Stupor describes a symptom complex whose central feature is a reduction in, or absence of, relational function identified by the inability to initiate speech or action in a patient who appears awake and even alert.
Stupor (from Latin stupure, literally “insensible”) may be clinically defined as awareness accompanied by profound lack of responsiveness. It usually occurs with some degree of clouding of consciousness but does not refer solely to a diminished level.
It is not necessarily the case that a patient who is inaccessible is in a state of coma or sopor. The absence of any obvious signs of activity, movement or response to external stimuli does not of itself mean that consciousness is impaired:
a patient may be fully conscious and yet profoundly unresponsive to his immediate environment.
While terms such as coma Opens in new window and sopor Opens in new window describe a substantial impairment of consciousness, stupor describes a profound lack of responsiveness to external stimuli and the environment rather than profound unawareness of it.
Components of Stupor
The two components of stupor are sometimes described as akinesia (as voluntary absence of any movement) and mutism (a voluntary absence of any speech).
Where a state of stupor appears to form part of a catatonic schizophrenic illness, it is usually described as catatonic stupor.
Catatonic stupor is defined in the DSM Glossary (1119) as a marked decrease in reactivity to the environment and reduction in spontaneous movements and activity, sometimes to the point of appearing to be unaware of one’s surroundings.
A stuporous patient requires repeated, stronger stimuli to show some arousal, and such patients may or may not open their eyes.
Full arousal and alertness are not achieved. However, with continuing external stimulation, restlessness and stereotypic motor responses are observed, but without the appropriate cognitive interactions.
The patient may look ahead or his eyes may wander, but he appears to take nothing in. A deep stuporous state closer to coma Opens in new window is differentiated by European clinicians and is referred to as sopor Opens in new window (from Latin sopor, meaning “deep sleep”).
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- A. Sims, Symptoms in the Mind (Bailliere Tindall, London, 1988).
- W. A. Lishman, Organic Psychiatry, The Psychological Consequences of Cerebral Disorder (Blackwell Scientific Publications, 2nd, ed., 1987), p.6.