stupor

Of the stupor is a symptom of a mostly mental illness. It is characterized by the fact that, despite being awake, the body falls into a state of rigidity. In extremely severe cases, a stupor can also indicate a life-threatening mental illness.

What is a stupor?

The stupor describes a state of physical rigidity in spite of an awake consciousness. It occurs as a symptom of various psychological or organic brain diseases.

The stupor describes a state of physical rigidity in spite of an awake consciousness. It occurs as a symptom of various psychological or organic brain diseases. The patients cannot react to what is spoken, although they are aware of everything. Often the stupor is accompanied by increased muscle tone, fever and disorders of the autonomic nervous system. Certain features such as muscle tone, eye movements or eye opening indicate a wakeful state.

Often a stupor occurs together with mutism (dumbness). Those affected do not react at all or only slightly to environmental stimuli. However, they are particularly sensitive to these stimuli. Food and fluid intake is also made more difficult, so that patients with stupor sometimes have to be fed artificially. Particularly severe forms of stupor can even lead to catalepsy.

Catalepsy is characterized by a so-called waxy increase in muscle tone, whereby a change in position of the limbs that has been brought about passively is kept immobile for a long time. Even the most uncomfortable positions of the joints remain.

causes

The causes of a stupor are many. Many mental illnesses can trigger a stupor. In the context of severe depression, so-called depressive stupor can occur. Those affected appear resigned and at the same time are at high risk of suicide. Most catatonic stupor is based on a schizophrenic psychosis.

This is characterized by catalepsy and is extremely life-threatening as a result of increased physical reactions such as fever or mineral metabolism disorders. The psychogenic stupor is caused by previous traumas or other stressful experiences. There is no evidence of schizophrenia, depression, or organic causes here.

An organically caused stupor can be triggered by meningitis, encephalitis (inflammation of the brain), epilepsy, other seizure disorders, brain tumors, brain edema, dementia, liver disease, hormonal diseases or an increased potassium level. A stupor can also occur as part of Parkinson's disease.

The same is true for acute porphyria and diabetic ketoacidosis. Medicines can also cause stupor. In particular, it can occur as a side effect when using neuroleptics. Finally, poisoning with drugs such as PCP or LSD often leads to stupor. The uncontrolled ingestion of sleeping pills and hypnotics (barbiturates, benzodiazepines) as well as opiates are often causes of the freezing state.

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Diseases with this symptom

• Meningitis
• dementia
• Liver disease
• Parkinson's
• Diabetic ketoacidosis

• Encephalitis
• Brain edema
• psychosis
• Hypercalcemia
• Mutism

• epilepsy
• Brain tumor
• trauma
• Hormonal imbalances
• Acute intermittent porphyria

Diagnosis & course

To diagnose the stupor, the doctor will first take a medical history. Since stupor patients cannot be addressed, the next of kin are asked about this. The first step in taking anamnesis is to find out whether there are already mental illnesses or have existed in the past. During the physical exam, the doctor checks the muscle tone and the patient's response to speech and pain stimuli.

Laboratory tests for blood, cerebrospinal fluid, or spinal fluid can provide information about possible organic diseases. This is followed by neurological examinations, measurements of electrical brain waves (EEG) and imaging methods such as magnetic resonance tomography. All examinations serve to determine whether organic or psychological causes are responsible for the stupor.

The manifestations of a stupor often also depend on the cause. It is also important for the doctor to recognize the correct shape by means of external characteristics. If, for example, there is catalepsy, the doctor can assume a catatonic stupor, which sometimes occurs in the context of schizophrenia. This condition is very life threatening. If the stupor persists for a long time, the striated muscles sometimes dissolve (rhabdomyolysis).

Rhabdomyolysis often leads to acute kidney failure. Other complications of a stupor are pneumonia with sepsis, thrombosis, skin ulcers or disorders of the electrolyte balance. In these cases, for proper treatment, the doctor must unequivocally diagnose or rule out the stupor as the cause of the complications.

Complications

A stupor usually arises due to mental illness, which can be accompanied by various consequences. General complications of a stupor are the breakdown of skeletal muscles (rhabdomyolysis). In addition, the kidneys can fail (renal insufficiency). Pneumonia, which can turn into sepsis, or thromboses and ulcers are other possible consequences of stupor.

Typically, a stupor arises in depression. These can often be associated with anxiety or panic disorders. Those affected no longer dare to go out in public and isolate themselves socially, which only increases the symptoms. Compulsive disorders can also occur. Affected people sometimes have hallucinations and psychoses, which often drive them insane.

It is not uncommon for those affected to take drugs or drink alcohol to escape their worries. Frequent drug use only increases the symptoms of hallucinations and psychoses. Alcohol can also cause cirrhosis of the liver, the liver is no longer functional and can develop into liver cancer.

Eating disorders can also be a burden for those affected. They either eat more or less, which can lead to bulimia or obesity. Both secondary diseases are associated with an increased risk of cardiovascular diseases. This is also favored by the often associated lack of sleep. In the worst cases, the depressed person will commit suicide. Around 15 percent commit suicide in the course of the disease.

When should you go to the doctor?

If there is a suspicion of a stupor, it is always useful to see a doctor. The family doctor or a general practitioner can serve as the first point of contact. Since the stupor can be due to various causes, a referral to a specialist may be necessary after initial examinations. Those affected should definitely use such a transfer.

An emergency doctor can also be called in in an acute situation. This is especially true when it is unclear whether it is a stupor or another clinical picture. It is often not possible for outsiders to see whether the person concerned is conscious. Other diseases and syndromes can look very similar. This also includes serious illnesses such as strokes that require immediate treatment. It is therefore particularly useful in such an unclear and acute situation to make an emergency call.

For the same reason, self-diagnoses are to be viewed very critically. There is a risk that other causes will be ignored and serious complications will result.

A disease that can trigger the stupor may already be known. In this case, those affected can also contact their treating specialist themselves (if necessary after an initial clarification). However, you should not allow too much time to pass.

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Treatment & Therapy

The therapy for a stupor depends on the underlying disease. In the case of an organically caused stupor, the possibly present illness such as meningitis, encephalitis, brain edema or brain tumor must be treated. After the organic cause has healed, the stupor also disappears. A catatonic stupor is treated with neuroleptics such as fluphenazine or haloperidol.

In addition, tranquilizers and anxiety relievers can also be used. Anxiety relievers especially help with a psychogenic stupor. If there is a depressive stupor, antidepressants are used. Neuroleptics can also be prescribed in this case. In some cases, electroconvulsive therapy (ECT) helps. A seizure is provoked by electrical impulses. This treatment must be repeated for several consecutive days. There is hardly any health risk with this therapy.

Even if a stupor patient does not react to being spoken to, constant attention from all involved is very important. Former patients describe the constant address and attention as trust-building and relieving. In the case of a psychogenic stupor, a calm and low-stimulus atmosphere can often even enable a therapeutic conversation. Furthermore, constant monitoring of the vital functions is important in order to be able to identify complications quickly.

Outlook & forecast

The prognosis for stupor depends on the length of the acute condition and the triggering cause of the loss of consciousness. Recovery is considered likely if the patient can be addressed within 6 hours. If the language returns in the coming days or if the eyes are subject to voluntary movement, there is also a good chance of a cure.

Indicators of positive development are following instructions and responding appropriately to various speeches. The cognitive understanding and the content-related reaction to events is important for a good healing success.

The prospects are less good if the pupils do not contract when exposed to light. If the patient cannot follow an object with his eyes, this is also an indication of a complete recovery.

If seizures or a prolonged seizure occur more frequently within the first few days of the stupor, recovery is considered rather unlikely. If the person concerned is unable to move their hands or legs in a targeted manner after a week, the state of health is also classified as problematic.

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prevention

A stupor can only be prevented in the context of a known underlying disease. Treating them as best as possible will help avoid the freezing complication. There is no general prophylaxis of stupor due to the many possible causes.

You can do that yourself

Stupor is a state of absolute paralysis that can become life-threatening. The affected person is conscious, but can hardly make any movements. In addition, fever and muscle rigidity can occur, and normal urination and bowel movements are no longer present. Serious mental illnesses such as catatonic schizophrenia are a frequent background. However, the administration of certain psychotropic drugs can also trigger a stupor. This is especially true for certain neuroleptics.

Self-help is almost impossible with an acute stupor. This can only be resolved pharmacologically. This is why an inpatient setting is necessary for acute treatment.

However, through self-care in cooperation with doctors, those affected can strive to change basic drug attitudes that can trigger a stupor. If such a condition has occurred (possibly several times), it is advisable to change the medication with psychotropic drugs and to seek alternatives to the treatment of the underlying disease.

In addition, patients who notice that a stupor is looming should seek medical help from professionals very quickly, such as with a neurologist. However, since this often occurs in combination with severe mental illness and strong psychopharmacological medication, it is difficult for those affected to react in time themselves. Self-medication through the administration of relaxing agents that relieve rigidity is problematic and often not feasible.