The psychopathology of consciousness
modafinil tablet price п»їConsciousness has been studied since the annals of philosophy and from this study emerges the psychopathology of consciousness. In fact, after 2500 years of discipline, there seems to be no consensus on the definition of this construct.
Descartes spoke of spirit, and his efforts were directed at understanding what it meant for a spirit to be able to say something about itself; Block (1995) spoke of two types of consciousness and Chalmers (1998) assumed that it would take "a century or two" to resolve this question.
Currently, psychological consciousness is being studied and whether there are neural correlates with conscious states (PГ©rez, 2007). The lines of research do not seem to agree on the object of study: should we focus on the correlates of the states of consciousness or of the content of consciousness?
Psychopathological disorders of consciousnessAlthough the definition of consciousness does not seem clear, it is certain that there are specific disorders of consciousness. Bleuler (1857-1939), a Swiss psychiatrist, defined consciousness as the awareness of self-awareness.
Thus, the person with a disturbance of consciousness was unable to respond adequately and comprehensibly to the demands of the environment, nor to internal stimuli. Based on this definition, the psychopathology of consciousness was organized.
GastГі and Penades (2011, in Santos, HernГЎngomez, & Travillo, 2018) spoke of four characteristics of consciousness, especially relevant in the disorders presented below:
Subjectivity or privacy of our minds.
Existence of a single consciousness in each individual.
Every act is directed to an end.
Self-consciousness, which is the capacity to know oneself and recognize oneself as such.
Disorders of consciousness are organized according to what is affected by the alteration. The CeDe Manual of PIR Preparation of Psychopathology (2018) is taken as a reference to expose them.
Deficit disorders of consciousness: lost in a dreamThe psychopathology of consciousness includes deficit disorders of behavior. These are characterized by brain pictures where the person presents difficulties in "waking up", orienting themselves and responding to sensory stimulation. They appear lost in time or lethargy. There are three types of deficit consciousness disorders:
Lethargy, drowsiness or drowsiness: individuals are unable to maintain attention and alertness even if they make an effort to do so. Lethargy is not a subjective feeling of sleepiness due to poor rest, but an alteration where there is hardly any physical or verbal stimulation.
Obnubilation: the person is in a deeper state of distractibility and lack of stimulation, and feels confused and irritated when another subject tries to bring him out of this state. There is a disturbance of his entire psychological functioning, and there are also perceptual distortions -auditory, visual-.
Stupor: stupor can be seen in conditions such as catatonic schizophrenia. The subject abandons all voluntary movement and his verbalization is incoherent and barely understandable.
The complete absence of consciousness occurs when the person goes into a coma, where reflexes such as the pupilocorneal reflex disappear, and a flat electroencephalogram is shown for thirty minutes. It is at that moment when we can say that there is no longer consciousness in the person.
Productive disorders of consciousness: hallucination in excessIn the psychopathology of consciousness we also find alterations that suggest that, although there is consciousness, it is far removed from reality, giving rise to hallucinations and delusions.
Onirism, or dream delirium, understood as confusion between the real and the imaginary, appears in all productive disorders of consciousness. In this confusion, people imagine dream-like states, interspersed with moments of lucidity. Onirism or confusion can be seen through these disorders:
Asthenic-apathetic stage: it appears mostly in elderly people, preceding toxic-confusional pictures. The asthenic-apathetic stage may appear in people at risk of delirium, and is characterized by affective lability, irritability, fatigue and apathy. There are also alterations in psychological functions such as memory or attention.
Confusional stage: precedes the acute confusional state or delirium. There are symptoms such as loss of coherence, memory distortion, incomprehensible language and behavioral disinhibition.
Delirium: delirium is an acute brain dysfunction that produces a global alteration of the mental state and is characterized by an alteration of consciousness, where there are marked attentional disturbances, and disorders of perception, thinking, short and long term memories, psychomotor activity and the sleep-wake cycle.
The change of context in deliriumDelirium usually occurs in elderly people who are admitted -for totally different reasons-. When the night comes, they go into an acute confusional state.
The change of context, the level of anxiety involved in being in a hospital, produces this. The serious problem is that hospital workers often don't know what to do. Context switching is the key.
Disorders of narrowing of the field of consciousness: division between thought and behaviorThese disorders are characterized by the lack of continuity between perception and cognition, but with an apparently "normal" behavior, full of automatisms.
We find as main disorder of the narrowing of the field of consciousness the twilight states. In the twilight state, the consciousness is totally blurred, but the understanding of the world, although distorted, is partial.
The subject's behavior seems to be in consonance with the environment and this occurs because automatisms appear in his behavior. These automatisms are involuntary movements -that is, they are not performed from consciousness- that the subject knew how to do before the twilight state.
This differentiates them from people with schizophrenia, for example, whose automatisms give rise to bizarre behavior.
In twilight states, impulses may also appear. Impulsions are impulsive behaviors with no cognitive basis - this differentiates them from compulsions that may appear, for example, in OCD.
Twilight states, however, come abruptly, but also disappear abruptly. They usually last a few hours or a few days, and the subject has no memory of the episode he or she has just experienced.
Psychopathology of the consciousness is also found in psychological or neurological disorders without this being the main problem. This is the case of alterations such as depersonalization and derealization, which usually appear in anxiety, panic and neurotic disorders.
Depersonalization is defined by Cruzado, NГєГ±ez and Rojas (2013) as an alteration of the consciousness of the self, where the person feels himself as distant and distant; the subject is a mere spectator of the mental processes and his body; he is only able to define his symptoms with expressions such as "as if" due to the difficulty in describing them.
Depersonalization, although found in psychological and psychiatric conditions, also appears in people without alterations due to physical or emotional exhaustion, stress or sleep deprivation.
Derealization is a similar alteration, however, it implies a change in the experience and perception of the world and not of oneself.
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