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Delirium tremens


can occur acutely, especially if any provoking harmful factors contribute to this, however, there may be precursors. 2-3 days before the onset of the disease, sleep is disturbed, which becomes superficial, anxious, with nightmare dreams. The patient wakes up all in sweat, anxiety. There may be short-term illusory deceptions of perception: the picture on the wallpaper, the image in the paintings, etc. seems to be "alive".
Psychosis itself usually develops in the evening. Anxiety is growing. There are deceptions of perception, visual and auditory. The patient begins to see objects and phenomena that do not exist in reality. Often see clusters of small animals (mice, rats, cats), insects (flies, cockroaches, bugs), less often large animals "like in a zoo", devils (so they say - "drunk to hell"). Visual illusions (hallucinations) can be single, multiple or scene-like. Auditory deceptions of perception can join in - the "voices" of people, devils. Since the patient is in a state of dull consciousness, hallucinatory images for him are more relevant than real-life events. Therefore, all the patient’s behavior is determined by painful visions and “voices”, and not by the real situation. The patient sees mice and tries to escape from them: he hits them, screams, gets away from them on the bed, on the closet, runs away from home. He does not distinguish real objects from hallucinatory ones, therefore he can, for example, in order to defend himself, attack a real policeman instead of what he seems to be. Due to the fact that the patient is not a passive contemplator of his deceptive perceptions, but an active participant in all “events”, he is also a danger to himself (maybe, “escaping”, go out the window, jump from a height, commit suicide) and for others (kill the "pursuer"). The patient usually has an orientation disorder in the place (does not know where he is), time (what day, day), but the orientation is preserved in his own personality (he knows his name, surname, who he is, where he works, how old he is, etc.).
Excitement climaxes at night. In the afternoon, the state improves, sometimes to complete "enlightenment" and the appearance of criticism for the episode. This fact should be taken into account by both patients and medical personnel, as the possibility of an exacerbation of the condition the next night is not excluded.
The name of the psychosis "delirium tremens" is due to the fact that patients have a peculiar general tremor with trembling hands, uncertain unsteady gait, illegible handwriting, slurred speech. Along with mental disorders, somatoneurological are also detected: redness of the face, sharp sweating, palpitations, fluctuations in blood pressure, acute toxic hepatitis or cirrhosis, increased tendon reflexes. Sometimes during the period of psychosis convulsive epileptic seizures are noted.
Delirium usually lasts 3-5 days, even without treatment. In severe concomitant somatic disorders - up to 10 days. Recovery from abortive (short-term) delirium occurs after prolonged sleep. In other cases, medical intervention is required. Currently, fatal outcomes are rare, although possible in the case of a serious violation of cardiovascular activity, liver failure, cerebral edema.
Treatment:
A patient in a state of delirium should be hospitalized immediately. In the hospital, therapy is prescribed aimed at stopping excitation (tranquilizers, antipsychotics, barbiturates), as well as detoxification (cleansing the body of alcohol metabolism products). Sometimes after a long sleep, the patient wakes up almost healthy. In severe somatic condition, funds are prescribed to maintain the cardiovascular system, liver, and kidneys.