Stupor: Causes, Treatment & Help

Stupor is a symptom of a mostly mental illness. It is characterized by the body going into a state of rigidity despite being awake and conscious. In extremely severe cases, stupor may also indicate a life-threatening mental illness.

What is a stupor?

Stupor refers to a physical state of rigidity despite an awake consciousness. It occurs as a symptom of various mental or brain disorders. Stupor refers to a physical state of rigidity despite an awake consciousness. It occurs as a symptom in various mental or brain-organic disorders. Patients are unable to respond to speech, although they are aware of everything. Stupor is often accompanied by increased muscle tone, fever and disturbances of the autonomic nervous system. In this case, certain features such as muscle tone, eye movements, or eye opening indicate an awake state. Stupor often occurs together with mutism (muteness). The affected persons do not react at all or only slightly to environmental stimuli. However, they perceive these stimuli with particular sensitivity. It is also difficult to take in food and fluids, so that patients with stupor sometimes have to be fed artificially. In particularly severe forms of stupor, catalepsy may even occur. Catalepsy is characterized by a so-called waxy increase in muscle tone, whereby a once passively induced change in position of the limbs is maintained immobile for a prolonged period of time. Even the most uncomfortable positions of the joints persist.

Causes

There are many causes of stupor. Many mental illnesses can trigger a stupor. In the context of severe depression, the so-called depressive stupor may occur. The affected person appears resigned and is at the same time highly suicidal. Catatonic stupor is usually caused by schizophrenic psychosis. This is characterized by catalepsy and is highly life-threatening as a result of increased physical reactions such as fever or mineral metabolism disorders. Psychogenic stupor is caused by previous traumas or other stressful experiences. Here, there is no evidence of schizophrenia, depression, or organic causes. An organically caused stupor can be triggered by meningitis, encephalitis (inflammation of the brain), epilepsy, other seizure disorders, brain tumors, cerebral edema, dementia, liver disease, hormonal disorders, or elevated potassium levels, among others. Stupor may also occur in the context of Parkinson’s disease. The same is true for acute porphyria and diabetic ketoacidosis. Medications can also cause stupor. In particular, it can occur as a side effect of the use of neuroleptics. Finally, poisoning with drugs such as PCP or LSD often results in stupor. Uncontrolled use of sleeping pills and hypnotics (barbiturates, benzodiazepines) and opiates are also common causes of stupor.

Diseases with this symptom

  • Meningitis
  • Dementia
  • Liver disease
  • Parkinson’s disease
  • Diabetic ketoacidosis
  • Encephalitis
  • Cerebral edema
  • Psychosis
  • Hypercalcemia
  • Mutism
  • Epilepsy
  • Brain tumor
  • Trauma
  • Hormonal imbalances
  • Acute intermittent porphyria

Diagnosis and course

To diagnose stupor, the doctor will first take a history of the patient’s medical history. Since stupor patients are unresponsive, next of kin are interviewed for this purpose. The first step in taking the medical history is to find out whether mental illnesses are already present or have been present in the past. During the physical examination, the doctor checks the patient’s muscle tone and response to stimuli and pain. Laboratory tests for blood, cerebrospinal fluid or spinal fluid can provide information about possible organic diseases. This is followed by neurological examinations, measurements of electrical brain waves (EEG) and imaging procedures such as magnetic resonance imaging. All examinations serve to determine whether organic or psychological causes are responsible for the stupor. The manifestations of a stupor often also depend on the cause.Thus, it is also important for the physician to recognize the correct form by external features. For example, if catalepsy is present, the physician can assume a catatonic stupor, which sometimes occurs in the context of schizophrenia. This condition is very life-threatening. Prolonged stupor sometimes results in dissolution of the transversely striated muscles (rhabdomyolysis). Rhabdomyolysis often leads to acute renal failure. Other complications of stupor include pneumonia with sepsis, thrombosis, skin ulcers, or electrolyte imbalances. In these cases, for proper treatment, the physician must diagnose or rule out stupor without doubt as the cause of the complications.

Complications

Stupor most often occurs because of mental illness, which can be associated with a variety of consequences. Common complications of stupor include skeletal muscle breakdown (rhabdomyolysis). In addition, renal failure may occur (renal insufficiency). Pneumonia, which may progress to sepsis, or thrombosis and ulcers are other conceivable consequences of a stupor. Typically, a stupor develops in depression. These can often be accompanied by anxiety or panic disorders. Affected persons no longer dare to go out in public and isolate themselves socially, which only intensifies the symptomatology. Compulsive disorders can also occur. Affected persons sometimes experience hallucinations and have psychoses, which often cause them to become insane. It is not uncommon for sufferers to take drugs or drink alcohol to escape their worries. Frequent drug use only exacerbates the symptomatology of hallucinations and psychosis. Alcohol can also cause cirrhosis of the liver, which is no longer functional and can turn into liver cancer. Eating disorders can also affect the sufferer. They either eat more or less, so bulimia or obesity can result. Both secondary diseases are associated with an increased risk of cardiovascular disease. This is also favored by the lack of sleep, which is often part of it. In the worst cases, the depressive commits suicide. Approximately 15 percent take their own lives in the course of the disease.

When should you go to the doctor?

If stupor is suspected, it is always a good idea to see a doctor. The family doctor or a general practitioner can serve as the first point of contact. Since stupor can be due to various causes, a referral to a specialist may be necessary after initial investigations. Patients should definitely make use of such a referral. In an acute situation, an emergency physician may also be called in. This is especially true if it is unclear whether stupor or another clinical picture is involved. It is often impossible for outsiders to tell whether the affected person is conscious. Other diseases and syndromes can look very similar. These include serious illnesses such as strokes, for which immediate treatment is necessary. For this reason, it makes sense to make an emergency call, especially in such an unclear and acute situation. For the same reason, self-diagnoses should be viewed very critically. There is a risk that other causes will be disregarded, resulting in serious complications. There may already be a known illness that can trigger the stupor. In this case, those affected can (if necessary after an initial clarification) also contact their attending specialist themselves. However, they should not allow too much time to pass.

Treatment and therapy

The therapy of a stupor depends on the underlying disease. In the case of organically caused stupor, the disease that may be present, such as meningitis, encephalitis, cerebral edema, or brain tumor, must be treated. After the organic cause is cured, the stupor also disappears. Catatonic stupor is treated with neuroleptics such as fluphenazine or haloperidol. In addition, sedatives and anxiety relievers may also be used. Anxiety relievers are especially helpful in psychogenic stupor. If depressive stupor is present, antidepressants are used. Neuroleptics may also be prescribed in this case. In some cases, electroconvulsive therapy (ECT) helps. Here, electrical impulses are used to provoke a seizure. This treatment must be repeated on several consecutive days. There is hardly any health risk with this therapy.Even if a stupor patient does not respond to address, constant attention from all persons involved is very important. Former patients describe the constant address and attention as confidence-building and relieving. In the case of psychogenic stupor, a calm and non-stimulating atmosphere can often even facilitate a therapeutic conversation. Furthermore, constant monitoring of vital signs is important to quickly detect complications.

Outlook and prognosis

The prognosis for stupor depends on the length of the acute state and the precipitating cause of loss of consciousness. Recovery is considered likely if the patient is responsive within 6 hours. If speech returns or the eyes succumb to voluntary movement in the next few days, there is also a good chance of recovery. Indications of positive development are the patient’s compliance with instructions and appropriate response to various addresses. Cognitive understanding and responding to events in content is important for there to be a good chance of recovery. Less good prospects are present if the pupils do not contract when exposed to light. If the patient is unable to follow an object with the eyes, this is also an indication that recovery is not complete. If increased seizures or a prolonged seizure occur within the first few days of the stupor, recovery is considered unlikely. If the affected person is unable to move his or her hands or legs purposefully after more than a week, the state of health is also considered problematic.

Prevention

Prevention of stupor can only occur in the setting of a known underlying condition. Treating it as best as possible will help prevent stupor as a complication. There is no general prophylaxis for stupor because of the many possible causes.

Here’s what you can do yourself

Stupor is a state of absolute torpor that can become life-threatening. The affected person is conscious but can hardly make any movements. In addition, fever and muscle rigidity may occur, and normal urination and defecation are no longer present. More common backgrounds are severe mental illnesses such as catatonic schizophrenia. However, the administration of certain psychotropic drugs can also trigger stupor. This is especially true for certain neuroleptics. Self-help is almost impossible in acute stupor. This can only be resolved pharmacologically. Therefore, an inpatient setting is necessary for acute treatment. However, through self-care in cooperation with medical professionals, affected individuals can strive to change basic medicinal attitudes that can trigger a stupor. If such a condition has occurred (possibly multiple times), it is appropriate to modify medication with psychotropic drugs and to seek alternatives to treatment of the underlying condition. In addition, patients who notice that a stupor is imminent should seek medical help very quickly from specialists, such as a neurologist. However, because it often occurs in combination with severe mental illness and strong psychopharmacological medication, it is difficult for affected individuals to respond in time themselves. Self-medication by administering relaxing agents to resolve rigidity is problematic and often not feasible.