Psychiatric conditions/disorders usually only occur in fully conscious patients. Dysfunctions in consciousness become apparent when a patient responds adequately if addressed firmly, does not respond but still executes commands, or responds only to pain stimuli.
If a patient appears motionless, but is clearly conscious, with their eyes open, and seems to be following events; the patient is in a stupor. Rarely, there is some speech and sometimes there are specific movements. There are no emotional responses, but reactions to pain stimuli do occur. Stupor may refer to schizophrenia, short-term psychosis, depressive disorder, panic disorder, conversion disorder and simulation, but usually there is another medical cause, such as a brain tumour, stroke, encephalitis or a metabolic disorder.
A narrowed consciousness is a condition during which the patient is fully focused on a particular sensation, and does not respond to external stimuli. This is indicative of epileptic twilight states, intoxications, trance sensations, acute psychosis and dissociative disorders, such as dissociative fugue.
Conditions of slightly diminished or clouded consciousness are difficult to observe objectively. The preferred approach is to explore associated subjective characteristics, such as drowsiness and absent-mindedness.
