Amentia

AMENTIA (from the Greek prefix a- meaning negation, and the Latin mens meaning mind), acute confusion or acute 'nonsense', a psychopathological syndrome identified by Meynert and characterized by incoherence of thought, disturbance of the ability to orient oneself in one's surroundings, and a feeling of bewilderment. Initially, this term was applied to all cases of mental illness in which the prominent features were phenomena of an acute onset of profound disturbance of intellectual activity, expressed in confused speech, meaningless behavior, vivid but incoherent hallucinations, etc. In recent times, the concept of A. has been applied much more strictly, as a result of which its use has become relatively rare. At present, A. refers to a very small group of diseases in which an exogenous factor usually plays the main etiological role, most often acute infections or autointoxications (for example, puerperium, kidney diseases, etc.). The onset of the psychosis, which often develops in infections already after the temperature has fallen, is usually preceded for several days by prodromal symptoms in the form of headaches, ringing in the ears, insomnia, general restlessness combined with an indefinite feeling of fear, etc. Gradually, patients first become as if stunned, and then disturbances of consciousness, disorientation, and confusion develop. Individual elements of the surrounding reality are perceived correctly, but are not combined into a whole and are not connected with previous experience, remaining as fragmented, incoherent pieces of experience. Patients try but cannot understand what is happening around them, to think through and reason what is happening to them. Hence, feelings of helplessness and bewilderment, a sense that something is wrong, that the surroundings have somehow changed, etc. The mood is tearful, fearful, irritable. In addition to fragments of perception, consciousness is filled with incoherent and rapidly changing hallucinatory images, as well as extremely unstable, unexpectedly arising and quickly disappearing delusional thoughts, which gives most cases of A. a more or less pronounced delirious coloration (see Delusion). The speech of patients loses not only logical but also grammatical correctness, becoming completely confused. Affects remain lively at all times and, on the one hand, correspond to the patient's attempt to understand what is happening to them, and on the other hand, to the content of delusional thoughts and hallucinations. From time to time, the patient's consciousness may clear up, speech and behavior become more meaningful and coherent, only to return to the previous state after a very short interval. In some cases, the picture described corresponds to motor excitement, in others, on the contrary, immobility up to stupor is noted. Bonhoeffer distinguishes several forms of the amentive syndrome, depending on whether incoherence, motor phenomena, or hallucinatory phenomena predominate. The disease usually lasts several weeks (most often, not exceeding two months) and ends in recovery, in some cases, however, leaving behind more or less prolonged states of mental weakness, without sharp boundaries, passing into those terminal states with an organic substrate that sometimes develop after severe acute infections. It is not always easy to differentiate A. from other psychoses accompanying infections and intoxications, especially from attacks of schizophrenia beginning with states of confusion, and from phases of manic-depressive psychosis. Whether A. represents a symptom complex or an independent disease remains an unresolved question to this day; in any case, A. apparently unites a group of cases close to each other in pathogenesis, course, and outcome, why it can fully claim to be distinguished as a separate clinical form. Specific changes in the central nervous system that are characteristic of A. have not yet been identified. Its pathophysiology is also unknown. Sometimes expressions such as 'amentive symptom complex', 'amentive state', etc. are also used to denote pictures similar to the one described, observed in various endogenous and organic psychoses.