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The Treatment of the Special Forms of Mental Disease
Published in Francis X. Dercum, Rest, Suggestion, 2019
Treatment.—The treatment of stupor is essentially supporting in character. Like confusion, the disease is of long duration; many weeks, perhaps several months, pass by before convalescence is fully established, and during this time as much food as possible must be given to the patient. Feeding does not usually offer much difficulty; frequently it is possible to administer very large amounts of milk and raw eggs—even as much as three quarts of milk and six to eight eggs daily, with other food in addition. Now and then stupor is so profound as to necessitate a resort to forcible feeding.
Sleep, sedation and coma
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
Between alertness and coma are a variety of altered states of consciousness. Stupor is a state of unresponsiveness from which the patient may be aroused by vigorous and repeated stimuli. In palliative medicine it is usually a condition which progresses to coma. The moments of lightened awareness lessen, and responsiveness fades. PVS after severe brain injury consists of wakefulness without awareness. The eyes open spontaneously in response to verbal stimuli, the sleep–wake cycle exists and autonomic functions are maintained. No motor or comprehensible verbal output is possible. The minimal conscious state refers to a similar clinical state in which some semblance of response occurs. Slow visual tracking gives the appearance of communicating, though this is not able to be sustained. In the locked-in syndrome, consciousness is preserved but there is an almost complete inability to respond, only eye movements and blinking being preserved.
Naming the Mad Mind
Published in Petteri Pietikainen, Madness, 2015
Until the nineteenth century, madness had many faces but only a couple of names. From Greek antiquity, madness was typically divided into three main diagnostic categories: mania, melancholy and phrenitis. Mania denoted a state of confusion and over-activity, in which hallucinations, delusions and delirium were common. The counterpart to mania was not so much melancholy as stupor, a condition of greatly dulled or completely suspended sense or sensibility. According to humoral theory, stupor was caused by an excessive cooling of phlegma in the brain. Such a cooling made behaviour muted and produced a state of mental inertia (Healy 2008, 7). Attempts to explain the states of confusion in stupor were … confusing. For lack of a better explanation for the twilight state of consciousness, the medically credible term ‘disorientation’ was taken into use. During the second half of the nineteenth century, psychiatric efforts to find an adequate explanation for the states of confusion led to the introduction of the term ‘psychosis’. Thus, the terms ‘mania’ and ‘attacks of mania’ were replaced by ‘psychosis’ and ‘psychotic states’ or ‘episodes’. Regarding the two other main illnesses, melancholy, of which I will speak a little later, was not the same as today’s depression, while phrenitis is no longer in medical use. Phrenitis was defined in Hippocratic medicine as an inflammatory disease of the brain, and its main symptoms were fever and mental confusion or delirium. Pinel was the last eminent physician who used phrenitis in his classification. Today, such diagnoses as meningitis and encephalitis are used to name similar disorders.
Raymond D. Adams and Joseph M. Foley: Elaborating the neurologic manifestations of hepatic encephalopathy (1949–1953)
Published in Journal of the History of the Neurosciences, 2021
In any case, although Foley rarely used the term asterixis—the word he had helped coin with Father Cadigan—Adams was fond of it and used it in his chapters on liver disease in Harrison’s Textbook of Internal Medicine, and in his Principles of Neurology, written with Maurice Victor (Adams and Victor 1977, 737; Pal, Lin, and Laureno 2015): As Adams wrote in the first edition of Principles of Neurology, The confusional state [of hepatic stupor], before coma intervenes, is frequently combined with a characteristic intermittency of sustained muscle contraction, imparting an irregular “flapping” movement to the outstretched hands. The latter phenomenon, which was originally described in patients with hepatic stupor by Adams and Foley, and called asterixis (Gr. sterein, to fasten or support), is now recognized as a sign of various metabolic encephalopathies. (Adams and Victor 1977, 737)
PRES secondary to autonomic dysreflexia: A case series and review of the literature
Published in The Journal of Spinal Cord Medicine, 2021
Molly E. Hubbard, Aaron A. Phillips, Rebecca Charbonneau, Jordan W. Squair, Ann M. Parr, Andrei Krassioukov
PRES can arise from multiple pathologic conditions such as eclampsia, cyclosporine after transplant, and with severe hypertension.6 It is characterized by sudden headache, seizure, and visual abnormalities. Brain MRI demonstrates hyperintensity on T2 and FLAIR MRI sequences.6,7 PRES was first described in 1996 in a review of 15 cases with diverse histories, consisting of solid organ transplant, eclampsia, and uremia with renal failure8 though interestingly it is not always reversible nor benign.9,14,16 Over the past two decades other clinical signs associated with PRES have been identified, including cortical blindness, hemianopsia, or blurred vision. Other reports describe diminished alertness, stupor, paucity of speech, memory impairments and vomiting. Some of these signs and symptoms such as headaches, diminished alertness, stupor and memory impairments overlap with AD which also adds to the challenge of making an accurate diagnosis in SCI patients. Radiological signs of PRES are rarely seen in the anterior circulation.7 AD-associated PRES is a more complex syndrome than AD alone and is believed to be the result of impaired cerebral vascular autoregulation.27 Blurred vision was the most common visual symptom, followed by hemianopsia and cortical blindness. Imaging revealed T2 hyperintensities on MRI and hypodensities on CT scans in the posterior circulation. In our cases, AD was caused by UTIs and had lower BP than found in a typical hypertensive emergency.
Contextualizing ovarian pain in the late 19th century—Part 1: Women with “hysteria” and “hystero-epilepsy”
Published in Journal of the History of the Neurosciences, 2021
John Jarrell, Frank W. Stahnisch
The first consideration that the ovaries might be involved in what was then identified as hysteria was made by William Cullen (1710–1790) in Scotland (Cullen 1796). Cullen was a physician, chemist, agriculturalist, and a professor in the Edinburgh Medical School. He was the author of the important medical oeuvre First Lines of the Practice of Physic (1796). In its third tome, Cullen described the typical “fit” associated with hysteria this way: The disease attacks in paroxysms or fits. These commonly begin by some pain and fullness felt in the left side of the belly. … The patient is affected with a stupor and insensibility, while at the same time the body is agitated with various convulsions. … The trunk of the body is wreathed to and fro. … More or less suddenly, and frequently with repeated sighing and sobbing … the patient returns to the exercise of sense and motion but generally without any recollection of the several circumstances that had taken place during the fit. (Cullen 1796, 161)