Consciousness and conscious activities are based on a clear state of consciousness. The so-called conscious state means that the cerebral cortex is in an appropriate state of excitement or pre-excitation. In this state, the tension of cerebral cortex is maintained, which provides conditions for the rapid occurrence and development of various higher nervous activity processes and the smooth progress of various conditional connections. When the consciousness is clear, we can clearly understand all kinds of external objective things and their internal activities, and we can clearly realize our various spiritual activities. A clear state of consciousness must have good orientation, attention and understanding. Therefore, people's psychological process is accurate, continuous, flexible, positive and directional, and people's behavior has motivation, purpose, direction and foresight.
The disturbance of consciousness is caused by the inhibition of brain function. When consciousness is disturbed, firstly, the clarity of consciousness is destroyed, which leads to pathological changes in the excitability of cerebral cortex, and the perception of objective stimuli and the feeling of self cannot produce a clear impression, or it is difficult to perceive, or it cannot be perceived at all; The initiative of various psychological processes is reduced, or disjointed, fragmented, or stagnated at a certain stage, confined to a narrow range, and various conditional connections cannot be carried out smoothly, resulting in difficulties in analysis and synthesis, errors in judgment and reasoning, or all kinds of psychological activities can not be carried out at all, and are partially or completely forgotten afterwards.
Second, the classification of consciousness disorder 1. Acute disturbance of consciousness Acute disturbance of consciousness is mainly the disturbance of consciousness in the surrounding environment, which is caused by acute systemic diseases. It is usually divided into three types: the decrease of consciousness level, the change of consciousness content and the narrowing of consciousness range. The mechanism, etiology, basic concepts and differential diagnosis of different acute consciousness disorders are as follows.
Pavlov believes that the obstacle of consciousness is due to the diffusion of cerebral cortex inhibition, which is a protective inhibition process. Because of the different depth and breadth of the diffusion of cerebral cortex inhibition process, different consciousness disorders appear. When the inhibition process spreads to the whole cerebral cortex brainstem, drowsiness and coma occur. The "magnum" state is mainly due to the phase state of the second signal system. Under the influence of the second signal system, the activity of the first signal system is released and dominated by the emotional activity of the subcortical layer, so the symptoms should be chaotic. Dreaming is the strongest stimulus during the day, and some stimuli are still active under the background of shallow cerebral cortex inhibition. Delirium is due to the fact that the inhibition process of cerebral cortex is not deep, and the inhibition process at least spreads to the motor area, but the second signal system is inhibited, making the first signal system and subcortical activities relatively dominant. The state of insanity may be due to the extremely low activity of neurons in the cerebral cortex, which leads to the weakening and failure of the basic process of higher nervous activity. The interaction between the two signal systems is seriously unbalanced, and unconditional reflex is also the result of serious obstacles. Because subcortical excitement is dominant, this kind of excitement has a negative induction effect on the cerebral cortex, which may also be caused by pathological and temperament excitement lesions in the cerebral cortex.
Penfield pointed out that consciousness is closely related to reticular structure and cerebral cortex, while awakening state is mainly related to reticular structure and consciousness content is related to cerebral cortex. He believes that the specific projection system is the transmission path of various senses, and there are lateral branches in the brain stem that enter the reticular structure, and then diffuse projection from the thalamus to the cerebral cortex through the nonspecific or diffuse projection system. These nerve transmission impulses maintain the awake state of the cerebral cortex (also known as the ascending activation system). The other part is the ascending inhibitory system, which has an inhibitory effect on the cerebral cortex. Under the joint action of ascending activation system and ascending inhibition system, the cerebral cortex is in a suitable excited state. Only when the cerebral cortex is in a proper state of excitement can people correctly understand external objective things and their own psychological activities. If the brain stem is removed or injured and the reticular structure is damaged, there will be a loss of consciousness, but not necessarily after removing a large piece of cerebral cortex. In a word, the cerebral cortex relies on the ascending activation system of reticular structure to keep awake, so as to carry out various mental activities, and the content of consciousness is the overall function of the cerebral cortex, which is a unique higher nervous activity of human beings.
(1) There are many reasons for the disturbance of consciousness, which are often caused by various systemic diseases. It is also very difficult to describe them completely, but they can be roughly divided into several types:
Various physical diseases of the whole body: such as liver disease, kidney disease, lung disease, heart disease, endocrine disease and water-electrolyte disorder caused by various reasons.
Infected with toxic diseases: such as septicemia, typhoid fever, toxic dysentery, various drug poisoning and carbon monoxide poisoning.
Brain organic diseases: such as craniocerebral trauma, brain tumor, brain parasitic diseases, brain degenerative diseases, cerebrovascular diseases, seizures, etc.
Acute functional diseases: such as acute psychogenic reaction, hysteria, acute schizophrenia, affective disorder, etc.
(2) Symptoms ① Sleepiness: the clarity of consciousness is slightly reduced, which is manifested by the slow response of various psychological processes. In a quiet environment, patients are often in a state of lethargy, and may not respond to slight stimuli, but they still maintain painful reactions and have evasive actions. The patient's emotional response is indifferent, indifferent to external things, inattentive and poor orientation. Although I can talk to people, I speak slowly and simply, and my calculation is difficult, and my memory is declining. You can also do some simple actions, but you can also be awakened, but once the stimulation disappears, you will go back to sleep. At this time, swallowing, pupil and corneal reflex all exist. After the recovery of consciousness, the memory of the situation at that time was vague and fragmented.
② Turbid state: the clarity of consciousness is obviously reduced, mental activity is extremely slow, and the threshold of external stimulation is obviously increased, so it is difficult to cause a reaction except strong stimulation. Thinking activities are very slow, and repeated questions to patients can only get very simple responses or no answers. The patient's expression is dull, his reaction is slow, his attention is difficult to concentrate, and it is very difficult to remember and understand. Swallowing, corneal and light reversal still exist, but tongue spitting, lip licking and strong grasping may occur. Primitive actions such as sucking. After the disturbance of consciousness subsided, most of them were forgotten.
3 lethargic state: also known as shallow coma. Consciousness is not completely lost, but the clarity of consciousness is deeper than the above two, and the periphery and self-positioning are damaged. Unable to respond to common stimuli such as shouting or moving the patient's limbs. Acupuncture on patients' skin can lead to defensive reflex, and pressing the inner side of orbital margin with fingers can lead to facial muscle movement. The patient has no active behavior, bedridden and unable to take care of himself, incontinence, loss of thinking and speech function, and no cognitive and memory activities. Hyperreflexia or pathological reflex. Involuntary movements and tremors may occur. Corneal and eyelash reflexes are weakened, but light reflexes remain. It is anterograde amnesia after consciousness is restored.
4 coma: complete loss of consciousness. The functions of attention, memory, thinking and language disappear, and there is no response to any stimulus and no voluntary movement. Physiological reflexes such as orbital pressure, cornea, light and eyelashes are extremely weakened or disappeared, and pathological reflexes may occur. Once consciousness is restored, the coma process is completely forgotten.
⑤ Hazy state: Not only the clarity of consciousness is reduced, but also the scope of consciousness is narrowed or narrowed. The patient's activities are concentrated in a narrow range, and he can correctly perceive and respond to various stimuli within a certain range, and can complete some continuous actions, but it is difficult to perceive and judge things outside a certain range, and even it is difficult to give a correct evaluation or form a distorted impression. Such patients will lose their way. On the basis of the hazy state, there may be hallucinations, delusions and delusions, as well as psychomotor excitement and impulsive behavior under the control of hallucinations and delusions, which endanger the safety of people around or themselves. The hazy state of consciousness can appear suddenly or stop suddenly for several minutes, hours or days. After the attack, people can often enter a deep sleep state. When consciousness is restored, the experience of illness can be partially or completely forgotten.
⑥ Roaming automatism: This is a special form of parochial attack. Patients often have some complicated actions or behaviors with no purpose, which are extremely unsuitable or even meaningless to the situation at that time, such as rigidly opening and closing the door, or wandering aimlessly indoors and outdoors. This symptom suddenly appeared and then disappeared. Memory loss after waking up.
⑦ Delirium: it belongs to the consciousness obstacle of the change of consciousness content. Not only the clarity of consciousness is obviously reduced, but also a lot of illusions and hallucinations are produced. Hallucinations are mainly vivid, rich, lifelike and vivid hallucinations, and linguistic hallucinations are rare. Under the influence of cognitive impairment, patients often have panic and nervous emotional reactions, which are manifested as uncoordinated psychomotor excitement, and patients have behaviors such as running away, impulsive, hurting people or damaging things or self-injury. Patients' judgment and directional thinking are impaired, and they may have the delusion of being killed with incoherent and fragmented thinking, some are silent, some are shouting or talking to themselves. Peripheral disorientation, self-orientation still exists. The disorder of consciousness fluctuates from day to night. It usually lasts for several hours to several months. After the recovery of consciousness, patients often forget some or all of their experiences in the disease.
⑧ Mental disorder: basically the same as delirium, it is also an obstacle to the content of consciousness, but it is more serious than delirium, and the patient's peripheral consciousness and self-consciousness are lost. Thinking is extremely incoherent and mumbling, but there are fragments of hallucinations and delusions. Emotions are vacant, dull, fearful and anxious. Act excited and restless, move around, and do some chaotic and aimless little tricks. It usually lasts for days, weeks or longer. It is also characterized by light days and heavy nights. When consciousness came back, everything was forgotten.
(9) Dreaming state: While the consciousness clarity is reduced, there are illusions, hallucinations and delusional experiences, mainly false hallucinations. The patient seems to be in a dream, and these experiences are often combined with other imaginary experiences. Most of these dreams reflect some fragments of real life. Patients often indulge in hallucinations and lose contact with the external environment, and their self-orientation is usually not damaged. Patients not only participate in the dream experience, but also often appear as bystanders. This state can last for weeks to months.
2. Acute disturbance of consciousness (1) schizophrenia with functional psychosis. Schizophrenia patients usually have personality changes, split thinking, emotion, will and behavior, clinical manifestations of disharmony between the whole mental activity and the environment, and unconscious obstacles when they are conscious. At this time, the patient is excited, impulsive and destructive, and may even hurt himself or herself, with emotional fear. Cry or rejoice for no reason. After treatment, patients often forget part of their illness at this stage. When the onset is induced by obvious mental stimulation, the patient may be in a state of confusion, which is characterized by nervousness, anxiety, fear, excitement and anxiety, disorientation, hallucinations and delusions reflecting mental stimulation fragments, speech disorder and absurd logical reasoning. When the disease begins under the influence of infection, poisoning, childbirth or craniocerebral trauma, patients often have different degrees of consciousness disorder, which is manifested as hazy consciousness, delirium or dreaminess. At this time, patients have disorientation, agitation, incoherent thinking, language fragmentation, and obvious illusions, hallucinations and delusions. They show emotional tension, fear and anxiety, and will hurt others, hurt others or commit suicide. The characteristics of this disease are as follows: ① The duration of acute disturbance of consciousness is not long, and the disturbance of consciousness disappears after the acute stage or after the disappearance of infection, poisoning and mental factors. ② After the recovery of consciousness, it is manifested as the basic symptoms of schizophrenia, that is, the division of thinking, emotion and will, and the disharmony between the whole mental activity and the external environment.
(2) Manic state. Acute mania: the onset is more urgent, and there is often disturbance of consciousness. At this time, the patient's mood is extremely high, showing excitement, excitement, ecstasy and even shouting, constantly shouting slogans, being rude to people, and obviously increasing his speech, which can reach the level of screaming, incoherent and exaggerating delusions. In severe cases, the movements increase, people are restless for a moment, streaking, destroying furniture, tearing clothes and quilts, etc. So that patients can transition to delirium mania.
(3) Delirium Mania: The disease is transformed from acute mania, when the patient is unconscious, disoriented, hallucinating, delusional and delusional. The patient was highly excited, did not eat or sleep, and kept talking and doing. The sentences are irrelevant, but he is screaming, hoarse and speechless, and his actions have no purpose. Emotional tension, shivering, sweating, rapid pulse, dilated pupils, elevated body temperature, and inability to take care of themselves, which can be fatal if not treated in time. After the treatment method is improved, patients will forget most or all of their illness. The characteristics of this disease are: ① A history of recurrent mania or depression. ② The basic symptoms of patients are high mood, thinking escape and increased movements. ③ Acute or delirious manic episodes are mostly developed from hypomania. ④ Once the acute disturbance of consciousness disappears, the basic symptoms of mania are exposed.
(4) hysteria. A few days before the onset of hysteria, people often have an acute attack after mental stimulation, showing different degrees of consciousness disorder. ① Mild disturbance of consciousness: Most patients have acute onset induced by mental factors. In this case, the patient's emotional reaction is very strong, such as crying and laughing, rolling on the ground, making noise, shouting, breaking into a furious rage, chest tightness, punching, tearing clothes, pulling out hair, banging his head against the wall and other emotional outbursts. From tears to laughter, accompanied by dramatic expressions and movements, patients' conscious activities are mostly limited to the content related to emotions. Usually the attack time is short, and some amnesia occurs after the attack. ② Ambiguous state of consciousness: In this state, on the one hand, the clarity of the patient's consciousness is obviously reduced, on the other hand, the scope of consciousness is narrow, and the whole mental activity of the patient is consistent with the unpleasant inner experience that causes the disease. The orientation is incomplete, the patient's perception of the surrounding environment is relatively slow, the behavior and actions are consistent with the unpleasant experience caused by mental stimulation, the emotional response is vivid and vivid, and the patient's actions and expressions are dramatic and performative. Under the influence of narrowing the scope of consciousness and strong emotions, patients may have fantasies and psychogenic hallucinations. Hallucinations are common, and their images are vivid and concrete. Sometimes they also participate in illusion scenes, some of which are superstitious like ghosts and foxes. This hazy state often appears suddenly and stops. The duration usually does not exceed several tens of minutes. Most of them were completely or partially forgotten after being attacked. (3) Sleepless state: When the patient has a deep disturbance of consciousness, he does not respond to the usual external stimuli, stays in bed with his eyes closed all day, or occasionally turns over. You shouldn't scream if you don't push at this time. Your eyes are closed. If you open your eyelids, you can see the eyeball turn or squint to one side. Check that the pupil size is normal, the muscle tension is increased, the movable limbs have a sense of resistance, the pain stimulation response is weakened, the cornea is stored reversely, tendon reflexes are hyperactive or pathological reflexes may appear. When I regained consciousness, I forgot all about my illness. The characteristics of this disease are: ① obvious mental factors and strong emotional experience caused by them. ② There are obvious personality characteristics of hysteria. ③ The appearance and disappearance of symptoms are closely related to hints. ④ Symptoms are diverse, and the symptoms are obviously emotional, dramatic or theatrical. ⑤ Although there may be physical dysfunction, there is no positive section corresponding to clinical symptoms.
(5) reactive psychosis. Acute reactive psychosis is an acute disease caused by sudden and very serious mental trauma, often accompanied by different degrees of acute disturbance of consciousness, but the course of disease is short, the prognosis is good, and there are few residual symptoms. There are mainly the following kinds of consciousness disorders: ① hazy state of consciousness: the patient's level of consciousness clarity is reduced, his perception of the surrounding things is unclear, his performance is chaotic, his attention is not concentrated, his orientation is disordered, and he may have hallucinations or delusions that reflect the contents of psychological trauma, and his speech is messy and disorganized. Patients are nervous, fearful, disorderly, aimless, or agitated or impulsive. This state lasts for a short time and can usually be relieved within several hours to several days (especially after leaving the traumatic environment), and the episode can be partially or mostly forgotten afterwards. ② Reactive stupor: After the patient suffered severe mental trauma, he immediately developed mild disturbance of consciousness. On this basis, he suddenly froze and became stupefied. The patient's emotional response is slow, and he can be sedentary or stay in bed for a long time, silent all day, and slow to respond to the call of others and the coming of danger. Mild people may have mild psychomotor inhibition, showing a sub-coma state. The duration usually varies from several hours to several days. After the numbness is relieved, some diseases may be forgotten. (3) fugue-like reaction: Some patients may have confusion, nervousness and fear immediately after acute mental trauma, running or walking aimlessly, and once they wake up, they will partially forget the course of the disease. The characteristics of this disease are as follows: ① Abnormal traumatic experience. (2) Acute mental trauma occurs immediately after a few minutes or hours. ③ Mental symptoms are different degrees of acute disturbance of consciousness, or psychomotor excitement accompanied by intense experience, or psychomotor inhibition. ④ The course of the disease lasts for several hours to a week, and finally it is completely relieved.
3. Intermittent attack of consciousness disorder Intermittent attack of consciousness disorder is a short-term and frequent attack of consciousness disorder, and intermittent consciousness activity returns to normal, which is a type of acute consciousness disorder. More commonly, syncope, absence attack and convulsion caused by various reasons present different degrees of consciousness disorder. The differential diagnosis of intermittent paroxysmal diseases is as follows.
(1) syncope. Syncope, also known as syncope, is a sudden and brief loss of consciousness, which usually lasts for several seconds to several minutes. During the attack, the muscle tension of the whole body decreased, and it was impossible to maintain the standing posture and fainted, mainly because the brain was temporarily short of blood supply. It may also be caused by changes in blood chemical composition or hypoglycemia. After proper treatment or without any treatment, it can recover itself without leaving any symptoms and relapse.
Common causes of syncope are:
Cardiogenic syncope: ① Acute cardiac output obstruction: mainly severe valvular heart disease, cardiac tamponade, ventricular outflow tract infarction, atrial myxoma or spherical thrombus, etc. ② Arrhythmia: mainly seen in ventricular arrest, tachycardia and bradycardia. ③ Myopathy: seen in myocarditis, myocardial ischemia and myocardial infarction. ④ Obstruction of pulmonary blood flow: seen in primary pulmonary hypertension, pulmonary embolism and pulmonary stenosis.
Vascular dysfunction syncope: including vasoinhibitory syncope, carotid sinus syncope, micturition syncope, cough and swallowing syncope.
Encephalopathy syncope: ① Cerebrovascular diseases: including cerebral arteriosclerosis, cerebral artery stenosis or obstruction, transient ischemic attack, cerebral vasospasm, subarachnoid hemorrhage, etc. ② Arterial sinus syncope (cerebral type); ③ Aortic arch syndrome; ④ Medullary syncope, etc.
Hematological syncope: ① changes of blood carbon dioxide partial pressure: including low carbon dioxide (hyperventilation) and high blood carbon dioxide partial pressure (respiratory insufficiency); ② Hypoxia and cyanosis congenital heart disease; ③ hypoglycemia.
4. The most basic cause of hysterical syncope (1) is transient cerebral blood supply insufficiency. The average weight of adult brain is about1400 ~1500g, accounting for 2 ~ 2.5% of human body weight, while the blood flow obtained by the brain accounts for about 15% of the whole body, and the oxygen consumption of the brain accounts for about 20% of the whole body oxygen. Brain cells have poor ability to store energy substances and high oxygen consumption. Therefore, it is necessary to obtain it from appropriate cerebral blood flow in time. When the cerebral blood flow is interrupted for 6 ~ 10 seconds, brain cells can't get the substances and oxygen needed for metabolism, and they will lose consciousness. Due to acute cardiac insufficiency or sharp decrease in blood volume and sharp decrease in cardiac output, blood pressure will drop, blood supply to the brain cannot be adjusted in time, and cerebral perfusion pressure will drop to the minimum requirement of the brain, which will lead to syncope. When the tension of peripheral blood vessels loses reflexively or passively for various reasons, peripheral small vessels expand rapidly and widely. At this time, although the cardiac output did not decrease obviously, the blood pressure decreased obviously, and the cerebral perfusion pressure also decreased accordingly, resulting in insufficient blood supply to the brain and syncope. When there is cerebral vasospasm or occlusive disease, the cerebral vascular resistance increases obviously. When blood pressure drops slightly, the normal regulation of cerebral blood vessels is lost, which can cause insufficient blood supply to the brain and lead to syncope. In addition, due to some changes in blood composition, cerebrovascular resistance increases, which leads to a significant decrease in cerebral blood flow and also causes syncope.
(2) Symptoms before the onset of symptoms: Before the onset of syncope, patients may have premonitory symptoms, such as dizziness, general fatigue, tinnitus, trance, pale face, saliva in the mouth, sweating all over the body, etc.
Symptoms during the attack: When symptoms appear before the attack, if you lie flat or face down immediately, you can prevent syncope, otherwise the patient will have confusion, aggravate dizziness, nausea and vomiting, pale as wax, weak limbs, and head lower than chest. After about a few seconds, the whole body muscle tension was lost and the patient fell to the ground.
Symptoms after the attack: After the attack of syncope, patients sometimes have turbid consciousness and feel abdominal discomfort, which may be accompanied by nausea, even vomiting, diarrhea, head discomfort, sweating, pale face, cold limbs and some drowsiness. The mild attack lasts only a few seconds, and the severe attack can last for several minutes, and consciousness gradually recovers. If accompanied by convulsions, the recovery of consciousness can last for dozens of minutes.
5. Chronic unconsciousness is caused by a variety of cerebrovascular diseases, brain infections, carbon monoxide poisoning, brain trauma, brain hypoxia, etc. In the recovery process of patients, the autonomic nervous system first stabilizes, then the degree of coma gradually becomes shallow, and it begins to respond to specific external stimuli, which can present chronic unconsciousness to varying degrees. Two common chronic conscious disorders are identified as follows:
Brain syndrome. Also known as coma. It is mainly caused by carbon monoxide poisoning, hypoxic encephalopathy, encephalitis, brain trauma and cerebrovascular diseases. , bilateral extensive cerebral cortex and white matter atrophy. The clinical features of I are: ① disturbance of consciousness and aimless exercise; ② Sleep and awakening alternate. When awake, the line of sight is fixed, but the eyeball can't move with the object, lacking blink reflex, and sleeping more, but there is no day and night change; (3) external stimulation can make them awake, and strong stimulation can lead to joint movement. Most of them showed torsion spasm; ④ Incontinence of urine and urine, increased muscle tension and flexion of upper limbs. Primitive reflexes such as sucking, swallowing and strong grasping are positive.
Reflexive motor mutism This disease is rare in clinic. Mainly due to the damage of reticular activation system in the upper brain and thalamus. Common in local inflammation, tumors, vascular diseases or hypoxic diseases. The clinical manifestations are as follows: ① there are different degrees of consciousness disorder; ② There is no spontaneous action or speech at all; 3 When you wake up, you can blink your eyes, stare at the distance, and chase moving objects; ④ There are light reflex, corneal reflex and cough reflex; ⑤ Swallowing can occur after food clustering, and there is avoidance response to pain stimuli; ⑥ There is a sleep cycle, when you sleep, you can "wake up" because of external stimuli, but you can't really wake up; ⑦ Passive limb movements can cause resistance and incontinence.
6. Self-awareness obstacle Self-awareness refers to the individual's confirmation of the current subjective state, which mainly includes the following parts:
Existence consciousness: it means that people can have a realistic and exact experience of their own existence, rather than nothing.
Initiative consciousness: it means that people can realize that their spiritual activities are dominated and controlled by themselves rather than others.
Unity consciousness: it means that people can realize that they are the same person and the same "I" at different times, rather than becoming two or more "I" at different times.
Unity consciousness: refers to being a single person and an independent person at the same time.
Boundary consciousness: it means to realize that there is a certain boundary between oneself and others or things, and to experience that oneself and others or things are independent individuals.
Self-awareness disorder means that one or more of the above aspects are affected to varying degrees. As a result, patients can't correctly understand their current subjective state, including their own existence, and they are a single and independent individual. What is the difference between their present self and their past self, and they lose self-control and control over their psychological activities. In short, patients cannot correctly understand their own personality characteristics.
The complete loss of self-consciousness is mainly due to drowsiness, coma or insanity caused by various diseases. However, several special forms of self-awareness disorders can be seen in various functional psychosis, such as neurosis, schizophrenia, affective psychosis or mild brain organic psychosis.
(1) symptoms.
Dual personality: refers to the fact that the same person has two completely different inner experiences at different times, showing two different personalities, that is, two different personalities appear alternately on the same person. When one personality is dominant, another personality characteristic is completely excluded from his consciousness. When the same person has more than two personality characteristics, it is called multiple personality, which is seen in hysteria patients.
Personality change: the patient denies that he is the original self and claims to be another person or animal, but his behavior and language may not necessarily change accordingly. More common in hysteria or schizophrenia.
Disintegration of personality: the patient loses the realistic experience of his own behavior and feels that he is changing, not his original self. The patient feels empty, not his own, unreal or no longer exists. Or feel manipulated by alien forces or become an automaton. Personality disintegration is mostly related to nihilism and delusion. Can be seen in neurosis, depression or schizophrenia.
Reality disintegration: the patient feels that everything in the surrounding environment has become dim and vague, and things seem to be separated by a veil or a wall, becoming strange and distant, and everything has lost its vitality and has an unreal feeling. The feelings between relatives have also become indifferent, lacking emotional contact and care, and the family environment and workplace seem to have changed, so patients have the experience of dreams outside their bodies. Common in depression and schizophrenia.
Feeling of being leaked: The patient felt that his thoughts and feelings were leaked to the whole world, which set off a storm in the whole city and everyone knew it. Seen in schizophrenia.
Sense of dominance: Patients feel that their thoughts and behaviors are being dominated and controlled by others or external forces, but they cannot control themselves. Seen in schizophrenia.
Lack of self-knowledge: self-knowledge, also known as internal labor saving, refers to the ability of patients to understand their subjective or mental state, and should also be the ability to correctly analyze, judge and point out the similarities and differences between their own state and inner experience and whether they have mental illness.
To judge whether the patient's insight is complete, we should pay attention to the following aspects: ① Patients with complete insight can fully realize that they have suffered from the disease. ② Patients with complete self-knowledge can experience or perceive that their diseases are mental diseases. ③ Patients with complete self-knowledge can distinguish what is normal and what is abnormal or abnormal in their own performance or experience. ④ Patients with complete self-knowledge can clearly analyze and explain the reasons why morbid manifestations or experiences are morbid, such as their own understanding does not conform to objective facts or there is no objective reality at all. ⑤ Patients with complete insight can clearly understand the background and process of the occurrence and development of mental illness. ⑥ Patients with complete self-knowledge can not only admit that they are sick, but also take the initiative to seek medical treatment, urgently demand treatment and give active cooperation.
Lack of insight means that patients can't make a correct estimation or evaluation of their psychopathological state. I can't correctly understand the changes of my mental state and personality characteristics before and after my illness, and I can't understand the differences between my morbid thinking, emotions and behaviors and ordinary people. I just don't know the difference between "I" before illness and "I" in illness. Even denied illness and refused to receive treatment. Neurotic patients usually have complete insight. Severe mental patients, such as schizophrenics, often experience some abnormal psychopathological phenomena or are dubious about some of their symptoms in the early stage of onset or in the process of rehabilitation, which shows that they have partial self-knowledge. Total loss of insight usually occurs in the progressive or severe stage of the disease. Epiphany can be gradually recovered through treatment or remission. When the disease is cured or completely relieved, the epiphany is completely recovered, and the incomplete recovery of epiphany indicates that the mental illness is not completely cured or relieved. Therefore, the complete recovery of epiphany is one of the important indicators to judge whether the disease is cured.
(2) type.
Schizophrenia. Schizophrenia patients lack self-awareness in the severe stage of illness, and are often accompanied by various forms of self-awareness obstacles: ① The feeling of being exposed inside, also known as the feeling of being perceived. The patient believes in anything he thinks he already knows, even though he doesn't say it. Although the patient doesn't know through what channels or ways, the patient firmly believes that this matter has been known by everyone, and even caused a storm in the city. Everyone is talking about him or laughing at him. ② Sense of dominance: Patients firmly believe that their mental activities such as thinking, emotion, will and behavior are interfered, dominated, controlled and manipulated by external forces, and they cannot control themselves, even their visceral activities and sleep are controlled and manipulated by external forces. Therefore, numbness, fever, pain and other uncomfortable feelings often occur. Patients often think that these experiences and feelings are caused by the influence of radio, laser, infrared ray and electronic computer, so they are also called physical influence delusion. ③ Personality disintegration: The patient experiences that he/she is gradually changing, and a certain part of his/her body has left the trunk or the whole body no longer exists. ④ Personality separation: Some schizophrenics feel that they are divided into two parts, and the two parts talk in their brains. ⑤ Some patients don't answer their own names, but call themselves "he" in the third person. Psychological points