In the article we will consider what it is - akinetic mutism. This is a consequence of severe and large-scale trauma to brain structures. Psychotraumatic factors do not affect the syndrome. This ailment is observed after a person exits a coma pathological state. Akinetic mutism is severe, doctors often give unfavorable prognosis, since the processes in the brain are irreversible.
Reasons
For the first time, this disease was discussed in medical practice back in 1940. Psychiatrist Dr. Kearns specifically observed a sick patient with a brain tumor. Up to this point, pathology was considered only a mental disorder.
Akinetic mutism - most often this is a consequence of coming out of a coma. The comatose state could be caused by various factors, one of them is a severe head injury.
Another reason for the appearance of thedisease is a benign or malignant tumor in the brain. Deviations most often occur if the pathological process proceeds very quickly.
Another cause of akinetic mutism is thrombosis of the basilar artery. Thanks to it, our brain is sufficiently supplied with oxygen and the necessary nutrients. People suffering from osteochondrosis are at risk of getting such thrombosis. Provoke the appearance of blood clots in this bloodstream can be sports and household injuries, injuries in a car accident that occurred in the neck-collar zone or occipital.
Drug effects
There are cases of akinetic mutism with emotional reactions from the toxic effects of drugs. This can happen due to an overdose of drugs or the interaction of various drugs with each other. Taking large doses of some antibiotics provokes toxic poisoning. There have been cases of anomalies after taking psychotropic drugs.
The cause of the development of such a disease can also be a gunshot wound if it touched the frontal lobes of the brain, the thalamus. Also, ischemic stroke, intracerebral and subarachnoid hemorrhage can disrupt blood circulation.
In addition, akinetic mutism causes excessive accumulation of cerebrospinal fluid, a brain abscess in the head cavity.
In patients with HIV infection and alcohol poisoning
The disease is observed inpatients with HIV infection, as it provokes various neuropsychiatric complications. Deviations are also found in alcohol poisoning associated with damage to nerve endings in the brain.
Emotional reactions in mutism
Akinetic mutism is a condition in which the patient completely loses speech, but the very ability to speak remains. There is a lack of facial expressions and gestures, but the patient hears someone else's speech and understands it. He adequately perceives and reacts to the events taking place around him. He is well oriented in space and time. Positive reactions are observed with loud sounds, with temperature changes. There are no hallucinations or delusions. Despite all the reactions, the patient is in a supine state. He is not active, only able to move his gaze from object to object, but for a short time.
One of the varieties of mutism is a psychogenic form of the disease, provoked by psychological trauma. There are cases when this condition manifested itself in a selective form, when the patient spoke only with selected people.
Symptoms of the disease
The stay of a person with akinetic mutism syndrome is very difficult. He is fully conscious, but unable to communicate normally. During examinations, a high tone of muscle tissue in the limbs is determined. During additional examinations, the absence of disorders in the musculoskeletal and speech apparatus is revealed.
The patient is additionally examined to rule out meningeal symptoms. The color of the patient's skin is not changed. Blood pressure should be within normal limits, but there have been cases in which deviations were observed. Pulse at rest is rhythmic, within normal limits.
Complete silence is a characteristic symptom. A person does not have both passive and active speech. The patient finds it difficult to speak his thoughts out loud, and there is also no ability to repeat phrases after the doctor. However, the patient understands what is being said to him, the ability to analyze what he hears remains.
Another symptom is a complete lack of motor ability. A person is not able to control his body, while the ability to chew and swallow is available. There were cases when patients ate food that they were fed from a spoon. But most often, these patients are fed through a tube.
The patient is not observed during this period of tension and restlessness. It is not possible to assess the emotional state of a person. After recovery, amnesia most often occurs, the patient does not remember anything about his condition.
Treatment for akinetic mutism
Doctors face a difficult task. Due to the severity of the condition, a thorough, long-term, complex treatment is required under the daily supervision of medical personnel. The main goal of therapy is to diagnose the underlying disease that provoked akinetic mutism and take timely measures to eliminate it.consequences of pathology.
In most cases, surgery is needed to save the patient's life. During the operation, a hematoma (accumulation of blood) is removed if the syndrome is provoked by a violation of the blood supply to the brain. If a tumor is found, the neoplasm is excised. If the cause is hydrocephalus, a drain is installed to drain the cerebrospinal fluid.
Based on the tests carried out after the operation, treatment with medications is carried out: antipsychotic drugs - neuroleptics; nootropics; antidepressants of the SSRI class; benzodiazepine tranquilizers; vitamin and mineral complexes; drugs that normalize the level of blood pressure; anticoagulants - drugs that prevent the formation of blood clots.
The next step in the treatment are activities for the rehabilitation of speech functions. Doctors recommend constantly talking with the patient, hugging and holding his hand. A patient with akinetic mutism should eat frequently, six times a day.
Regular hygienic procedures are a mandatory requirement for patient care: washing the face, wiping all the skin, caring for the oral cavity and hair. Special measures should be taken to prevent bedsores. Relatives are advised to provide a pleasant psychological environment for the patient. Perhaps resort to the help of a psychologist for further adaptation.
To restore motor activity, you must perform: breathing techniques; medicalgymnastics; massage; acupuncture; physiotherapy.
Stages of recovery
Conventionally, doctors distinguish two stages of recovery of akinetic mutism in neurology:
- Restoring speech comprehension. The patient lies with half-open eyes, turns his head to the sound or light. There is a constant and stable fixation of the gaze, tracking objects. The completion of this stage is the first manifestation of speech understanding. This can be evidenced by the fact that the patient hears the words addressed to him, his facial expressions change, requests expressed in words are fulfilled, for example, to squeeze the doctor's hand. But all manipulations take place gradually. At first, the doctor puts his hand into the palm of the patient, then the tasks become more complicated every day, which provoke the patient to greater motor activity. They try to work out more complex commands further, with subsequent acceleration. Restoration of understanding of addressed speech indicates the absence of brain damage.
- Return of own speech in akinetic mutism after coma. The patient makes more and more active and different movements. The pronunciation of words indicates the completion of the first stage. This cannot be spontaneous, more often in response to the doctor's request to say something. The first sounds will be fuzzy. Only by individual signs can one guess what sound was uttered. Every day the situation improves, the patient begins to speak spontaneously, already without requests. After some time, the pronunciation of phrases is already possible. Then it will be possible to conduct a dialogue with the patient, whichallows you to objectively assess the state of his consciousness. Together with the restoration of speech function, the forms of voluntary movements are expanding. They become ordered.
Anartria
What is akinetic mutism with anarthria? One of the consequences of mutism is anartria, that is, a severe speech disorder. Manifested by obscure phrases, nasal pronunciation, with obvious stuttering. The patient's voice becomes hoarse. Often, after realizing such a defect, the patient communicates using notes or is generally silent. Often there is a problem with swallowing food.
Degrees of severity
The following degrees of anartry are shared:
- easy degree - a person is able to pronounce sounds, syllables;
- moderate severity - the patient can only pronounce individual sounds;
- severe degree - the patient is completely unable to speak, his sound activity is zero.
Forecast
A disappointing prognosis for akinetic mutism can only be when the organic brain damage is too great and can no longer be corrected. Also, if the patient had an advanced form of a mental disorder, there can be no talk of a complete recovery.
Disease prevention
Doctors recommend to reduce the likelihood of pathology:
- keep active;
- do sports;
- with any somatic andmental disorders in a timely manner to contact specialists.
The tendency to develop mutism is least marked in mentally he althy people who control the level of pressure, the state of the heart and blood vessels, refuse alcohol and are not nervous.
We considered it to be akinetic mutism.
