Alcoholic psychosis

Description:

Because of alcoholism, it is preferential in II and III stages, various psychoses, both acute, and chronic can develop.

Symptoms of Alcoholic psychosis:

Delirium tremens (tremens) develops usually against the background of an abstinence syndrome at the sharp termination of alcoholism or (more rare) during abstention from alcohol in cases of accession of somatopathies, injuries (especially changes). Initial symptoms of delirium tremens are deterioration in a night dream, separate vegetative symptoms (perspiration and trembling of hands), and also the general fussiness of the patient. Throughout short time it is possible to note various shades of mood while usually at a hungover syndrome the mood is uniform, it is characterized by depression and alarm. The state worsens by the evening (with nightfall) while in the afternoon it can improve so that allows the patient to carry out the professional duties. Further there is sleeplessness against the background of which at first there are visual illusions, and then various hallucinations  and nonsense. Dominance of visual hallucinations which are characterized by plurality of images and mobility is characteristic. More often it is insects (cockroaches, bugs, flies) and small animals (cats, rats, mice). Are characteristic vision of devils, snakes, "little aliens", the died relatives. Quite often auditory, tactile, olfactory hallucinations are at the same time noted. At the same time the mood of patients is extremely changeable: within a short period of time it is possible to observe fear, complacency, bewilderment, surprise, despair.
Patients usually continuously move, their mimicry is expressive. Motor reactions correspond to the hallucinations existing at present and mood. So, at fear and frightening hallucinations of the patient hides, defends, it is excited, in the period of complacent mood it is passive. The nonsense is sketchy and reflects the maintenance of hallucinations, more often it is a persecution complex. Patients are usually incorrectly oriented in the place (being to hospital, say that they houses, at work etc.), but oriented in own personality. Periodic disappearance of a part of symptoms is characteristic of delirium tremens, i.e. "light" intervals, and also naturally expressed strengthening of symptoms and are noted in the evening at night.
Delirium tremens constantly is followed by various vegetative frustration — trembling of hands, sharp perspiration, a dermahemia, especially persons. Body temperature is more often subfebrile. Pulse is speeded up.
Without treatment delirium tremens drags on on 1 — 1,5 week, can be complicated by alcoholic encephalopathy. Recovery happens after a deep long sleep more often.
Alcoholic hallucinosis develops at an abstinence syndrome or at hard drinking height. At the same time the main frustration are the plentiful auditory hallucinations which are combined with a persecution complex. The patient usually hears the words "said" by a large number of people — "chorus of voices". Often there is a conversation of "voices" among themselves about the patient, less often they are addressed to the most sick. At the same time "voices" threaten, accuse, offend. Quite often hallucinations have floutingly teasing character, amplify before shout, weaken before whisper. The crazy ideas (a persecution complex, physical destruction) are closely connected with the maintenance of auditory hallucinations, they are sketchy and are not systematized. In mood the intense alarm and fear prevail. At the beginning of alcoholic hallucinosis at patients motive excitement is observed, but soon there is some block or the behavior arranged, masking a disease that creates false and dangerous idea of improvement of a state. As a rule, symptoms of a disease amplify in evening and night time. Vegetative frustration, usual for an abstinence syndrome, are noted. Duration of alcoholic hallucinosis from 2 — 3 days to several weeks, in rare instances it drags on up to several months.
The alcoholic depression develops against the background of an abstinence syndrome, is characterized in depression - alarming mood, tearfulness, the ideas of self-destruction, and also the separate crazy ideas of the relation and prosecution. Duration of several days to 1 — 2 week. In a condition of an alcoholic depression patients can commit suicide.
Alcoholic epilepsy is characterized by big convulsive attacks which arise at the beginning of an abstinence syndrome (being a harbinger of the beginning tremens), at delirium tremens, more rare — at intoxication height. Small attacks, twilight stupefactions, auras (see Epilepsy) at the same time do not happen. With the termination of an alcohol abuse attacks most often disappear.
Alcoholic paranoid develops in a condition of an abstinence syndrome or at hard drinking height, is characterized by existence of nonsense. The maintenance of the crazy ideas is exhausted by the ideas of prosecution or marital infidelity. In the first case patients consider that there is a group of the people aiming them to rob or to kill. In gestures, acts and words of people around they see confirmation of the thoughts. Confusion, the intense alarm which is often replaced by fear is characteristic. Acts of patients have impulsive character: they jump off on the run from transport, suddenly rush to flight, ask for the help in bodies of militia, sometimes commit assaults on the imagined enemies. In some cases the nonsense is followed by not plentiful verbal illusions and hallucinations, separate delirious symptoms arising in evening and night time. Alcoholic paranoid proceeds from several days to several weeks, occasionally several months.
The delirium tremens of jealousy arises almost only at men, as a rule, after 40 years, develops gradually. In the beginning the patient notes that the wife began to treat him inattentively, and over time just with hostility. Even more often, in his opinion, she shows coldness in intimate relations and even just evades from them. At the same time it seems to it that the wife begins to watch more carefully the outward, even more often somewhere leaves, constantly is late, and, having come home, looks unusually brisk and confused. The patient becomes rough, excitable, violent, he demands "explanations" that involves all becoming frequent scandals. However the behavior of the wife only "worsens". Suspicions about its incorrectness, in the beginning vague and arising in connection with zapoyny states, become constant and surer. The patient usually claims that the wife changes him with someone from men of the immediate environment — young relatives, neighbors. If at first "unfaithfulness" is made outdoors, then over time the wife "becomes impudent" and indulges in "debauchery" already in the apartment. The patient begins to watch the wife, asks for the help in various instances and can even apply violent acts to the wife, often commits murder. With progressing of a disease of the patient begins to claim that the wife changed it and in the past, till a marriage and that children actually were born not from it. The jealousy delirium tremens usually accepts a chronic current with periodic aggravations.
Alcoholic encephalopathies arise at the alcoholism which is followed by chronic gastritis or enteritis is preferential at persons who drink much, but eat a little. They develop usually against the background of a hypovitaminosis in spring months. The most often found form of acute alcoholic encephalopathies — Gayet's encephalopathy — Vernike. It usually begins gradually, 2 — 3 months, more rare proceed longer. There is an accruing adynamy which is shown weakness, an exhaustion in combination with dysmnesias. Decreases, and then and appetite completely vanishes, the night dream falls apart, the liquid chair, vomiting, headaches, dizzinesses, balance loss are slightly less often observed. The psychosis arising at the same time most often is presented by a professional or mussitans delirium, more rare alarming and crazy states. Several days later after emergence of these disturbances the oglushennost or symptoms of an apathetic stupor passing into a coma are noted. Neurologic frustration are constant and expressed: increase in a tone of muscles and sensitivity to pain, for example to pricks comes to light. Often there are various hyperkinesias. Emergence of paralysis of oculomotor muscles, a photophobia, a nystagmus usually testifies to the highest phase of a disease. Are observed various on intensity and localization of the phenomenon of a polyneuropathy. From vegetative symptoms disturbances of a cordial rhythm and breath, fever of the central origin, an incontience of urine and a calla are usually noted; skin pale or dark-brown. The general physical condition of patients is characterized by the progressing weight loss, up to a cachexia. The disease without treatment most often comes to an end with death.
Carry korsakovsky psychosis and an alcoholic pseudoparalysis to chronic alcoholic encephalopathies. In one cases they develop during a row of months, in others — sharply, as a rule, after delirium tremens.
Korsakovsky psychosis develops against the background of an alcoholism, a thicket — after the postponed heavy tremens. There are gross violations of memory on the current events with impossibility of storing and reproduction (fixating amnesia). As a result of mnestichesky frustration disorientation in the place and time, not recognition of people around appears. Gaps in memory are replaced with false memoirs. Earlier acquired skills and knowledge usually remains in sufficient volume. The mood can carry an euphoric shade in combination with total or partial absence of criticism to the state. In the neurologic status the ophthalmoplegia, a nystagmus, an ataxy, the disturbances of tendon and periosteal jerks in upper and lower extremities which sometimes are combined with an atrophy of muscles appear.
The alcoholic pseudoparalysis is characterized by weak-mindedness with the expressed memory disturbances: disorders of storing in combination with confabulations (see Amnesia), loss of the acquired knowledge and skills, judgment disturbances, lack of criticism to the disease. The background of mood is defined by carelessness, in some cases the ideas of greatness are noted. The current is long.
Pathological intoxication — the rare option of acute psychosis proceeding with a picture of twilight disorder of consciousness or an acute paranoid syndrome which develops after the use of small doses of alcohol and can come after a condition of simple alcoholic intoxication. Pathological intoxication arises at persons with organic lesion by TsNS, epilepsy, an oligophrenia, a psychopathy more often and lasts of several minutes till several o'clock with the subsequent deep sleep and amnesia of all event. The behavior of the patient is defined by crazy experiences of fear, hallucinations in this connection he makes inadequate aggressive actions, suicide attempts. Externally such state is shown by chaotic motive excitement, is more often silent, is followed by sharp pallor of the person. Cases of pathological intoxication almost always become a subject of the subsequent forensic-psychiatric examinations.

Reasons of Alcoholic psychosis:

The major factors leading to developing of alcoholic psychoses are disbolism caused chronic (usually not less than 5 years) abuse of alcoholic drinks.

Treatment of Alcoholic psychosis:

First of all it is necessary to exclude (at inspection of the patient) traumatic psychosis. Increase of weight of a state, consciousness disturbance deepening, emergence and strengthening of neurologic frustration with meningeal symptoms, lack of improvement of a state during the day, firmness of delirious frustration force to assume difficult (alcoholic and traumatic) character of a delirium.
Taking into account that psychotic frustration at acute alcoholic psychosis can temporarily be stopped by alcohol intake, it is reasonable to use before infusional therapy mix 0,3 — 0,4 g of the phenobarbital dissolved in 30 — 50 ml of alcohol with addition 100 — 120 ml of water which is allowed to drink to the patient. Then it is necessary to take care of mechanical fixing of the patient (especially during the first hours). It is possible to use for this purpose, for example, a grid from a usual country hammock, having covered with it the patient: at all external unattractiveness this least injuring means more preferably than standard "knittings".
Treatment of a tremens is based only on the pathogenetic principles. Intensive infusional care (same as at alcoholic abstinence) it has to be combined with high doses of psychotropic drugs: intravenously or intramusculary enter 3 — 4 ml of 0,5% of solution of Seduxenum to 2 — 3 times a day; intramusculary 1 — 2 ml of 0,5% of solution of a haloperidol, 2 — 3 ml of 2,5% of solution of Tisercinum or aminazine (the last in cases of the expressed psychotic symptomatology can be entered and intravenously). High doses of vitamin B are necessary, (on 5 ml 3 — 4 times a day). The best forecast is observed at addition of high doses of nootropil (to 5 g orally or to 20 ml intravenously).
Infusional therapy at alcoholic gallyutsinoza is carried out usually once and only in cases of the expressed vegetative frustration. The main place in treatment belongs to psychotropic drugs: to Tisercinum, a haloperidol, Stelazinum (Triphtazinum) which in the first days enter parenterally.
At treatment of alcoholic encephalopathies the main attention is paid to massive vitamin therapy (vitamins of group B and C) and to nootropic means.
At all stages of treatment of alcoholic psychoses the average medical personnel have to execute all appointments with extreme care, watch closely changes in a condition of the patient and report on them on the doctor. The importance of a sisterly nosotrophy with alcoholic psychosis is equated to the importance of care of the postoperative patient.