Stupor: what it is, types, causes, symptoms and treatment

This alteration of consciousness causes people to remain in a state of total passivity.

Let us think for a moment about each and every action we carry out every day. Walking, talking, reading, eating... many of them we do practically automatically, while others require a certain effort.

However, each and every one of them has something in common: they require a certain level of awareness that allows us to perform them. And we do not always have it, for example when we are asleep. Our level of consciousness can oscillate to a great extent in a natural way.

However, sometimes some illnesses, injuries or disorders can provoke a deficient state of consciousness from which we are unable to emerge. The most serious example of this is coma, but there are also other similar disorders or alterations of great severity. This is the case of stuporof which we are going to speak throughout this article.

What is the stupor?

It is possible that in more than conversation we have heard or even used the term stupor to refer to a state of surprise that prevents us from reacting. This is a popular and valid use of this word, but there is also a medical meaning or meaning.

In this sense, the name stupor is given to a condition or alteration of the state of consciousness of a personin which there is a marked decrease in consciousness. On the other hand, due to the altered state of consciousness of those who manifest stupor, their behavior also becomes very passive, barely reacting to the elements of the environment.

Because of its implications, stupor indicates the presence of a very significant disturbance in the person's mode of functioning, and the duration of this state is highly variable.

Symptoms

Stupor is a state of loss or deficit of consciousness in which the subject remains in a semi-conscious state and does not react to environmental stimulation. It is virtually impossible to bring the subject out of this state unless a very intense and powerful stimulation is applied, something that will slightly and temporarily increase alertness. Some of the stimuli that can alter his state are, for example, screams or painful stimulation.

The most notorious characteristic of this state is the reactivity and the lack of voluntary movements, something that separates stupor from other alterations of consciousness such as confusion or obnubilation. confusion or obnubilation and makes it the closest state of consciousness and antecedent to coma. This is, after the latter, the most profound alteration of consciousness.

It is possible that in moments of elevation of consciousness the subject may make small gestures or even make some small vocalization or sound, although these will not be very coherent and will not be related to the context.

It is important to bear in mind that this state is neither feigned nor voluntary, so that the lack of attention to the environment is a consequence and not a cause of the state of stupor. Cognitive activity is diminished in the absence of a vigilant and attentive state and indifference is produced at the affective level.

Types

Although the concept of stupor is defined with the explanation given above, it is possible to identify different types of stupor depending on their cause and some specific characteristics linked to them.

1. Organic stupor

First of all, it is worth mentioning that we can find an organic type of stupor, in which the cause of such a state is a neurological alteration of Biological or acquired origin.. This type of stupor is characterized by the tendency to appear in a context of diffuse brain dysfunction, and is usually observed with a blank stare or closed eyes. In this state it is possible to carry out some unusual actions.

2. Psychiatric stupor

Another of the main types of stupor is psychiatric, derived from some kind of psychopathology.. Within it we can mainly find catatonic stupor, melancholic/depressive stupor and dissociative stupor.

2.1. Catatonic stupor

This is a type of stupor that appears in patients with catatonic schizophrenia. In this case usually appears waxy flexibility or maintenance of the posture in which the subject is placed, with muscular hypertonia. Mutatism, oppositional behaviors or automatic obedience may also be observed.

2.2. Melancholic stupor

A subtype of stupor that appears in depressive conditions, more frequently in cases in which the depression is endogenous..

In this case the subject does not respond to stimuli due to a total inhibition of behavior and speech, and contrary to other types of mutism, it is possible that there is a bodily expression denoting sadness (although the emotion is also totally inhibited).

2.3. Dissociative stupor

It is usually linked to the experience of some stressful or traumatic eventwhich causes a dissociation in the psyche of the person who experiences it. There is immobility, but if the subject is placed in a forced position, he/she returns to the original position. There is no resistance or muscular rigidity.

Causes of onset

As we can see, stupor is a condition that can be caused by a wide variety of causes, both organic and psychological.

Organic causes

Among the organic causes we can find the suffering of cerebrovascular accidents or the possible acquisition of some type of infection at cerebral or meningeal level.

The affected areas may be multiple and there may be diffuse neuronal damage, but it is also possible that there may be damage at the level of the reticular activating system or SAR (the part of the brain (part of the brain responsible for maintaining wakefulness and located in the brainstem) or areas such as the supratentorial.

Another possible cause could be the existence of some type of tumor, which can cause stupor if it compresses or affects the areas that govern consciousness, or if not enough blood, nutrients and oxygen reach the brain. Some diseases or severe hypoglycemia may also cause this condition.

It can also be caused by food intoxication, substance (including alcohol) or pharmacological intoxication. It is also possible for a person to reach a state of stupor after having suffered some type of craniocerebral trauma. In these cases the stupor is due to damage, lesions or alterations in the functioning of neurons.

Psychiatric alteration

Regarding the stupor of psychiatric type, it appears as a manifestation or symptom of as a manifestation or symptom of different pathologies.. Some of the most common are schizophrenia (specifically in the old catatonic subtype) or even in cases of melancholic depression.

The causes of these disorders are not generally known, although there are different hypotheses concerning each of these disorders. For example, the presence of aversive and traumatic events is often a trigger for those of the dissociative type.

Treatment of stupor

The existence of some type of stupor is a condition to be taken into account due to the absence of response and ability to act and maintain normative functioning. For this it is necessary to to go quickly to the emergency room in case it happens (especially if it occurs abruptly and suddenly).

In general, first of all it is essential to ensure vital signs and biological stability, as well as to monitor the patient's condition.

It should be borne in mind that stupor may be a symptom of an organic pathology or even of a stroke or traumatic brain injury, which could lead to serious sequelae, disability or even death if left untreated. Similarly, intoxication should also be treated differentially.

In case the stupor is the product of a pathology with an identifiable organic base, a complete recovery is not expected, although it is true that in some cases the symptoms disappear spontaneously after some time has passed. Thus, in the case of psychiatric or neurological diseases, treatments are carried out to alleviate the negative consequences of the pathology, not to completely eliminate either stupor or the other forms in which the disease expresses itself.

Subsequently and after analyzing the causes, the appropriate treatment will be applied in each case, according to its causes.

Bibliographical references:

• American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).
• Berrios, G.E. (1981). Stupor: A Conceptual History. Psychological Medicine. 11: pp. 677 - 688.
• Martinez, M.V. and Sáez, M.L. (2007). Alterations in the level of consciousness. Medicine: Accredited Continuing Medical Education Program, 9 (87): 5585-5591.
• Plum, F. & Posner, J.B. (1972). The Diagnosis of Stupor and Coma. Contemporary Neurology Series. 10: pp. 1 - 286.
• Santos, J.L.. (2012). Psychopathology. Manual CEDE de Preparación PIR, 01. CEDE: Madrid.