Stupor is another serious complication of depression. It is a term that leads to disagreement between neurologists and psychiatrists, who use it in different ways. It is sometimes used to describe an intermediate stage on the spectrum of impaired consciousness that eventually leads to coma. Lishman30 argues that this is an incorrect use of the concept, which he believes is more appropriately defined as a syndrome in which the patient is conscious but makes no spontaneous movement and shows little response to external stimuli; in the most advanced form of stupor the patient is completely mute and immobile. Consciousness is inferred by the fact that there may be purposeful eye movements, following the actions of other people in the vicinity, and also by the patient's recall of events once recovery has occurred. In psychiatric practice, depression and schizophrenia are the commonest causes of stupor.31,32 The diagnosis depends on eliciting a history of relevant symptoms during the weeks before the onset of stupor. In the case of depression there is a history of progressive psychomotor retardation in addition to the psychological symptoms of low mood, guilt, and self reproach. A full neurological evaluation, including magnetic resonance imaging (MRI) of the brain, is essential before a diagnosis can be made with confidence. Cerebral disorders that can give rise to the clinical picture of stupor include dementia, encephalitis, and cerebral tumour or cyst in the upper midbrain or posterior diencephalon causing increased intracranial pressure.

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