion of the patient and the unfavorable course of the underlying disease. After leaving amentia, severe asthenia and complete amnesia are observed.