DISORDERS OF

CONSCIOUSNES
S
Presented By : Garima Nirankai
 Table of contents
Consciousness Unconsciousness
01 02
Dimensions of Pathology of
Consciousness Consciousness
03 04
Consciousness
State of awareness of the self and
the environment
One must be conscious in order
to able to experience the world.
It is to know about oneself and
the world.
 Characteristics of the consciousness

• It is restrained to any external physical description, for example, the

redness of the colour red as we perceive it.

• It is intentional.

• It has content, it is always about something.

• It is unified into a whole.

Unconsciousness
Mental activities within an individual that
proceed without his awareness
Acc. To Jaspers
● Something that is not an inner existence and
does not occur as an experience

● Something that is not thought of as an object

and has gone unregarded.

● Something which has not reached any

knowledge of itself

● .’. No subjective experience

 Three dimensions of consciousness
• A person suffering from serious brain disease may be unconscious;
consciousness in this instance is seen as being on continuum, with a
normal state of consciousness at one and death at the other end.

• Someone who is asleep is unconscious; again there is a continuum from

full wakefulness to deep sleep.

• An alert and healthy person is aware of only certain parts of his

environment both internally and externally; of the rest, he is unconscious.
There is also a continuum here from full vigilance directed towards the
immediate object of awareness to total unawareness
Dimensions of
consciousness
 Vigilance-Drowsiness
● Vigilance is a stage of consciousness where individual deliberately remains
alert

● Anxiety, interests, fear, enjoyment are the promoting factors, whereas,

boredom encourages drowsiness

● Some abnormal state of health increases vigilance, while many diminish it

● Drowsiness diminished alertness and attention that is not under the patient’s
control
 LUCIDITY- CLOUDING

● Lucidity can be demonstrated only in clarity of thought on a particular topic;

clear in consciousness

● Clouding is a lesser stages of impairment of consciousness

● In clouding, most intellectual functions are impaired; attention,

concentration, comprehension, recognition and understanding
 Consciousness of self

● Ability to experience full wakefulness of self and clear

awareness of self and surroundings
PATHOLOGY OF CONSCIOUSNESS

Abnormal states of consciousness show a

lowering of consciousness or heightened
consciousness
 Heightened Consciousness
● Subjective sense of richer perception; colour seems brighter and changes in
mood.

● Subjective experience of increased alertness and a greater capacity for

intellectual activity, memory and understanding.

● There may also be Synaethesiae ( a sensory stimulus in one modality resulting

in sensory experience in another; for example. Hearing a fingernail drawn
down a blackboard results in a cold feeling down in the spine
 Heightened Consciousness

● Both heightening of consciousness and synaesthesiae, may occur in normal

and healthy people at times of emotional, social or religious crisis.

● For example, falling in love, winning a large sum of money, at sudden

religious conversion

● Certain drug- hallucinogens, e.g. LSD

● Early psychotic illness, especially in mania, or less often in schizophrenia

 Quantitative lowering of consciousness
Consciousness may be considered as a
continuum from full alertness and
awareness to coma
 CLOUDING OF CONSCIOUNSES
● As we read, clouding is a lesser stages of impairment of consciousness with
deterioration in thinking, attention, perception, memory and usually
drowsiness and reduced awareness of the environment

● Clouding may be seen in a wide variety of acute organic conditions,

including drugs, head injury, meningeal irritation caused by infection.

● It is also known as mental confusion or mental fog

 DROWSINESS
● This is the next level of progressive impairment

● The patient is awake but will drift into sleep if left without sensory stimulation

● Slow in actions, slurred speech, sluggish in intention and sleepy on subjective

description

● Reflexes, inc. coughing and swallowing is present but reduced, muscle tone is
also diminished

● Causes can be head injury, tumour, epilepsy, infection and overdose of drugs
( tricyclic antidepressants)
 COMA
● The drowsy pt. is conscious but lapsing at times into unconsciousness, while
in coma, the patient is unconscious.

● In lighter states, with strong stimuli, he may be momentarily rousable.

● There are no verbal responses to painful stimuli, righting of posture has been
lost, reflexes and muscle tone is present but greatly diminished, breathing is
slow, deep and rhythmic; skin may be flushed.

● In later stages, pt. is no longer rousable; he is deeply unconscious.

Qualitative changes of
consciousness
 Delirium

● Global impairment of cognitive functions, a reduced

level of consciousness, attention abnormalities,
increased or decreased psychomotor activity and a
disordered sleep- wake cycle.

.
 Fluctuations of consciousness

● It occurs in healthy, in sleep and in fatigue

● Epilepsy pt. experience fluctuations of consciousness relation to fits and it

may occur before, during or after seizures.

● In delirious states, there may be considerable diurnal fluctuations of

consciousness.

● The patient becomes more disoriented, disturbed mood, illusions and

hallucinations.
 CONFUSION

● Loss of capacity for clear and coherent thought.

● Confusion of thinking can be described as

occurring either when the individual describes his
own thinking as being confused or when the
external observer considers that the thought
processes are disturbed and confused.
 TWILIGHT STATE
● It is interruption of the continuity of consciousness.

● It is usually an organic condition and occurs in the context of epilepsy,

alcoholism, brain trauma and dissociative states.

● It has abrupt onset, variable duration ( from few hours to few weeks), it has
occurrence of unexpected violent acts or emotional out bursting during
otherwise normal

● Consciousness may be markedly impaired or normal during episodes; there

may be associated dream like states, delusions or hallucinations.
 PATHOLOGICAL INTOXICATION

● This one type of twilight state is associated with

alcoholism

● Has senseless and violent behaviour

● Then have prolonged sleep

● Total or partial amnesia for the disturbed

behaviour occurs
 DREAM LIKE STATE ( ONEIROID)

● Lowering of the level of consciousness which is the subjective experience

of a rise in the threshold for all incoming stimuli.

● The patient is disorientated for time and place, confused, experiences

elaborate hallucinations and marked emotional change.

● May appear to be living in a dream world, and so called occupational

delirium.
 STUPOR
● It is a reduction or absence of relational motor functions and speech.

● It does not lie on a continuum from wakefulness to coma. It does occur with
some degree of clouding of consciousness.

● In this state patient is unable to initiate speech or action but appears awake
and even alert .

● However , it is important to realize that the symptoms of akinesis and mutism in

a conscious patient may occur with schizophrenia, with affective psychoses and
in dissociative states.
 HYSTERICAL TWILIGHT STATE

● In severe anxiety, the patient may be so preoccupied by their conflicts that they
are not fully aware of their environment and find that they have hazy idea of
what has happened in the past hour or so. This might suggest to the patient that
amnesia is a solution to their problems, so that they forget their personal
identity and the whole of their past as a temporary solution for their difficulties.

● This restriction of consciousness resulting from unconscious motives has been

termed as “ hysterical twilight state”