Hysterical attack or exhaustion of the nervous system. How to treat hysterical psychopathy

A hysterical attack or attack is an acute reaction of a person to an extremely powerful emotional irritation or event. A certain protest, which includes not only a mental, but also a physical component in order to influence a certain situation, in conditions that do not meet the requirements or expectations of such an individual.

However, despite the fact that it is based on provocation and the desire to influence others or change the situation as a whole, it cannot be said one hundred percent that the person is completely in control of his consciousness and state during such an attack. Therefore, assistance during a hysterical attack should be provided in a timely manner in order to avoid serious consequences for the health of such a person.

Most often, a hysterical attack is observed in women and children. Symptoms may resemble other acute conditions. The overall picture boils down to the following complaints, which are characteristic of both hysterical and epileptic seizures:

• uncoordinated, complex movements;
• wringing of limbs;
• hair pulling;
• arching the body;
• coordination disorders;
• hiccups, belching;
• spasm, vomiting;
• disturbances of cardiac activity and pulse;
• mindless walking or running;
• repetition of the same phrases.

However, there are clear differences between an epileptic seizure and a hysterical one.

1. A fall during hysteria never harms the patient; he falls extremely carefully. In epileptic cases, injuries are often observed due to the complete uncontrollability of the condition.
2. During hysteria, there is no discharge from the mouth, the tongue does not bite and never sinks.
3. Consciousness is not completely lost only during hysteria. The person remembers the attack and does not fall asleep after it.
4. During hysteria, cases of involuntary urination or defecation are extremely rare.
5. There is no excessive sweating during hysteria. The pupils react to light during a hysterical attack.
6. After the end of the hysterical attack, patients may say that they “don’t understand” what happened to them and are “genuinely surprised.” After hysteria, facial muscle contractions, hiccups, or trembling may persist. All this goes away after sleep.

Unlike withdrawal symptoms, patients with a hysterical attack never request any treatment or pills. But patients with abstinence are always “in the know” about what they need to use and in what doses.

However, hysterics are able to further think up and diagnose some dangerous and incurable disease in themselves, provoking even greater attention to their person. Therefore, if attacks of hysteria recur, you must definitely consult a psychologist.

Hysterical attacks in women are usually associated with hysterical accentuation in general. Such representatives of the fair sex are already emotional and tend to attract everyone's attention. Therefore, when providing first aid during a hysterical attack, be sure to try to remain calm, reassure those around you and not encourage further similar behavior with concessions and unprofitable compromises. Otherwise, there is a chance that such attacks will become more of a norm in response to disagreement. Remember: the more “spectators” watch the attack, the longer it lasts.

What needs to be done?

First aid:

• try to isolate the person from strangers, ideally move them to a separate room;
• give ammonia to smell;
• do not react emotionally to what is happening, remain silent;
• ideally, calmly observe the person; the fact is that against the background of a seizure, attempts at self-harm or thoughtless acts of a suicidal nature may occur, which must be prevented.

What can't you do?

• engage in a discussion or shout at a person;
• leave it unattended to avoid worsening the condition or acts of self-harm;
• forcefully hold the limbs or head of such a person so as not to lead to dislocation of the joints;
• crowd around a large number of people, cry, lament, or call others for help.

The last point is worth considering especially in the context of the appeal of one client, whose wife, during any quarrels and disagreements, was prone to such attacks. At the same time, the young family lived with the wife’s parents and her grandmother. And at the peak of the attack, the wife’s mother usually began to cry and lament loudly, calling all the household members and accusing the man of “bringing her daughter to this.”

Such a reaction immediately led to a clearly pronounced convulsive hysterical attack, when the woman began to arch unnaturally. Long-term therapy, promoting the separation of the woman from her family, as from “additional spectators,” contributed to the complete cessation of this kind of reaction.

Practicing psychologists often describe female clients whose relatives have come in with cases of hysterical attacks. In this case, as a rule, the first calls are made to other specialists: neurologists, for example. The suspiciousness of such patients has already been mentioned. Therefore, in the case of personal requests, they most often come from surgeons or neurosurgeons, cardiologists and psychiatrists. However, it is psychologists who are able to offer a number of techniques that can not help specifically during the attack itself, but pay attention to other aspects of the personality, which are the basis for this kind of reaction.

It is also worth paying attention to the relatives of such people. Due to initial appeals not to the appropriate specialists, the final verdict or diagnosis is delayed and proceeds, rather, by excluding more serious diseases. Therefore, such patients often tend to turn to alternative medicine, fortune tellers, healers and psychics. And they are good at recognizing hysterical personalities and can profit from such sessions, skillfully manipulating the client’s expectations.

Signs of childhood hysteria

Hysterical seizures in children are associated primarily with the immaturity of the nervous system and the child’s inability to verbalize his disagreement.

However, such attacks may also be associated with:

As a rule, the first case of a seizure can be observed in a child at 2 years of age. And they go away by the age of three. If after this a similar trend is observed, then you should consult a psychologist.

The signs of a fit of hysteria in children are similar to the main ones described above. With the difference that “convulsive bridge” is observed more often in young children. They also tend to inflict various minor injuries on themselves: scratching their faces, hitting their heads or hitting their heads. In addition, the child often tries to hit the parent who is nearby. And in most cases - mother. This distinguishes this condition in children from adult seizures, which often pass “bloodlessly” and without injury to the patient.

Condition correction

First aid for hysteria in children should also be carried out without outside witnesses and in a place where the child is least likely to be injured. Pull your baby away from corners and door frames, as well as sharp and fragile objects.

Try to remove the child’s scarf, if he has one, and his hat with strings. This is important so that the baby does not strangle himself. And most importantly, but most difficult, do everything to remain calm yourself.

Screaming and proving to a child in such a state is a waste of energy. You must wait until the seizure ends. After it, children feel physically exhausted. They just need to be hugged and pitied. If you push a child away, you can provoke new inappropriate behavior or reaction: hiccups, new attempts at self-harm, stuttering and much more.

It is not only what you did when your child had hysteria that is important. It is necessary to behave correctly and consciously after it. Talk through what happened so that the child can hear that the same thing can be calmly said in words, without debilitating hysterics. Emphasize how such things upset you and tire him. And do not forget to insist on your own, on what started this “emotional protest”: after all, do not buy this toy or do something: give it away, put it away.

A hysterical seizure is a type that is manifested by an indicative emotional state (tears, screaming, loud laughter, arching of the back, wringing of limbs), as well as convulsive and temporary seizures.

This type of disease has been known to scientists since ancient times. For example, Hippocrates carefully studied this phenomenon and called it “rabies of the uterus,” because this is a completely logical explanation.

It is known that hysterical attacks of this kind are observed in most cases in females; they occur much less frequently in children and are practically never found among men.

Modern researchers associate the disease with individual personality characteristics (character, temperament). The risk group includes those people who are prone to suggestion, fantasizing, have an unstable type of behavior and changeable mood. In order to somehow attract the attention of others, they resort to committing such non-standard actions.

If the disease is not diagnosed in a timely manner and its symptoms increase over time and become more pronounced, then treatment should only be carried out by a qualified psychiatrist. In each case, treatment is individualized and must be followed until complete recovery.

Factors provoking the development of hysterics

Like every mental illness, the main cause of the development of hysteria is disturbances occurring in the standard behavior of the individual. This also includes upbringing, character, temperament and resistance to suggestion.

In most cases, a person’s infantilism, hysterical manifestations of character, as well as a genetic predisposition to this type of disorder can cause a hysterical attack.

Various factors can cause a seizure, a special place among which is occupied by the following:

• the presence of severe diseases of internal organs in a person;
• frequent physical overexertion;
• professional activity that does not bring proper satisfaction;
• frequent conflicts and quarrels in the family circle;
• recent injuries;
• regular consumption of alcoholic beverages;
• improper use of medications;
• frequent stressful situations and nervous tension.

Scientists have proven the fact that this disease can only manifest itself in people with certain character traits. So, for a person in whom certain traits do not manifest themselves under the influence of unfavorable factors, they will soon begin to develop.

It has been proven that hysteria is a condition that cannot arise abruptly; it requires a certain kind of preparation (for example, like actors, before a performance).

What does this look like in real life?

A hysterical attack is characterized by a number of different symptoms. We list the main ones:

At the same time, the following manifestations of an attack of hysteria are also observed:

• the quality of vision and hearing deteriorates significantly;
• a person’s field of vision narrows;
• hysterical blindness manifests itself, which affects 1 or both eyes at once;
• deafness (temporary);
• the patient's voice ceases to be clear and sonorous (aphonia);
• muteness appears;
• a person begins to speak in syllables;
• stuttering;
• during an attack, paralysis of individual limbs or the entire body develops ();
• the muscles of the tongue, neck and face become paralyzed;
• bending the body in the opposite direction (in the form of an arc).

A patient who is characterized by frequent hysterical seizures is characterized by the following symptoms:

• refusal to eat;
• inability to swallow food on your own;
• vomiting and nausea (psychogenic origin);
• frequent belching, coughing and yawning.
• presence of flatulence;
• shortness of breath, which in most cases resembles an attack of bronchial asthma.

First aid

To provide first aid in case of a hysterical attack, you must follow the following rules:

• you need to try to calm down all the people around you;
• after this, the patient will need to be moved to a quieter place;
• it is desirable that as few people as possible be nearby;
• if possible, give alcohol (ammonia) a sniff;
• You shouldn't stand too close to the person, but it is important to stay at a distance so that they can see you.

• leaving a person during a hysterical attack;
• forcibly restrain the patient's arms, neck, legs and head;
• shout at the patient.

Competent solution to the problem

The main task of treating a hysterical attack is to get rid of the reasons that provoked it. To do this, you will definitely need the help of a psychotherapist.

According to an individually designed program, he will conduct psychotherapeutic sessions, which will consist of various trainings, hypnosis and suggestion.

Also, the treatment of hysteria is accompanied by the use of psychotropic and restorative medications. They not only strengthen the patient’s immune system, but also help normalize his mental state.

As additional therapy, bromine preparations, Andexin, Librium, and minimal doses of Reserpine and Aminazine are prescribed.

Stopping medication or changing the dosage on your own is strictly prohibited! Drug treatment is carried out under the strict supervision of the attending physician!

Traditional medicine also helps to achieve good results in treating an attack of hysteria. They are not only absolutely safe for human health, but also help restore the vitality of the patient’s body. For example, before going to bed, it will be very useful to drink a cup of decoction based on motherwort, chamomile, mint, lemon balm or valerian.

The use of these herbs is contraindicated only in case of individual intolerance or allergic reactions.

Before using traditional methods of treatment, it is imperative to consult a specialist. It is important to find out whether these herbs are compatible with the components of the medications you are using.

Let's say no to hysteria

Prevention of a hysterical attack mainly consists in ensuring that all relatives who surround the patient show a normal attitude towards him.

This means that you should not be overprotective, because the patient may understand everything incorrectly, which will become the reason for another manifestation of a hysterical state. Walking in the fresh air and engaging in some calm and soothing activity will be helpful.

It is important to remember that a favorable and positive atmosphere must always be present in the family (quarrels and scandals can only aggravate the course of the disease).

Paroxysms - short-term, suddenly occurring and suddenly ending disorders, prone to stereotypic repetition. Most often paroxysms caused by epilepsy and organic diseases with epileptiform symptoms(tumors, vascular diseases, injuries, infections and intoxications). Sometimes it is necessary to distinguish hysterical seizures and paroxysmal attacks of anxiety and fear (panic attacks) from epileptic ones.

Epileptic (and epileptiform) seizures - This manifestation of organic brain damage, as a result of which the entire brain or its individual parts are involved in pathological rhythmic activity, recorded in the form of specific complexes on the EEG. Pathological activity may include loss of consciousness, seizures, episodes of hallucinations, delusions, or bizarre behavior.

Characteristic signs of epileptic (and epileptiform) paroxysms:

spontaneity (absence of provoking factors);

sudden onset;

relatively short duration (seconds, minutes, sometimes tens of minutes);

sudden cessation, sometimes after sleep;

stereotyping and repetition.

The specific symptoms of a seizure depend on which parts of the brain are involved in the pathological activity. It is customary to divide seizures into generalized and partial (focal).

Generalized seizures , at which all parts of the brain at the same time are susceptible to pathological activity, manifest loss of consciousness(sometimes with general convulsions). In patients no memories remain about a seizure.

Partial seizures never do not lead to complete loss of consciousness, patients remain individual memories about paroxysm, pathological activity only arises in one of the parts of the brain. Thus, occipital epilepsy is manifested by periods of blindness or flashes and flickering in the eyes, temporal epilepsy - by episodes of hallucinations (auditory, olfactory, visual), damage to the precentral gyrus - by unilateral convulsions in one of the limbs (Jacksonian seizures). The partial nature of the seizure is also indicated by the presence of precursors (unpleasant sensations in the body that occur several minutes or hours before the attack) and an aura (a short initial phase of the seizure, which is stored in the patient’s memory). Doctors pay special attention to partial seizures because they may be the first manifestation of focal brain lesions, such as tumors.

Seizures are usually classified according to their main clinical manifestations.

Epileptic paroxysms include:

grand mal seizures (grand mal, clonic-tonic seizures);

minor seizures (petit mal, simple and complex absence seizures, myoclonic seizures);

twilight cloudings of consciousness (outpatient automatisms, somnambulism, trances, hallucinatory-delusional variant);

dysphoria;

special states of consciousness (psychosensory seizures, attacks of “déjà vu” and “jamay vu”, paroxysms of delusional and hallucinatory structure);

Jacksonian seizures with convulsions in one of the limbs.

Grand mal seizures (grandmal) - This attacks lasting up to 2 minutes, manifested by loss of consciousness and convulsions. Loss of consciousness in this case reaches the level of coma (all types of reflexes are absent: pain, tendon, pupillary). A grand mal seizure usually begins suddenly, only sometimes patients experience a few seconds before loss of consciousness. aura in the form of separate deceptions of perception ( smell, visual images, body discomfort, nausea), movement disorders or emotional disturbances ( feeling anxious, angry, confused, or happy).

At the beginning of the attack arise tonic convulsions: All muscles of the body contract simultaneously. At the same time, the patient falls sharply, which can cause injury, is sometimes observed shrill scream.

After 10-30 s appear clonic seizures, all muscles simultaneously relax and then contract again and again, which is manifested by characteristic rocking movements. During clonic convulsions the patient not breathing, therefore the initial pallor of the face is replaced by cyanosis. During this period the patient may leak urine, bite tongue, often foaming at the mouth.

Clonic seizures may continue from 30 s to 1.5 min, then sick regains consciousness.

Usually within 2-3 hours after a seizure the patient experiences fatigue and drowsiness.

With a grand mal seizure there is always high probability of injury due to a sudden fall and clonic convulsive movements.

Minor seizures (petitmal) - Very short (less than a minute) attacks of loss of consciousness, not accompanied by convulsions and falls. Never for minor seizures no aura observed, the patients themselves don't remember anything about the attack, don't notice him. Others describe petit mal seizures as short-term episodes of disconnection, when the patient suddenly becomes silent, he has a strange “floating” absent-minded gaze- this disorder is called absence seizure(from the French absence - absence). Sometimes the picture of absence is complemented by a short movement: bowing, nodding, turning, throwing back (complex absence). In this case, patients may drop objects from their hands or break dishes.

During adolescence Minor seizures are often manifested by repeated shuddering and twitching; such attacks are called myoclonic seizures. Patients themselves do not notice them; relatives may not attach importance to this disorder or even consider it a bad habit.

Twilight stupefactions are described in detail in the previous section. The main feature of the disorder is This is a paroxysmal disturbance of consciousness, manifested by relatively complex actions and behaviors, followed by complete amnesia for the entire period of psychosis.

Dysphoria - This short bursts of angry-depressive mood with irritability, sullenness, grumbling, outbursts of anger, verbal abuse or even dangerous aggressive behavior. Outbreaks occur unexpectedly and do not always reflect the real situation. Characteristic gradual accumulation of discontent followed by a sharp discharge of emotions when all the accumulated irritation is realized in the patient’s behavior. In contrast to the twilight stupefaction of the patient doesn't have amnesia period of excitement, can subsequently quite accurately describe his actions. Having calmed down, he often apologizes for his actions.

Special states of consciousness , as well as dysphoria, are not accompanied by complete amnesia, which indicates the partial nature of the attacks. Symptoms may vary, however in the same patient all painful phenomena are stereotypically repeated, so that each subsequent attack is similar to all previous ones. Some patients experience sensory disturbances in the form of changes in size, shape, color, position in space of observed objects and disturbances in the body diagram (psychosensory seizures); others may experience attacks of derealization and depersonalization of the “already seen” type (déjà vu) and “never not seen” (jamais vu) or short-term episodes of delirium and hallucinations. Although with all the listed variants of paroxysms consciousness is not completely switched off, the patients’ memories of the attack are incomplete and fragmentary; One’s own experiences are better remembered, while the actions and statements of others may not be imprinted in memory.

Hysterical reactions is a series of mental, sensory and motor disorders that arise due to overstrain of the basic physiological processes in the cerebral cortex. More often they are observed in hysteria, sometimes in other mental illnesses (schizophrenia, involutive psychoses).

Etiology of hysterical attack. In the development of a hysterical attack, the leading role belongs to the action of an external factor that traumatizes the psyche or indirectly weakens it.

Pathogenesis of seizures in hysteria associated with the occurrence of psychogenically caused dysfunction in the cortical structures and formations of the hypothalamic-limbic-reticular complex.

Clinic (signs) of a hysterical attack (convulsions)

A distinctive feature of hysterical symptoms is theatricality, demonstrativeness of manifestations, the attack intensifies or prolongs when there is a crowd of people around the patient.

Attack begins suddenly, without an aura, against the background of a conflict situation and, as a rule, is not accompanied by a loss of consciousness (unlike an epileptic seizure), but there may also be a twilight stupefaction. Memories of the seizure and its surroundings are usually preserved, but fragmentary. The seizure lasts from several minutes to several hours and is characterized by various motor manifestations. Patients usually do not fall, but slowly sink to the floor without causing serious harm to themselves.

arise chaotic semi-voluntary movements, which at the same time are varied, complex and expressive: patients squirm, bang their heads, tear their hair, clothes, clench their teeth, tremble, roll on the floor, scream, repeat the same phrase. The appearance of a “hysterical arc” is typical, when the patient rests on the surface only with his heels and the back of his head, and the torso is bent in an arc. Control of the function of the pelvic organs is preserved. Urinary incontinence is sometimes observed, but involuntary bowel movements do not occur. The eyelids are usually tightly compressed and patients resist attempts to open them. The shape of the pupils is not changed, their reaction to light and painful stimuli is within normal limits. When you bring cotton wool soaked in ammonia to your face, you can cause a protective reaction. Frequent shallow breathing is characteristic. Pronounced hemodynamic changes are usually not observed. Often, patients develop hysterical mutism (muteness), functional changes in the auditory and visual apparatus, which are manifested by the inability to perceive complex stimuli, but with the preservation of an elementary unconditioned reaction.

Others may be noted functional changes in the central nervous system: inability to walk in the absence of objective signs of paresis (hysterical paralysis); anesthesia of areas like stockings or gloves that does not correspond to the innervation zones.

Thanks to their preserved consciousness, patients are suggestible. A change in the external situation, lack of attention and interest from others can cause a gradual relief of the seizure. A seizure can be suddenly stopped by a strong stimulus (an injection, a sharp sound, splashes of cold water), which distinguishes it from an epileptic seizure, which cannot be stopped by such measures. Differentiate a hysterical attack from epileptic The absence of stereotypical repetition, sequence of development, separation of tonic and clonic phases, and tongue biting also allows this. Sleep usually does not occur after the seizure ends.

It must be remembered that hysterical reaction may manifest itself as a state of lethargy, the so-called psychotic stupor, characterized by complete immobilization and relaxation of muscles. In this case, there is no reaction to painful stimuli, the expression of suffering freezes on the face, the patients breathe heavily and noisily. Gradually, breathing becomes shallow, the pulse quickens. In appearance, the patient may resemble the deceased, which is why this condition was previously called “imaginary death.”

Seizure

A seizure is the result of an uncontrolled sudden influx of electrical energy into the brain; in simple words, it is a kind of short circuit.

If even short-term convulsive seizures occur, you should immediately consult a doctor. Leading Russian doctors, luminaries of medicine, practice at the Yusupov Hospital, who will quickly determine the cause of seizures and prescribe a course of effective treatment.

Waiting and self-medication in this case is the wrong and risky choice, which over time can lead to serious and unpromising consequences.

Some seizures are very short-lived and mild in nature. However, they can go unnoticed even by those people who have them.

In many cases, convulsive seizures present a terrifying picture: a person falls to the floor, foam comes out of his mouth, legs and arms convulse.

Seizures are classified as partial seizures (which occur due to abnormal electrical activity of neurons in a specific area of ​​the brain) and generalized seizures. Its occurrence is associated with abnormal electrical activity of nerve cells scattered in the brain.

Causes of seizures

Seizures can occur for a number of reasons. In young children, seizures can be a sign of infectious diseases, in particular, the spread of the infectious process to the cells of the brain and its membranes. They can also be a consequence of high body temperature.

In people of any age, seizures can appear after:

• stroke;
• epilepsy;
• traumatic brain injury;
• neuroinfections;
• tumors.

A separate form of convulsions is distinguished - a hysterical attack. It is most often observed in adolescents and young women. Particular attention is paid to seizures in pregnant women. It may occur due to late severe toxicosis.

The causes of a seizure are also drug or alcohol withdrawal, or rather withdrawal syndrome, as well as a change in the regimen of certain anticonvulsants and an overdose of certain medications.

In some cases, to get rid of seizures that occur, doctors recommend patients change their lifestyle, but in most cases they still need to undergo a course of therapy.

Neurologists at the Yusupov Hospital develop a treatment regimen for each patient individually, taking into account a number of factors.

Treatment of seizures

For any seizure, regardless of its severity, you must call an ambulance.

Only an experienced doctor can distinguish a hysterical attack from a true convulsive one. In all other cases, it should be considered as possible epileptic and the patient’s condition should be taken with complete seriousness and responsibility.

First of all, the patient should be protected from injury and damage during a seizure. To do this, place a soft pillow or folded clothing under your head. You also need to place something soft under your feet and hands.

In no case should foreign objects be placed between the patient’s teeth - spoons, forks, etc., since at the time of convulsions they can provoke respiratory arrest or lead to the entry of a foreign body into the respiratory tract (a broken tooth crown, etc.).

If a child has a seizure, then before the ambulance arrives, it is necessary to apply a cold compress to his forehead and in the area of ​​the right hypochondrium. It is also allowed to give the child an antipyretic drug.

Treatment of seizures at the Yusupov Hospital

At the Yusupov Hospital, patients are seen 24 hours a day, 7 days a week. Doctors will quickly and efficiently diagnose, determine the cause of seizures and prescribe a course of effective treatment. The clinic accepts patients aged 18 years and older.

After a seizure, patients require hospitalization. The wards of the Yusupov Hospital are equipped with modern medical equipment, appliances, and comfortable furniture, which makes the patient’s stay in the hospital comfortable. The professionalism of the doctors at the Yusupov Hospital allows them to “get patients back on their feet” in a short time and avoid complications and repeated convulsive seizures.

Under no circumstances should seizures be ignored; they do not go away on their own, seizures will recur more often, and the disease will begin to progress. Timely medical intervention for seizures is very important to avoid the development of severe pathologies.

You can make an appointment at the Yusupov Hospital by phone.

Recognizing an epileptic seizure

There are a number of paroxysmal syndromes that may be vaguely similar to an epileptic seizure. When a doctor directly observes a seizure, only rarely can diagnostic doubt arise in this regard. But it is not often possible to directly observe an epileptic seizure. Much more often one has to judge the nature of a seizure based on the story about it either of the patient himself or those around him, and then such doubts can often arise.

Below is a list of paroxysmal conditions that may somewhat resemble an epileptic seizure and which should always be kept in mind when making this recognition.

Hysteria. Convulsive seizures during hysteria are currently observed among our patients much less frequently than was the case before, which, of course, was the result of both the penetration of advanced socialist culture into the broadest layers of our population, and the result of a more correct view of doctors on the essence and causes of hysteria . Nevertheless, even now we occasionally see large convulsive seizures of a hysterical nature.

Not so long ago, differentiating hysterical seizures from epileptic seizures presented considerable difficulties and served as the reason for a large number of special studies. Nowadays, hardly any experienced doctor can doubt the nature of the observed seizure - there are too many differences between seizures of one kind and another, explained by the fact that in one case convulsions are an automatic discharge of nervous energy playing out in the motor analyzer, and in In another case, it is the result of a complex mental conflict in a person with severe imbalance of signaling systems. This is where all the differences come from.

An epileptic seizure, as we saw above, can sometimes develop in connection with a mental experience such as surprise, fear, etc., but for the most part it occurs unexpectedly and “spontaneously.” A hysterical attack is an affective reaction - the patient reacts this way to much more complex life experiences - resentment towards someone, annoyance at others, some failure in life, grief, etc.

During an epileptic seizure, consciousness is completely lost, and no contact with the patient is possible. During a hysterical attack, some contact with the patient can still be made, and when such a patient is in convulsions, he begins to beat harder if they try to restrain him. If during a convulsive seizure the patient seriously injured himself, it was certainly an epileptic seizure.

Convulsions in epilepsy are inexpressive and meaningless, just as the cry often emitted by the patient at the first moment of a seizure is inexpressive and meaningless. Convulsions during hysteria are more coordinated and expressive. These are not contractions of certain muscles, but certain actions. Instead of an unmodulated epileptic cry, a patient with hysteria during an attack expressively cries, sobs or moans.

During an epileptic seizure, the pupils lose their light reaction, which persists during a hysterical seizure. The extinction of tendon reflexes and the appearance of pathological reflexes are not observed during hysteria. Biting your tongue always indicates epilepsy. A patient with hysteria can, of course, urinate on himself during a seizure, but this happens extremely rarely.

Hysterical seizures last longer than epileptic seizures. They are also more polymorphic compared to epileptic seizures, which occur in a much more stereotypical manner.

Patients behave differently even after the seizure ends. While a patient with epilepsy comes to his senses after loss of consciousness, for the most part, does not immediately, but for some time is still unable to correctly navigate his surroundings and experiences general weakness and headache, a patient with hysteria, waking up after a seizure, immediately returns to his normal state, and sometimes even feels some calm or relief after a nervous discharge has occurred.

In this differential diagnosis, one can also take into account the fact that hysterical attacks never occur in a state of sleep and never occur if the patient is completely alone.

It has been pointed out more than once that strictly pathognomonic individual symptoms for distinguishing these seizures from each other apparently do not exist and that such a diagnosis should always be based on a comprehensive assessment. The latter is true, although it should be borne in mind that until recently, the attribution of such clearly organic symptoms to a hysterical attack, such as, for example, loss of light reactions of the pupils, etc., was apparently based on the fact that at that time many , then still unknown variants of an epileptic seizure passed for hysteria.

In controversial cases, detection of characteristic changes in brain biocurrents outside of seizures helps resolve the issue.

If, therefore, it is for the most part not difficult to distinguish a convulsive attack of epilepsy from a convulsive attack of hysteria, then the situation changes significantly when we have before us some less common variants of an epileptic seizure, and especially manifestations of mesencephalic, diencephalic or mesodiencephalic epilepsy.

During seizures of this type, patients are usually in a clear consciousness. With fear, they notice a number of very unpleasant and difficult symptoms, such as shortness of breath, palpitations, chills, cold extremities, diarrhea and painful cramps in different parts of the body. They usually give a natural emotional reaction to all these symptoms, often crying, rushing about, cannot find a place for themselves and ask for help. All this can easily give the impression of hysteria to an inexperienced doctor. However, with a more careful assessment, we are also able to notice in relation to these seizures that they are fundamentally different from the emotive discharges in hysteria. Tonic convulsions during mesencephalic crises do not express anything, and vegetative symptoms during diencephalic crises go far beyond the vegetative symptoms of emotions. In addition, both meso and diencephalic seizures are completely devoid of that element of deliberate pretense, from which no manifestation of hysterical neurosis is completely free.

Sometimes it is more difficult to distinguish the state of epileptic automatism from the somewhat similar symptoms of hysteria. Such a difficulty may arise in those (rare) cases when the actions performed during epileptic automatism are not just inconsistently absurd, but develop into more formalized behavior. Thus, one of our patients with epilepsy during such conditions always tried to hug and kiss neighboring patients. Obviously, here the patient’s automatic behavior was dictated by the old temporary connections she had, and this gave the first impression of experiencing some kind of complex mental conflict. Diagnosis of such complex states of automatism is only possible in a comprehensive manner, taking into account all other features of the disease and its course.

Until recently, difficulties in diagnosing between epilepsy and hysteria led to attempts to substantiate the idea of ​​some kind of combined or transitional form, which was called “hystero-epilepsy.” Modern elucidation of the fundamentally completely different mechanisms underlying one and the other disease makes, of course, the idea of ​​such transitional forms invalid and the diagnosis of “hystero-epilepsy” should never be made. On the other hand, it is not so rare that there may be combinations of both diseases in the same person. It is precisely patients with epilepsy, especially if the seizure occurs in them with preserved consciousness, that can also give hysterical seizures, which are, as it were, a psychogenic imitation of their main seizures. Such combinations have been noted more than once in diencephalic and mesodiencephalic seizures. However, it was usually not difficult to distinguish real seizures from their hysterical imitation. Clarification of the basic hysterical background of the higher nervous activity of these patients, as well as the presence of other manifestations of suggestibility and hysteria in them, facilitates this diagnosis.

Fainting. Among other paroxysmal disturbances of consciousness that may be a reason for confusion with epilepsy, one should point out general vasomotor syncope (syncope). It is necessary to remember the following features: when a patient faints, he does not lose consciousness immediately, but gradually, and before losing consciousness he feels “sick” for some time, his vision becomes dark, he experiences dizziness, general weakness, nausea; during fainting, the patient’s face turns pale, the pulse becomes weak; There are no convulsions, no tongue biting, no involuntary urination during fainting. The patient comes to his senses after vasomotor fainting also not immediately, but gradually. Often, when a patient lying down after fainting raises his head, he feels ill again, his vision becomes dark, and he again has to lie down for a while, since in a horizontal position the remaining anemia of the brain does not reach such a degree.

Fainting is often provoked by bad air (smoky, unventilated room), as well as fear associated with pain, as during various medical procedures (subcutaneous injections, tooth extraction, etc.). The sight of blood in impressionable people sometimes provokes lightheadedness and can lead to fainting.

With all these features, vasomotor syncope differs sharply from disturbances of consciousness of epileptic origin.

Also, short attacks of hypertension, the so-called “cerebral vascular crises,” can sometimes be mistaken for epileptic discharges. After dizziness or a short loss of consciousness, mild symptoms of prolapse may remain, in the form, for example, of temporary speech disturbances or temporary paresis, etc. And since such attacks can be repeated in some cases, this, naturally, may lead the doctor to think about seizures of focal epilepsy. These conditions differ from epileptic seizures, in addition to the presence of significant arterial hypertension, also in the persistence of interictal residual symptoms.

Seizures of loss of consciousness, sometimes with convulsions, developing due to brain anemia in Adams-Stokes syndrome, differ from epilepsy in the presence of a sharp disturbance of mid-vascular activity (bradycardia, transient ventricular fibrillation due to atrioventricular block).

Various variations of the so-called intention seizure, or Rülf syndrome, may also have some similarities with an epileptic seizure. These are peculiar, short convulsive discharges provoked by unprepared active movement. Such patients must therefore very carefully and gradually begin any new movement, especially after the previous resting phase. In this case, the convulsive seizure itself can be either more cortical or more subcortical in nature. In the first case, a spasm, starting from a muscle group that has entered an active state, then spreads to adjacent segments, following the contiguity of the cortical fields and in this respect resembling a Jacksonian-type spasm. In the second case, the spasm immediately spreads more diffusely, resembling motility in athetosis and differing from athetosis only in that the process occurs here in the form of individual paroxysms associated with active innervation.

Consciousness during an intentional convulsion, unlike an epileptic seizure, is never impaired. A peculiar difference is that intentional spasm usually bothers patients very little, who, having adapted to their defect, often cope well with the demands of everyday life.

The pathophysiological basis of this peculiar syndrome differs significantly from the mechanism of epileptic discharge. It is here that, along with the increased excitability of the motor analyzer, the lack of concentration of the excitatory process clearly comes to the fore. In these patients, the process of surrounding the working sections of the motor analyzer with negative induction occurs very slowly, and they require some time for the focus of excitation in the cerebral cortex to be well demarcated and for the excitation from this focus not to spread to adjacent sections. It should be said that diagnosis of epilepsy can present certain difficulties in these cases, especially since in some cases an intentional spasm can be combined, for example, with epileptic seizures that occurred in childhood.

In some cases, the reason for possible confusion with a convulsive epileptic seizure may be the conditions of early contracture developing in severely organic patients, if they occur in the form of separate short attacks. Such short convulsive paroxysms can closely resemble the seizures of mesencephalic epilepsy described above. The fundamental difference between these conditions can be that such a convulsion is essentially a spontaneously occurring protective reflex spasm and that with it one can always detect a massively developed syndrome of protective reflexes, which is in no way characteristic of convulsions of an epileptic nature.

The so-called effort dystonia deserves special mention. This syndrome, which has not yet been fully studied at the present time, consists of short-term, but very massive convulsive installations such as torsion dystonia, which occur with every attempt of the patient to make any movement, and here it is no longer required at all, as was the case with an intention spasm, so that the movement is urgent, or unprepared. For example, the patient wants to raise his arm, but instead a tonic flexion spasm of the trunk muscles occurs, etc.

This syndrome has been described in extrapyramidal movement disorders. The sudden development of such a widespread tonic spasm may somewhat resemble tonic variants of an epileptic seizure, but a closer study of this hyperkinesis immediately reveals its connection with active innervation and, therefore, a completely different mechanism of origin.

In the same way, other paroxysmal seizures in extrapyramidal syndromes should be strictly distinguished from epilepsy. This includes numerous types of paroxysmal hyperkinesis that occur in the chronic phase of epidemic encephalitis, of which the so-called “gaze convulsion” is the most common. These are characteristic “violent movements”, the difference of which from epilepsy we spoke above when discussing the problem of so-called “subcortical” or “striatal” epilepsy. The so-called “facial paraspasm”, which usually develops against the background of either cerebral arteriosclerosis or a history of encephalitis, also has nothing in common with epilepsy, although it can manifest itself in the form of separate convulsive paroxysms, separated from each other by relatively light intervals. Common phenomena of the so-called “paradoxical kinesia” (the appearance and disappearance of spasms in special motor conditions), often found in facial paraspasm, easily allow
distinguish these forms of hyperkinesis from epileptiform states. These conditions are described in more detail in the section “Local convulsions”.

It is easy to distinguish the so-called facial hemispasm from focal forms of epilepsy, although recently attempts have been made to combine these diseases. However, these attempts (for more details, see the corresponding section) were apparently based on the fact that they were based on not entirely pure cases of facial hemispasm. Pure cases of this syndrome have a clearly different, non-epileptic origin: they are distinguished by a strictly maintained locality of the peripheral type, after each convulsive discharge they do not leave paresis, do not show characteristic changes in the biocurrents of the brain and are not amenable to antiepileptic therapy.

Nocturnal epileptic seizures, especially in children, sometimes give rise to confusion with nocturnal enuresis. The fact that if a child suffering from enuresis urinates in bed at night can help in recognizing these syndromes, he wakes up completely healthy in the morning, sometimes feeling only natural awkwardness from what happened. On the contrary, after an epileptic seizure that occurred in a dream, the patient wakes up in the morning exhausted and with a headache.

In the same way, one should distinguish between attacks of ordinary neurotic sleepwalking and attacks of epileptic automatism, as discussed above.

Attacks of so-called static epilepsy can have very great similarities with attacks of cataplexy, especially since we often do not observe them directly, but only know about them from the stories of the patients themselves or those around them.

To distinguish these attacks from each other, it is important to remember that attacks of cataplexy are usually directly provoked by some (usually pleasant) emotion, and also that patients suffering from cataplexy, as a rule, also simultaneously experience episodic falling asleep in the form of characteristic attacks of narcolepsy. In addition, an attack of static epilepsy lasts for the most part shorter than an attack of cataplexy.

It is usually not difficult to distinguish attacks of epileptic sleep from narcoleptic seizures: attacks of epileptic sleep are much longer, while the sleep itself is much deeper.

In cases where an epileptic seizure begins with a vestibular aura, and such an aura can appear in isolation, naturally, sometimes a very difficult question arises about the difference between these conditions and attacks of Meniere's vertigo. Diagnosis can often only be complex, taking into account other signs of epilepsy. One of the diagnostic signs, apparently, can be the fact that dizziness during epileptic vestibular aura does not depend on one or another position of the head and is not accompanied by such strong autonomic repercussion as during angioneurotic vestibular crises.

An epileptic seizure differs from a migraine attack in so many ways that, it would seem, diagnostic difficulties should not arise here. However, in a number of observations it turns out that some manifestations of the so-called associated migraine may closely resemble epileptic auras.

For example, pre-ictal hemiparesthesia or scotomas during migraine can give rise to confusion. One of the good differential diagnostic signs can be the different speed of symptom generalization in these conditions: a migraine focal symptom spreads across the cortex much more slowly. Thus, it was indicated that migraine paresthesias that began, for example, in the arm, require tens of minutes to spread over the entire half of the body, while a similar syndrome in Jacksonian epilepsy develops much more quickly. The slowness with which migrainous atrial scotoma spreads across the visual field is also well known.

In some cases, certain diagnostic difficulties may still arise. Thus, Kissel, Arnoux and Hartmann recently described an observation of a girl who, during her menstruation, experienced either migraine attacks or epileptic seizures, both of which were preceded by the same visual aura. It is remarkable that the same aura could be observed in her in isolated form. In this regard, one can also recall the observation of Shavani, in which attacks of ophthalmic migraine and epilepsy with visual aura alternated.

All these individual elements of similarity between both diseases are probably explained by the fact that although the immediate mechanism of the appearance of both diseases remains unknown to us, nevertheless, there is obviously some pathogenetic relationship between them. This is evident at least from the frequency of secondary cases of migraine in families from which patients with epilepsy come, as well as from the relatively high frequency of a combination of epilepsy and migraines in the same person. The relationship of both diseases is confirmed pharmacologically. Thus, it turned out that in the presence of migraine, the smallest dose of Cardiazol is enough to cause an epileptic seizure.

Finally, it should be borne in mind that attacks of a special state of consciousness can also give rise to diagnostic errors. Namely, somewhat similar conditions can be observed in neuroses. These are short-term and usually completely identical disturbances of consciousness, sometimes occurring in those suffering from neuroses, each time under the influence of some stereotypical external cause. Such reasons include various situations that require either a very strong concentration of attention or a very rapid transition of attention from one thing to another. This is, for example, the need to urgently switch attention in some new direction, sometimes in conditions of decreased cortical tone, or the need to fix attention in several directions simultaneously, or simply the presence of a negative emotion. In such cases, patients speak of “numbness”, or “inhibition”, “freezing of thought”, “remoteness”, etc., that is, they use definitions very close to how patients with epilepsy describe their special conditions. Probably, these conditions are based on pathological irradiation of the inhibitory process through the cortex due to the weakness of internal inhibition.

These conditions, which have not yet been sufficiently studied, are often mistakenly considered to be a manifestation of epilepsy. They differ from epilepsy in a number of very significant characteristics.

Thus, these conditions always develop with a clear reason, which includes a typical neurosogenic situation, namely: overstrain of nervous processes or their mobility. Further, these patients do not show other signs of epilepsy, but constantly display a number of other neurasthenic symptoms. It is also not possible to detect changes in the biocurrents of the brain characteristic of epilepsy in them. Antiepileptic treatment does not help them either, but therapy aimed at combating neurosis often brings them significant relief.

These “special conditions” of a neurotic nature should therefore always be remembered in order to avoid unjustified overdiagnosis of epilepsy.

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Concept of epilepsy

Providing assistance at the onset of an attack

Help after the attack ends

The concept of a hysterical attack

How to stop a hysterical attack and hysteria

The concept of sleepwalking, or sleepwalkingAssisting with sleepwalking

Four commandments: how to reduce the likelihood of an epileptic seizure

CONCEPT OF EPILEPSY

Epilepsy, or more precisely, epileptic seizures, was known to healers in ancient times. Many great generals and emperors, artists and writers suffered from such attacks. The biographies of Julius Caesar, Napoleon and some Russian tsars do not hide cases of epilepsy.

People marked by this ailment were considered either bearers of a divine gift (in the writings of Hippocrates, epilepsy is described as a sacred disease), or as the devil's spawn and fiends of hell.

Many soothsayers and priests, sorcerers and shamans did not so much surprise ordinary people with their predictions as they shocked them with their behavior during communication with otherworldly forces.

Indeed, an epileptic seizure causes fear and shock in the person who sees it for the first time.

A sudden loud cry, a frozen body stretched out like a string (Greek epilepsia - meaning grasping, squeezing, tension) falls with a roar in terrible convulsions.

A rapidly turning blue face with wide pupils that do not respond to light; breathing with a wheeze when inhaling and foamy, often mixed with blood, discharge from the mouth - all this cannot but cause horror among others. To top it all off, involuntary urine leakage occurs.

The attack lasts no more than 3-5 minutes. After a seizure, the patient is insane for some time, has difficulty finding his bearings and cannot clearly answer any question.

The worst thing is something else: the patient cannot remember what happened, but stories about the details of the seizure have an extremely depressing effect on him.

A person is ashamed of his illness, is afraid to strike up friendships and avoids not only marriage, but also any intimate relationships. His illness becomes a family secret and a cross that he will bear all his life. Loneliness and a sense of inferiority are the lot of this unfortunate man.

If those close to him and those around him cannot understand his problems and do not stop focusing on a detailed description of the attacks, then mental deviations, constant depression, alienation and loss of interest in life will become inevitable.

REMEMBER! The more fear a person experiences before a seizure recurs, the more likely it is to occur.

SIGNS OF AN EPILEPTIC ATTACK:

Sudden loss of consciousness with a characteristic cry before falling.

Cramps.

Foamy discharge from the mouth, often mixed with blood.

Wide pupils that do not respond to light, with mandatory preservation of the pulse in the carotid artery.

Involuntary urination.

PROVIDING ASSISTANCE AT THE BEGINNING OF AN ATTACK

Of course, such a sudden and shocking onset of an attack can confuse even doctors, and wide pupils that do not react to light force one to think about clinical death and begin chest compressions - an extremely erroneous action in this situation.

REMEMBER! Wide pupils that do not respond to light with a preserved pulse in the carotid artery and convulsions throughout the body are reliable signs of an epileptic attack.

No matter how scared you are, you need to quickly run up to the patient and turn him on his side. Only in this position can one prevent the tongue from sinking, the aspiration of saliva and blood, which sometimes flows out profusely in the event of a tongue bite.

Very often they make a grave mistake: they try to turn and press only the head tightly to the floor - such an action is tantamount to murder.

REMEMBER! It is unacceptable to press the patient to the floor or turn only the patient’s head.

The convulsively twitching body and the head beating on the floor should be fixed in a completely different way.

First, turn your entire shoulder girdle on its side and lean on it with your whole body. Even to hold a sick child, the efforts of an adult are not enough.

Secondly, only after fixing the shoulder girdle can the patient’s head be pressed to the floor.

It is advisable to place rolled-up clothing or a small pillow under it.

In this situation, it is necessary to protect the patient as much as possible from any injuries, so broken glass and sharp objects, furniture and even your own glasses should be as far away from you as possible.

REMEMBER! There is no need to take any measures to prevent tongue biting. There was not a single case of tongue biting. A bitten tongue heals within 2-3 days. But the bitten off fingers of an incompetent rescuer are not even isolated cases.

How to secure a child's head and shoulder girdle
in case of an epileptic seizure

Turn the child onto his side.

Sit astride his shoulders

Gently press your head to the floor and wait until the attack ends

What to do? In cases of epileptic seizure in an adult?
With the patient lying on his back, press his body and arms to the floor until the attack ends.

UNACCEPTABLE!
Insert spoons or other metal objects into the patient’s mouth.

The duel between metal and tooth has never ended in favor of bone tissue. A broken tooth is a foreign body in the larynx, and bleeding from its socket is another problem in an extremely dangerous situation.

IT IS FORBIDDEN!
Trying to insert wooden objects between teeth.

Pencils and spatulas are unpredictable in their strength, and their fragments become murder weapons.

TO KEEP THE PATIENT DURING AN ATTACK
FROM ACCIDENTAL INJURIES, IT IS NECESSARY TO MOVE AS FAR AS POSSIBLE FROM THE LEGS OF THE FURNITURE,
BROKEN GLASS AND SHARP OBJECTS.

HELP AFTER THE END OF AN ATTACK
Immediately after the cessation of convulsions and the restoration of calm breathing, consciousness gradually begins to return to the patient. It is as if he is waking up after a deep sleep: he does not recognize those around him, cannot understand how he ended up in this place, his speech is slow, incoherent, and it is impossible to get intelligible answers from him. However, the person is already able to stand up and move independently.

God forbid we let him go in this state. Neither traffic lights, nor police whistles, nor the heart-rending screams of car horns will save him from death. He is not adequate in his reactions and actions.

REMEMBER! The patient should not be released immediately after the attack ends.

He needs at least a short sleep, and in most cases the attack gradually turns into deep sleep: breathing evens out, convulsive twitching disappears, the face turns pink. All you need to do is monitor the breathing of the sleeping person and come to his aid in time if the attack recurs. Only after 2-3 hours of deep sleep can you be sure of the complete cessation of the attack and the safety of the patient.

REMEMBER! In all cases of an epileptic seizure, you must call a doctor or an ambulance.

Very often, such an attack with loss of consciousness, convulsions and breathing problems can be a manifestation of a number of serious diseases.

UNDER NO EVENT CAN YOU!
Hide epilepsy attacks.

REMEMBER! Such an attack on a driver or pilot will definitely end in tragedy. At the same time, epilepsy has its own treatment, and it is very successful.

ASSISTANCE SCHEME
IN EPILEPTIC ATTACK

UNACCEPTABLE!
Press to the floor or turn only the patient's head.

UNACCEPTABLE!
Release the patient without examination by a doctor.

THE CONCEPT OF A HYSTERICAL ATTACK

REMEMBER! A hysterical attack is not a sight for the faint of heart.

The patient (women are more often susceptible to this condition) rolls on the floor and hits her head, tearing her face and chest with her nails, tears her hair and clothes, bends in an arc, leaning on the floor with the back of her head and heels (hysterical arc), growls, screams, moans, shouting what These are phrases, and this is far from a complete list of actions that a hysterical woman’s imagination is capable of.

Seizures can be so varied in their manifestations that there is no need to dwell in detail on the description of how the patient will wring her hands and what will spew out of her mouth (saliva or choice swearing).

The main thing is that during a hysterical attack, unlike an epileptic one, the pupils necessarily react to light and there is no involuntary urination or tongue biting.

REMEMBER! A hysterical attack occurs in the presence of at least one spectator. The more spectators, the brighter the performance.

In Rus' and in some countries of Islam there was a whole institute of semi-professional hysterical cliques. It doesn’t matter what made these women scream: money or religious fanaticism - the result was pogroms and riots, religious wars and civil unrest, lynching and mass executions.

History does not know a single example when the actions of a clique led to noble and humane results.

The impact of a seizure on the average person is colossal, even contrary to common sense and human morality. The calls of psychopaths are aimed at committing the most vile acts.

Unfortunately, even today some unscrupulous political leaders willingly resort to hysteria when they lack logic and arguments.

REMEMBER! A hysterical attack is dangerous not so much for the patient as for those around him.

During a seizure, the patient rarely inflicts serious injuries on herself: even if she falls to the floor, she will first choose a cleaner place and only then lie down.

The danger lies elsewhere: the sympathy of the audience ignites passion in her and gets her going to such an extent that it can be difficult for her to stop.

REMEMBER! The biggest evil of hysterics is the ease of achieving the goal: for the baby - getting the desired toy; for an adult - the fulfillment of his whim.

Having once experienced success in achieving a goal and believed in the reliability of this method, you can become a truly sick person with a very bad character.

A child in this situation is like a domestic terrorist who has taken the peace of the entire family hostage. The criminal future of such offspring is beyond doubt.

HOW TO STOP
HYSTERICAL ATTACK AND HYSTERICAL

It’s as easy as shelling pears to end a seizure, or rather, to stop a performance: just remove the audience or suddenly hit the hysterical woman on the cheek, pour cold water on her, or suddenly drop something with a crash.

An instant reaction will occur: the patient will shudder, look around and is unlikely to continue her performance.

To prevent a recurrence of the attack, it is necessary to remove the patient from the crowd. If there is even a minor injury, you should definitely call an ambulance and consult the patient with a psychiatrist.

REMEMBER! Self-control, firmness and a little sarcasm in the perception of what is happening will help to stop the hysteria.

ABOUT THE MAIN DIFFERENCES OF A HYSTERICAL ATTACK
FROM EPILEPTIC:

During hysteria, the consciousness and reaction of crustaceans to light are preserved.

During a hysterical attack, a psychopath will definitely indicate a hysterical arc, which never occurs with epilepsy.

UNACCEPTABLE!
Go on about hysteria.

SCHEME FOR PROVIDING HELP IN HYSTERICAL ATTACKS

THE CONCEPT OF SLEEPWALKING OR SLEEPWALKING

Sleepwalking, sleepwalking, or somnambulism (Latin somnus - sleep + ambulare - walk, move), is not so rare in our lives.

Most often, this happens to a child who sits up in bed in the middle of the night, gets up and walks around the room, or performs any other habitual, fairly coordinated actions: getting dressed, washing, folding or sorting out objects, then returns to bed or lies down elsewhere and continues to sleep. . In this case, the eyes are open, but the gaze is directed somewhere into the distance.

It’s not surprising to be afraid of a sleepwalker. The sight of a somnambulist wandering down the corridor makes nightmare lovers' hair stand on end.

REMEMBER! A sharp shout or noise can frighten a sleepwalker to death.

He will instantly lose his balance and fall. A broken face and stuttering are far from the most severe consequences of such an awakening.

PROVIDING ASSISTANCE WITH SLEEPWALKING

First of all, you need to approach the child as quietly as possible, without turning on the light, and carefully, so that he does not wake up, take him by the arm and lead him to the bed. It is advisable to also carefully remove his clothes, put him in bed and cover him with a blanket.

There is nothing complicated about these actions. But if a child walks along the cornice or towards the railway, many difficult problems arise.

As a rule, the next morning the child remembers absolutely nothing about what happened. Many people have found themselves in a similar state at least once in childhood. Sleepwalking in children cannot be considered a disease unless it occurs every night.

REMEMBER! Never tell your child about his night walks.

RULES FOR PROVIDING ASSISTANCE WITH SLEEPWALKING:

Quietly, trying not to wake up, approach the child from behind.

Carefully take him by the arm and lead him to the bed.

Lay down and cover with a blanket.

In the morning, under no circumstances tell him about what happened.

If this happens again, consult a doctor.

Under no circumstances!
Wake up or turn on bright lights.

Unacceptable!
Talk about night adventures

Somnambulists
and chronic fatigue syndrome

Adult somnambulists, and even in broad daylight, are also a very likely occurrence. With some forms of epilepsy and mental disorders, and more often with extreme fatigue, a person suddenly discovers that he ended up in another city, but does not remember at all how this happened.

If something similar happened to you or your loved ones, then do not hesitate to contact a clinical psychologist. Most likely, this visit will force you to reconsider your workload and workday routine, which will completely eliminate such problems.

Shift workers, rescuers, truck drivers and aircraft crews are very familiar with the expression “go on autopilot.”

The person does not remember at all what happened to him on the way to work, how he handed over money for a ticket, or answered some simple questions. Actions that were repeated many times were performed thoughtlessly, automatically.

A protective reaction of the nervous system occurs when it is overloaded. Everyday, trivial information is discarded as unnecessary.

You can feel a similar selective reaction of your brain now. You are completely unaware of your clothes, shoes and watches while reading this text. True, provided that these items do not cause any inconvenience. You simply forget about them or don’t pay any attention to them. For the cerebral cortex, this is unnecessary, redundant information. If you are very tired, this is your defensive reaction.

But when you “on autopilot” cross the road in an unspecified place, this is your death.

REMEMBER If you can’t remember how you got on the subway or train, if you run home in a panic to take the pan off the heat or turn off the iron, and everything is turned off by you, then you are entering chronic fatigue syndrome.

A person who has entered into this syndrome, due to the automaticity of his actions, can commit a very serious accident. The only sure and reliable way out of this situation is to take a vacation for 2-3 days and get a good night’s sleep.

NO PERSON
WHO WOULDN'T FAIL AT LEAST
turn off from work at home.
the iron he had already turned off!

We use the expression “throw a tantrum” quite often, but few people think about the fact that this is not simple behavioral promiscuity, but a real disease, with its own symptoms, clinic and treatment.

What is a hysterical attack?

A hysterical attack is a type of neurosis, manifested by indicative emotional states (tears, screams, laughter, arching, wringing of hands), convulsive hyperkinesis, periodic paralysis, etc. The disease has been known since ancient times; Hippocrates described this disease, calling it “rabies of the uterus,” which has a very clear explanation. Hysterical fits are more typical for women, they are less likely to bother children and occur only as an exception in men.

Professor Jean-Martin Charcot shows students a woman in a hysterical fit

At the moment, the disease is associated with a certain personality type. People subject to attacks of hysteria are suggestible and self-hypnosis, prone to fantasizing, unstable in behavior and mood, love to attract attention with extravagant actions, and strive to be theatrical in public. Such people need spectators who will babysit and care for them, then they receive the necessary psychological release.

Often, hysterical attacks are associated with other psychosomatic deviations: phobias, dislike of colors, numbers, pictures, conviction of a conspiracy against oneself. Hysteria affects approximately 7-9% of the world's population. Among these people there are those who suffer from severe hysteria - hysterical psychopathy. The seizures of such people are not a performance, but a real disease that you need to know, and also be able to provide assistance to such patients. Often, the first signs of hysteria appear already in childhood, so parents of children who react violently to everything, bend over backwards, and scream angrily should be shown to a pediatric neurologist.

In cases where the problem has been growing for years and an adult is already suffering from severe hysterical neuroses, only a psychiatrist can help. An examination is carried out individually for each patient, an anamnesis is collected, tests are taken and, as a result, specific treatment is prescribed that is suitable only for this patient. As a rule, these are several groups of drugs (hypnotics, tranquilizers, anxolytics) and psychotherapy.

Psychotherapy in this case is prescribed to reveal those life circumstances that influenced the development of the disease. With its help, they try to level out their significance in a person’s life.

Symptoms of hysteria

A hysterical attack is characterized by an extreme variety of symptoms

A hysterical attack is characterized by an extreme variety of symptoms. This is explained by the self-hypnosis of patients, “thanks to” which patients can depict the clinic of almost any disease. Seizures occur in most cases after an emotional experience.

Hysteria is characterized by signs of “rationality”, i.e. the patient experiences only the symptom that he “needs” or is “beneficial” at the moment.

Hysterical attacks begin with hysterical paroxysm, which follows an unpleasant experience, a quarrel, or indifference on the part of loved ones. A seizure begins with the corresponding symptoms:

Crying, laughing, screaming

Pain in the heart area

Tachycardia (rapid heartbeat)

Feeling short of air

Hysterical ball (feeling of a lump rolling up to the throat)

The patient falls, convulsions may occur

Hyperemia of the skin of the face, neck, chest

Eyes are closed (when trying to open, the patient closes them again)

Sometimes patients tear their clothes, hair, and hit their heads

It is worth noting features that are not characteristic of a hysterical attack: the patient has no bruises, no bitten tongue, the attack never develops in a sleeping person, there is no involuntary urination, the person answers questions, there is no sleep.

Sensitivity disorders are very common. The patient temporarily ceases to feel parts of the body, sometimes cannot move them, and sometimes experiences severe pain in the body. The affected areas are always varied, these can be the limbs, the abdomen, sometimes there is a feeling of a “driven nail” in a localized area of ​​the head. The intensity of the sensitivity disorder varies, from mild discomfort to severe pain.

Sensory organ disorder:

Visual and hearing impairment

Narrowing of visual fields

Hysterical blindness (can be in one or both eyes)

Hysterical deafness

• Hysterical aphonia (lack of sonority of voice)
• Muteness (cannot make sounds or words)
• Chant (syllable by syllable)
• Stuttering

A characteristic feature of speech disorders is the patient’s willingness to enter into written contact.

• Paralysis (paresis)
• Inability to perform movements
• Unilateral paresis of the arm
• Paralysis of the muscles of the tongue, face, neck
• Trembling of the whole body or individual parts
• Nervous tics of facial muscles
• Arching the body

It should be noted that hysterical seizures do not mean real paralysis, but an elementary inability to make voluntary movements. Often, hysterical paralysis, paresis, and hyperkinesis disappear during sleep.

Disorder of internal organs:

• Lack of appetite
• Swallowing disorder
• Psychogenic vomiting
• Nausea, belching, yawning, cough, hiccups
• Pseudoappendicitis, flatulence
• Shortness of breath, imitation of an attack of bronchial asthma

The basis of mental disorders is the desire to always be the center of attention, excessive emotionality, inhibition, psychotic stupor, tearfulness, a tendency to exaggerate and the desire to play a leading role among others. All the patient’s behavior is characterized by theatricality, demonstrativeness, and to some extent infantilism; one gets the impression that the person is “glad about his illness.”

Hysterical seizures in children

Symptomatic manifestations of mental seizures in children depend on the nature of the psychological trauma and on the personal characteristics of the patient (suspiciousness, anxiety, hysteria).

The child is characterized by increased sensitivity, impressionability, suggestibility, selfishness, mood instability, and egocentrism. One of the main features is recognition among parents, peers, society, the so-called “family idol”.

For young children, it is common to hold their breath when crying, provoked by the child’s dissatisfaction or anger when his requests are not satisfied. At older ages, the symptoms are more varied, sometimes similar to attacks of epilepsy, bronchial asthma, and suffocation. The seizure is characterized by theatricality and lasts until the child gets what he wants.

Less commonly observed are stuttering, neurotic tics, blinking tics, whining, and tongue-tiedness. All these symptoms arise (or intensify) in the presence of persons towards whom the hysterical reaction is directed.

A more common symptom is enuresis (bedwetting), which often occurs due to changes in the environment (a new kindergarten, school, home, the appearance of a second child in the family). Temporarily removing the baby from a traumatic environment can lead to a decrease in diuresis attacks.

Diagnosis of the disease

The diagnosis can be made by a neurologist or psychiatrist after the necessary examination, during which an increase in tendon reflexes and tremor of the fingers are noted. During the examination, patients often behave unbalanced, may groan, scream, demonstrate increased motor reflexes, spontaneously shudder, and cry.

One of the methods for diagnosing hysterical seizures is color diagnostics. The method represents the rejection of a certain color during the development of a particular condition.

For example, a person dislikes the color orange; this may indicate low self-esteem, problems with socialization and communication. Such people usually do not like to appear in crowded places; it is difficult for them to find a common language with others and make new acquaintances. Rejection of the color blue and its shades indicates excessive anxiety, irritability, and agitation. Dislike for the color red indicates disturbances in the sexual sphere or psychological discomfort that arose against this background. Color diagnostics is currently not very common in medical institutions, but the technique is accurate and in demand.

First aid

It is often difficult to understand whether the person in front of you is sick or an actor. But despite this, it is worth knowing the mandatory first aid recommendations in this situation.



Do not persuade the person to calm down, do not feel sorry for him, do not be like the patient and do not fall into panic yourself, this will only encourage the hysteroid even more. Be indifferent, in some cases you can go to another room or room. If the symptoms are violent and the patient does not want to calm down, try to splash cold water on his face, bring him to inhale the vapor of ammonia, give a gentle slap in the face, press on the painful point in the elbow fossa. Do not indulge the patient under any circumstances; if possible, remove strangers or take the patient to another room. After this, call the attending physician; do not leave the person alone until the medical worker arrives. After an attack, give the patient a glass of cold water.

During an attack, you should not hold the patient’s arms, head, neck or leave him unattended.

To prevent attacks, you can take courses of tinctures of valerian, motherwort, and use sleeping pills. The patient’s attention should not be focused on his illness and its symptoms.

Hysterical seizures first appear in childhood or adolescence. With age, clinical manifestations smooth out, but in the menopause they can again appear and worsen. But with systematic observation and treatment, exacerbations pass, patients begin to feel much better, without seeking help from a doctor for years. The prognosis of the disease is favorable if the disease is detected and treated in childhood or adolescence. We should not forget that hysterical fits may not always be a disease, but only a personality trait. Therefore, it is always worth consulting with a specialist.

Providing first aid for strokes, epileptic and hysterical seizures

Stroke- acute circulatory disorder in the brain and spinal cord as a result of hypertension and atherosclerosis of cerebral vessels. The disease occurs suddenly, often without any warning, both during wakefulness and during sleep. The patient loses consciousness, vomiting, and involuntary separation of urine and feces occur.

The face is hyperemic, with cyanosis of the nose and ears. Breathing is disturbed, frequent, wheezing, replaced by rare single breaths or its cessation. The pulse slows down to 40-50 per minute. Paralysis of the limbs, facial asymmetry (paralysis of the facial muscles of half the face) and anisocoria (uneven pupil width) are often detected. Sometimes a stroke occurs less violently, but is always accompanied by paralysis of the limbs and speech impairment.

The patient must be placed on the bed, clothes unbuttoned, and sufficient fresh air provided. The head should be covered with ice packs, and heating pads should be placed at the feet. Absolute peace is necessary. If swallowing persists, give sedatives (tincture of valerian, bromides), drugs that lower blood pressure (dibazole, papaverine).

It is necessary to monitor breathing, prevent tongue retraction, and remove mucus and vomit from the mouth. Moving and transporting to a hospital is possible only after a doctor’s conclusion about the patient’s transportability.

Epileptic seizure- one of the forms of manifestation of mental illness - epilepsy. During a seizure, there is a sudden loss of consciousness with tonic and then clonic convulsions, a sharp turn of the head to the side and the release of foamy fluid from the mouth.

In the first seconds of an attack, the patient falls, often receiving injuries. There is a pronounced cyanosis of the face, the pupils do not react to light. During a seizure, involuntary urination and defecation occur.

The duration of the attack is 1-3 minutes. After the seizures stop, the patient falls asleep and does not remember what happened to him.

When providing first aid, you should not hold the patient during convulsions and transfer him to another place. Place something soft under your head, unbutton your clothes, and place a folded handkerchief between your teeth to prevent tongue biting. After the seizures stop, it is necessary to transport the patient home or to a medical facility.

An epileptic seizure and stroke must be distinguished from a hysterical seizure.

Hysterical attack

A hysterical attack usually develops during the daytime and is preceded by a violent, unpleasant experience for the patient. A patient with hysteria falls gradually in a convenient place, without hurting himself; the observed convulsions are chaotic and spectacularly expressive.

There is no foamy discharge from the mouth, consciousness is preserved, breathing is not impaired, the pupils react to light. The duration of the seizure depends on the reaction of others: the longer it is, the more attention is paid to the patient. Involuntary urination, as a rule, does not occur.

After the seizures stop, the patient continues his activities, does not fall asleep, and is not stunned.

When providing first aid, the patient should not be restrained; it is necessary to move it to a quiet place and remove strangers, give it a sniff of ammonia. Under such conditions, the patient quickly calms down and the attack passes.

First aid in public places. Reference

Angina pectoris

A symptom of heart disease, not the disease itself. These are pressing pains that appear in the heart muscle when it tries to do its job without receiving enough blood, and therefore oxygen and glucose.

Symptoms:
– Constrictive pain in the center of the chest;
– Spread of pain to the left or both arms, along the back or up the neck;
– Seizures are associated with physical effort;
– There may be a lack of air;
– Pale skin and blue lips may occur.
Help with an angina attack:

Help the patient sit down and take the most comfortable position. Place some rolled up clothes on him.

Ask if he has heart medicine (nitroglycerin). If available in pill form, the medicine should be placed under the tongue (only if the patient is conscious). If it is in aerosol form, it should be sprayed under the tongue.

Loosen tight clothing and make it easier for the patient to breathe. Calm him down.

Observe whether the pain goes away after one or two minutes of rest. If the pain persists, it is not angina, but a heart attack. Urgent hospitalization of the patient is vital and can save his life.

Heart attack

Symptoms:
– A sudden attack of sharp pain in the middle of the chest or behind the sternum;
– Pain may spread to the arms, back or throat;
– The patient’s confidence that he is dying;
– Dizziness and fainting;
– Profuse sweat;
– Paleness;
– Weak, rapid pulse. May be intermittent (normal heart rate is 60–80 beats per minute);
- Lack of air;
– Sometimes loss of consciousness;
– Sometimes cardiac arrest.

Help for a heart attack

If the patient is conscious, move him to a reclining position. Place pillows (rolled clothing) under your head, shoulders and knees. Loosen tight clothing around the neck, chest and waist.

Calm the patient and help him relax.

Call for help and have someone call an ambulance and say that the patient is having a heart attack.

Check your pulse and breathing. If the victim becomes unconscious, place him on his side and regularly check his breathing and pulse.

If breathing stops, give mouth-to-mouth artificial respiration. The mechanism of artificial respiration is as follows:
– Place the victim on a horizontal surface.
– Clear the victim’s mouth and throat of saliva, mucus, soil and other foreign objects; if the jaws are tightly clenched, move them apart.
– Tilt the victim’s head back, placing one hand on the forehead and the other on the back of the head.
– Take a deep breath, bending over to the victim, seal the area of ​​his mouth with your lips and exhale. The exhalation should last about 1 second and help lift the victim’s chest. In this case, the victim’s nostrils should be closed and the mouth covered with gauze or a handkerchief for hygiene reasons.
– The frequency of artificial respiration is 16–18 times per minute.
– Periodically empty the victim’s stomach of air by pressing on the epigastric region.

If cardiac activity stops, begin performing chest compressions.

The mechanism of external cardiac massage is as follows: with a sharp push-like pressure on the chest, it is displaced by 3-5 cm, this is facilitated by relaxation of the muscles of the victim who is in a state of agony. This movement leads to compression of the heart, and it can begin to perform its pumping function - it pushes blood into the aorta and pulmonary artery when compressed, and when expanded, it sucks in venous blood.

When performing an external cardiac massage, the victim is placed on his back, on a flat and hard surface (floor, table, ground, etc.), and the belt and collar of his clothes are unfastened. The person providing assistance, standing on the left side, places the palm of the hand on the lower third of the sternum, places the second palm crosswise on top and applies strong measured pressure towards the spine.

Correct position of the hands: the thumb is directed towards the victim’s head (legs). Pressures are applied in the form of pushes, at least 60 per minute.

When performing a massage on an adult, significant effort is required not only from the hands, but also from the entire body. In children, massage is performed with one hand, and in infants and newborns - with the tips of the index and middle fingers, with a frequency of 100–110 shocks per minute. The displacement of the sternum in children should be within 1.5–2 cm.

The effectiveness of indirect cardiac massage is ensured only in combination with artificial respiration. It is more convenient for two people to carry them out. In this case, the first one makes one blow of air into the lungs, then the second one makes five pressures on the chest. If the victim’s cardiac activity has recovered, the pulse is determined, the face has turned pink, then the cardiac massage is stopped, and artificial respiration is continued in the same rhythm until spontaneous breathing is restored. The issue of stopping measures to provide assistance to the victim is decided by a doctor called to the scene of the incident.

Sudden cardiac arrest

Symptoms:
– A person falls, loses consciousness and lies motionless;
– There are no breathing movements;
– The pulse cannot be felt anywhere;
– The skin turns gray.

In case of cardiac arrest:

Scream, call for help. Have someone call for an ambulance and say that the patient is in cardiac arrest.

Perform two mouth-to-mouth blows. Proceed with external cardiac massage. Every 15 presses, do two blows. This should be done before the ambulance arrives.

Fainting

Symptoms:
– Paleness;
– Sweating;
- Dizziness;
– Deterioration of vision;
– Ringing in the ears;
- Loss of consciousness;
- A fall.

Fainting is accompanied by paleness and coldness of the skin. Breathing is slow, shallow, weak and rare pulse (up to 40–50 beats per minute).

First aid for fainting:

It is necessary to lay the victim on his back so that his head is slightly lowered and his legs are raised.

To make breathing easier, free your neck and chest from constricting clothing.

Rub the patient's temples with ammonia and bring a cotton swab soaked in ammonia to his nose, and sprinkle his face with cold water.

In case of prolonged fainting, artificial respiration is indicated.

Epileptic seizure

Sudden loss of consciousness with a characteristic cry before falling. The head is thrown back, the arms are bent, the fingers are clenched into fists, the legs are straightened. The chest freezes in the position of maximum exhalation. Then convulsions and involuntary body movements begin. Foam comes from the mouth, sometimes mixed with blood; involuntary urination and defecation occur. This continues for up to two minutes. After this, the patient calms down. His consciousness is absent, his muscles are relaxed, there are automatic movements. Breathing changes from convulsive to quiet and calm. Deep sleep sets in, after half an hour it is replaced by superficial, light sleep, lasting up to several hours. After an attack - short-term memory loss.

First aid for an epileptic seizure

Help should consist, first of all, in preventing injury to the patient. If you manage to notice the warning signs of a seizure, support the patient so that he does not fall backward, move him as far as possible from furniture, glass and sharp objects. Try to smoothly lower it to the floor, placing any soft object (jacket, slippers, bag) under your head, and turn it on its side. Press your shoulder girdle and head toward the floor. At the next stage, you must try to unclench the patient’s teeth and insert between them (from the side) some hard object wrapped in cloth. This will prevent you from biting your tongue. Be sure to call an ambulance. Until the doctor arrives, do not let the patient go and monitor his condition. After the end of the seizure, when the patient falls asleep, under no circumstances should you wake him up; he should wake up on his own.

Airway obstruction:

Airway blockage usually occurs when a foreign body, such as an unchewed piece of food or a hard piece of candy, enters the windpipe when inhaled.

Symptoms:
– A man grabs his throat with his hand;
– Shows clear signs of panic and confusion;
– Cannot speak;
– Breathing comes out first with a whistle, and then stops altogether;
– Turns blue or sometimes turns pale;
– After about a minute he loses consciousness.

First aid for airway blockage:

Conscious adult: The victim should bend forward so that his head is below his waist. Tap him sharply between his shoulder blades with the heel of your palm.

For a conscious child, place him or her in your lap, face down, and tap the heel of your hand between the shoulder blades.

If an adult or child is unconscious:

Turn the victim onto their side, facing you. Tilt his head back. If necessary, tap him on the back four times with the heel of your hand.

Infants and small children:

Place your baby face down in your arm. Support his head and chest with your palm.

Gently tap your baby four times between your shoulder blades with your fingers. If this does not help, try the abdominal pressure method.

Hysterical attack

Symptoms (lasts several minutes or hours): consciousness remains; there is no sudden fall; excessive agitation in behavior and speech; screams and sobs - especially in the crowd; sometimes – arching of the whole body with support on the back of the head and heels (“hysterical arc”).

Hysterical psychopaths strive to attract attention to themselves, stand out with their defiantly strange clothes and “demonstrative” behavior.