Mental state of the patient

Quantitative disorders
Qualitative disorders
Causes of consciousness disorders
Emotional instability

is especially assessed as the state of consciousness, in which we evaluate patient's physical and mental condition and his/her ability to communicate with external environment.
The worsening of these functions is manifested by the qualitative or quantitative disorders of consciousness.
Quantitative disorders
   Somnolence is a pathological sleepiness with a possibility of awakening. Verbal answers to questions are correct; reactions are slowed down.
   Sopor is a more serious disorder, with no reaction to a verbal stimulus. Wakening is restricted to painful stimuli. After this sort of stimulus stops, the patient returns to the original state of consciousness.
   Coma (unconsciousness) is the most severe disorder of the consciousness; reaction to a painful stimulus is missing. Gradually, the reflexes vanish, including the pupil and corneal reflexes.
   Syncope (faintness) is a short-time loss of consciousness caused by insufficient blood supply of the central nervous system.
Qualitative disorders
are characterised by the disorientation in time, place, and person.
   Amentia is a disorder of perception with hallucinations and motor hyperactivity.
   Delirium is a more severe state with prevailing visual hallucinations (small animals), memory disorders, agitation, or sleepiness.
   Obnubilation (blackout) manifests by an unconscious action of the patient (the patient does not retain memory from this state).
Causes of consciousness disorders
   Circulatory (primary in case of ischaemia, haemorrhage, embolism of CNS, or secondary to a heart failure or arrhythmia);
   Inflammatory (meningitis, meningoencephalitis, brain abscess);
   Metabolic (hyperglycaemia, hypoglycaemia, liver or kidney failure, hydration disorders, especially dehydration);
    Intoxications (alcohol abuse, drugs),
   Psychiatric illnesses,
   In association with injuries, tumours and epilepsy.
Part of the examination is evaluating patient's action and behaviour, his/her mood and and view on the illness.
Emotional instability
   Anxiety is usually a sing of neurosis or a secondary reaction to the uncertainty, associated with the illness.
   Depression manifests as an unsubstantiated sorrow (endogenic) or as a reaction to the situation.
   Mania, manifests by an exceedingly cheerful mood, inappropriate to the situation.
Emotional lability can be a sign of neuroses, psychoses, brain arteriosclerosis, metabolic encephalopathy, and acute and chronic alcohol intoxication.


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