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

Let's think for a moment about each and every one of the actions 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 have something in common: they require a certain level of awareness that allows us to execute them. And we do not always have it, such as when we are asleep. Our level of consciousness can fluctuate greatly naturally.

However, sometimes some diseases, injuries or disorders can cause a deficient state of consciousness from which we are not able to get out. The most serious example of this is coma, but there are also other similar and very serious disorders or alterations. It is the case of stupor, which we are going to talk about throughout this article.

• Related article: "State of minimal consciousness: symptoms and causes"

What is stupor?

It is possible that in more than one 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 of stupor is given to a condition or alteration of a person's state of consciousness, in which there is a marked decrease in this. 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.

Due to its implications, stupor indicates the presence of a very significant disturbance in the person's way 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 practically impossible to get him 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 their state are, for example, screaming 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 obtundation and makes it the state of consciousness closest to and antecedent to a coma. It is, after the latter, the most profound alteration of consciousness.

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

It is important to bear in mind that this state is not feigned or voluntary, so 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 occurs at an affective level.

Guys

Despite the fact that the concept of stupor is defined with the explanation given above, the truth is that it is possible identify different types of stupor based on their cause and some specific characteristics linked to they.

1. organic stupor

In the first place it is worth mentioning that we can find an organic type stupor, in which the cause of said state is a neurological disorder of biological or acquired origin. This type of stupor is characterized by a tendency to appear in a context of diffuse cerebral dysfunction, and a blank stare or closed eyes are often observed. In this state, you may perform 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, melancholic/depressive and dissociative stupor.

2.1. catatonic stupor

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

• You may be interested in: "Catatonia: causes, symptoms and treatment of this syndrome"

2.2. melancholic stupor

A subtype of stupor that appears in depressive pictures, more frequently in cases where 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 body expression that denotes sadness (despite the fact that the emotion is also completely inhibited).

23. dissociative stupor

It is usually linked to the experimentation of a stressful or traumatic event, which causes a dissociation in the psyche of those who experience it. There is immobility, but if the subject is placed in a forced position, it returns to the original position. There is no resistance or muscle stiffness.

Causes of the appearance

As we can see, stupor is a condition that can occur for a wide variety of causes, both organically and psychologically.

organic causes

Within the organic causes we can find the suffering of cerebrovascular accidents or the possible acquisition of some type of infection at the 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 reticular activation system or SAR level (part of the brain that is 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 you compress or they affect the areas that govern consciousness, or if not enough blood, nutrients and oxygen reach the brain. Some diseases or suffering from severe hypoglycemia could also generate this state.

It can also occur before food poisoning, substance use (including alcohol) or pharmacological. It is also possible for a person to reach a state of stupor after having suffered some type of head injury. In these cases, the stupor is due to damage, injury or alterations in the functioning of the neurons.

psychiatric disturbance

With regard to psychiatric stupor, it appears 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 regarding each of these disorders. For example, the presence of aversive and traumatic events is usually a trigger for those of the dissociative type.

• Related article: "What is schizophrenia? symptoms and treatments"

treatment of stupor

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

In general, in the first place it is essential to ensure vital signs and biological stability, as well as monitor their condition.

It must be borne in mind that stupor can be a symptom of an organic pathology or even a stroke or head trauma, which could lead to serious sequelae, disability or even death if not be treated. In the same way, a poisoning should also be treated differentially.

In the event that the stupor is the product of an identifiable organic-based pathology, recovery is not expected. complete, although it is true that in some cases the symptoms disappear spontaneously after a while time. Thus, in the face of psychiatric or neurological diseases, treatments are carried out to alleviate the negative consequences of pathology, not to completely eliminate either stupor or the other forms in which the disease manifests itself. express.

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

Bibliographic 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. CEDE PIR Preparation Manual, 01. CEDE: Madrid.