Impaired consciousness

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Disorder of consciousness is a disorder of one of the vital functions and elementary functions of the human psyche. It is one of the psychopathological symptoms .

In German-speaking psychopathology, impaired consciousness is understood to mean any impairment or (subjectively possibly even positively perceived) change in the usual (normal, average or habitually assumed) daily, normal or everyday consciousness . The ability of those affected to control themselves is changed in such a way that the possibility of normal interaction with them is difficult or impossible.

Formally, the disturbances of consciousness can be divided into quantitative and qualitative disturbances of consciousness .

to form

Quantitative disturbances of consciousness

Classification according to ICD-10
R40.0 Drowsiness / somnolence
R40.1 Sopor / Precoma
R40.2 Coma / loss of consciousness
ICD-10 online (WHO version 2019)

Quantitative disturbances of consciousness are reductions in consciousness , as they affect the level of alertness (the vigilance ). The levels of alertness range from drowsiness through somnolence and sopor to unconsciousness or the various degrees of coma .

  1. Drowsiness : Thinking and acting are clearlyslowed downto apathy and the ability to orientate is reduced or restricted; Little spontaneous linguistic utterances, slow thinking and reduced comprehension. Easily awakened by speaking or touching.
  2. Somnolence : There is a constant drowsiness or a tendency to sleep, which can be interrupted at any time by simple wake-up stimuli. No spontaneous linguistic utterances; if so, then incomprehensible (murmuring). Reflexes are preserved. Reduced concentration and alertness.
  3. Sopor : A sleep-like state from which those affected can only beawakenedwith great effort and the application of strong stimuli, such as painful stimuli . No longer oriented, no verbal utterances, received reflexes.
  4. Coma : the highest level of loss of consciousness when someone cannot be awakened by any means; Neurologically , on the basis of increasing reflex failures, further degrees can be differentiatedup to the deepest coma , in which centralvital reflexesare extinguished and the greatest danger to life is through cessation of breathing. No defensive movements.
    A special case of coma is the so-called vegetative state or Apallic syndrome . A distinction must be made between the coma as an uncontrolled loss of consciousness and the drug-induced decrease in consciousness, which is referred to in medicine as an artificial coma .

In emergency medicine, the classification based on the Glasgow Coma Scale (GCS) is common. A reduction in consciousness can be recognized by the fact that the patient only slows down, does not react appropriately to the situation or not at all to (loud) speaking and touching. In the case of an advanced disturbance of consciousness, it shows only untargeted defense or no reaction to pain stimuli.

Qualitative disorders of consciousness

Qualitative disorders of consciousness affect the clarity of consciousness, i.e. That is, the contents of consciousness are changed and the clarity of consciousness is reduced.

Qualitative disturbances of consciousness in addition to the applicable level of consciousness all forms of consciousness narrowing and consciousness shift and augmentation .

  • Of clouding of consciousness is called in confusion of thought and action, d. H. lack of clarity in visualizing the experience in one's own area or in the environment with confusion in thinking and acting. These include disorientation, anxiety, hallucinations, disturbances in the sleep-wake cycle and vegetative disorders that can be life-threatening. Action and communication are disturbed. A clouding of consciousness can exist constantly and thus be continuous, but it can also only occur temporarily (“fragmented consciousness”).
  • A narrowing of consciousness consists in an experience-related, mental or emotional fixation on an aspect of the experience with the result of reduced responsiveness , a shifted state of consciousness and amnesia. The person is not disoriented. This state begins and usually ends within a short time.
    Occurrence : after epileptic seizures, traumatic brain injuries, brain inflammation or in pathological intoxication.
  • With a shift in consciousness / expanding / - change is an unusual change in the level of consciousness compared to the usual or normal daily waking consciousness. A change in the waking life with feelings of an increase in intensity or brightness. It can occur in the form of increased alertness (“surveillance”), possibly combined with a similarly altered perceptual ability as is the case with higher, often meditative or supported degrees of mindfulness . Often, an "ecstatic" experience that goes well beyond "enthusiasm" - especially emotional ones  - is included in this, although this consists of a spontaneous and experience-related concentrative intensification of consciousness and thus a narrowing of consciousness to something that is currently experienced. Ecstasies are thus similar to trance , into which they can also pass if in the individual case it is not actually one.
    Occurrence : drugs, incipient mania, incipient schizophrenia, intense meditation.

causes

Causes of quantitative disturbances of consciousness (decreased consciousness)

Loss of consciousness is always a symptom of a physical health disorder . The following can be considered:

Legal implications

civil right

Disturbances of consciousness of all kinds lead to the ineffectiveness of legal transactions in civil law ( § 105 BGB ), acts of affect under certain circumstances lead to inability to commit offenses ( § 827 BGB). However, there is an exception to the ability to commit a crime when consuming alcohol ("spiritual drink") and intoxicating substances: If the perpetrator voluntarily and with knowledge or grossly negligent ignorance of the intoxication has put himself in a state that precludes free will formation, then acts he is still guilty, § 827 sentence 2 BGB.

Criminal law

Involuntary behavior in a state of unconsciousness does not fall under the concept of an act in criminal law .

If the suspect is mentally ill, mentally handicapped or through intoxicating drugs and medication into a state that precludes conscious perception and free will, he is, depending on the intensity / severity of the impairment, incapable of guilt ( § 20 StGB ) or less guilty when committing an emotional act ( § 21 StGB).

A criminal liability for intoxication ( § 323a StGB) is still possible, provided that the actual or because of the principle “ in dubio pro reo ” cannot be ruled out inability to be guilty of alcohol or other intoxicants. This provision, which the Nazi legislature inserted into the German Criminal Code in 1933 (see article on intoxication), conflicts with the principle of guilt , as it is criminally linked to "getting intoxicated / getting drunk" and the offense committed incapable of guilt (e.g. B. murder) is only considered as an objective condition of criminal liability . These constitutional concerns are taken into account (the principle of guilt follows from the rule of law in Article 20 (3 ) of the Basic Law ) with the fact that the sentence under Section 323a of the Criminal Code (fine or imprisonment up to 5 years) in the judgment may not be higher than it is the threat of punishment for “intoxication” permits, Section 323a (2) StGB. A further possibility to establish accusation even in a state of incapacity and thus to enable a punishment is the controversial legal figure of the “ actio libera in causa ” (German: an action free in its cause). The accusable element is not seen in the offense itself, but in the decision taken before the intoxication to commit the offense in a state of incapacity. The actio libera in causa also meets constitutional concerns. One sees in it a violation of the principle of coincidence under criminal law (anchored in Article 103, Paragraph 2 of the Basic Law), according to which the offense and guilt must exist at the same time. While numerous possibilities of justification are used in the literature (actio libera in causa as an exception to the principle of coincidence, shifting criminal liability forward, intoxicating offender is the innocent tool for the same offender in the normal state), which are more or less justifiable (see the main article on actio libera in causa), the jurisprudence completely rejects this legal concept for personal offenses such as § 316 and § 153 StGB and abstains from commenting in the other cases. The figure of the negligent actio libera in causa, however, is superfluous, since one z. B. in the case of accidental killing of a child by a completely drunk and therefore not culpable offender, with appropriate predictability, can already see a negligence breach of duty of care at the start of the journey or in the risk of drunk driving.

The measures of reform and protection are not affected by the conflict with the principle of guilt, because they can be imposed independently of personal reproach (= guilt) . Specifically, placement in a psychiatric hospital ( Section 63 StGB) or in a rehab facility ( Section 64 StGB) comes into consideration.

See also

literature

Individual evidence

  1. ↑ For example in Christian Scharfetter: Allgemeine Psychopathologie. An introduction. Thieme, Stuttgart 1976, ISBN 3-13-531501-0 , pp. 28-35, where on p. 35 under 2.5.3. even an explicit increase in consciousness (expansion of consciousness) as a subchapter of Chap. 2.5 Pathology of consciousness - disorders of consciousness - disorders of vigilance and clarity of consciousness is listed.
  2. ↑ The neutral description of altered states of consciousness is more common in basic psychological research; s. alongside Charles Tart's book States of Consciousness. In: Psychol. Processes , El Cerrito CA 1983 his classic Altered States of Consciousness. Doubleday, New York 1971 and, indirectly related to it, also his practically oriented work Wide awake and consciously living. Scherz, Munich 1988, ISBN 3-502-67595-3 , since 1995 Arbor, Freiamt, ISBN 3-924195-24-2 .
  3. ↑ by Charles Tart in Living Wide Awake and Conscious. (1988) called everyday or consensus trance from the perspective of a fully developed and consistently mindful consciousness for certain reasons , s. especially chap. 10 The everyday trance or consensus trance - the sleep of ordinary consciousness (pp. 127–154).
  4. ^ Johann Deutsch, Franz Georg Schnekenburger: Pediatrics and pediatric surgery: for nursing professions . Georg Thieme Verlag, 2011, ISBN 978-3-13-167731-0 ( google.com [accessed on May 27, 2016]).
  5. ↑ Electricity accident. (No longer available online.) Archived from the original on September 11, 2016 ; accessed on May 28, 2016 .