Die Verwirrung um Verwirrtheit, Stupor und Koma. Terminologische Bemerkungen zu den Bewusstseinsstörungen

Abstract

Taxonomy and nomenclature of normal and abnormal states of consciousness have been highly variable, imprecise and sometimes confusing, because the terms used to describe them have been given different meanings depending on medical field (e.g. neurology and psychiatry) and language. Compounding the difficulty is the fact that the terms continue to be changed in an attempt to reflect pathophysiology of disturbed consciousness which, however, is still not fully understood. In this article the terminological development and various definitions of the terms sopor, stupor, delirium, akinetic mutism and coma vigile, apallisches Syndrom (apallic syndrome) or vegetative state are being described with special emphasis on the German and English medical usage and some discrepant denotations. Acute confusional state (akuter Verwirrtheitszustand) e.g. has been classified either as a symptom or -inauspiciously - also as syndrome/disease thereby making it synonymous to delirium. The English usage of the term in neurology instead of sopor (semi-comatose state) stands in contrast to the psychiatric usage, where stupor implies absence of voluntary movement and responsiveness to external stimuli while being fully awake (e.g. dissociative stupor). German designations such as Bonhoeffer's akuter exogener Reaktions-typ (acute exogenous reaction type) as umbrella term for symptomatic psychoses, Wieck's Durch-gangssyndrome (transitional syndromes) for acute reversible organic psychic disorders with unaltered consciousness or Dammerzustand (twilight state) are being discussed and related to the term delirium with its various definitions in recent years.