Alcoholism

Alcoholism - a disease caused by the systematic use of alcoholic beverages; Is manifested by a constant need for intoxication, a disorder of mental activity, somatic and neurological impairments, a decline in working capacity, a loss of social ties, a degradation of the individual.

Symptoms, course. Occurs due to regular use of alcoholic beverages, however, fully formed, can continue to develop and with abstinence from alcohol. It is characterized by four syndromes, the sequential development of which determines the stages of the disease. Syndrome of altered reactivity: changes in the tolerance of alcoholic beverages, the disappearance of protective reactions in alcohol overdose, the ability to systematically consume alcohol and perversion of its effects, amnesia for intoxication. The syndrome of mental dependence: the drive for intoxication - the so-called mental obsessive (obsessive), mental discomfort in a sober state and the improvement of mental functions in a state of intoxication. Syndrome of physical dependence: physical (irrepressible) need for intoxication, loss of control over the amount of alcohol consumed, manifestations of abstinence, improvement of physical functions in a state of intoxication. Syndrome of the effects of chronic intoxication in the mental, neurological, somatic and social activities. Mental consequences: asthenia, psychopathy, loss of personality (coarsening, loss of interest, moral values), affective disorders (mood swings, depression, dysphoria) with aggressiveness and suicidal tendencies, in far-reaching cases-dementia (dementia); A characteristic manifestation - the so-called alcoholic humor (flat, coarse, tactless); Psychotic states can arise-acute (delirious, hallucinatory-paranoid syndromes) and chronic (hallucinosis, delirium of jealousy, Korsakov's psychosis). Neurological consequences: acute cerebral (so-called dyscirculatory toxicity syndromes) - epileptiform, Gaie - Wernicke, cerebellar, striopallidal insufficiency; Peripheral neuritis, atrophy of the visual, auditory nerves (especially when using surrogates). Somatic consequences: defeat of the cardiovascular system, respiratory system, stomach, liver and pancreas, kidneys (see Annex 2 to Part II), polyglandular insufficiency of the endocrine system, immune exhaustion.

High morbidity, mortality (shortening of life for 15-20 years). Traumatism is typical (often with a lagging appeal for help with the aim of concealing intoxication), a decrease in working capacity (due to carelessness, violation of discipline, lack of desire to work, loss of skills, stupidity, fussiness). The timing of the appearance of the syndrome of chronic intoxication depends not only on the stage of illness, prescription and the degree of abuse of alcohol, but also on the constitutional vulnerability of individual body systems; Social consequences - from working and living conditions.

The Prodrome. Against the background of household drunkenness, toxic signs of intoxication decrease (including the next morning - headache, weakness, lack of appetite, relaxation); The sedative effect of alcohol decreases; And in intoxication, and in a sober state, the vitality, motor activity, mood rises; Do not disturb the appetite, sleep, sexual sphere. Reception of alcoholic beverages during the daytime does not cause discomfort; There is a feeling of saturation in intoxication, vomiting with an overdose, but the next morning after an overdose disgust disappears when remembering about alcohol. The rise in vitality can be replaced by long periods of irritability, conflict (which is removed in a state of intoxication).

The first stage (duration from 1 year to 4-5 years). Syndrome of altered reactivity: increase in 4-5 times the tolerance of alcohol, the ability to receive high doses daily, the disappearance of vomiting in case of an overdose, the pronounced activating effect of alcohol with the saved sedative, the forgetting of individual episodes of the period of intoxication (palimpsests). The syndrome of mental dependence: constant thoughts about alcohol, a rise in mood in anticipation of drinking, a feeling of dissatisfaction in a sober state. Attraction is still amenable to control. In a moderate degree of intoxication, mental functions are accelerated, but some of them with a loss of quality (eg, superficiality, distractibility with extended attention). Syndrome of physical dependence is absent, the syndrome of consequences of intoxication can be limited to asthenic manifestations, temporary somatoneurological dysfunctions with nonspecific symptoms.

The second stage (duration 5-15 years). Syndrome of altered reactivity: maximum tolerability of alcohol; Daily drunkenness, breaks are explained by external circumstances (lack of money, conflict) and create the impression of periodicity - the so-called pseudo-suspensions. The sedative effect of alcohol disappears, only the activating one is observed. Palimpsests are replaced by complete amnesia of the end of intoxication with the external orderliness of behavior, unlike amnesia in non-alcoholic, which occurs with co-opine intoxication with immobility; At first, amnesia occurs when taking high doses. The syndrome of mental dependence: mental well-being depends on the constancy of intoxication; In a sober state - disorganization of mental activity, inability to do mental work; The attraction that occupied thoughts, which determined the mood and feelings, is now suppressed by intense physical dependence. Syndrome of physical dependence: uncontrollable attraction to alcohol, dictating behavior, distorting the notion of moral values, relationships.

In a sober state, the patient is relaxed, depressed, irritable, and inoperable. The reception of alcohol restores physical functions, but the loss of control usually leads to excessive intoxication. A sharp break in drunkenness causes an abstinent syndrome in the form of sympathetic-tonic overexcitation in the mental and somatoneurological spheres: exophthalmos, mydriasis, hyperemia of the upper torso, pastoznost, large hot sweat, tremor of fingers, hands, tongue, eyelids, gray-brown, thick coating on Tongue, nausea, vomiting, indigestion, urinary retention, lack of appetite, insomnia, dizziness and headache, pain in the heart, liver. Acceleration of anxiety, night anxiety, convulsive attack can be harbingers of acute psychosis.

The syndrome of the consequences of intoxication in the mental sphere is represented by a decrease in the level of the individual, loss of creativity, weakening of the intellect, psychopathy, affective disorders. Delusional ideas of jealousy, expressed first only in a state of intoxication, can later go into a persistent delirium, extremely dangerous for the patient and his loved ones. Neurological examination includes neuritis, scotoma, narrowing of the visual fields, decreased hearing on certain frequencies, atactic disorders, nystagmus, impaired accuracy and coordination of movements, cerebral acute syndromes are possible. When somatic research is a lesion of the cardiovascular system, the liver, etc. Any intercurrent disease, trauma, surgical intervention can be complicated by acute alcoholic psychosis (delirious syndrome). High tolerance of alcohol creates cross tolerance to some means for anesthesia.

The third stage (duration 5-10 years). Syndrome of altered reactivity: decreased tolerance of alcohol. The long-term drunkenness ends with psychophysical exhaustion (true binges) followed by abstinence from several days to several months, it is possible to maintain regular (daily) drunkenness, deep intoxication is achieved in small doses. The activating effect of alcohol decreases, it only moderately levels the tone, almost every intoxication ends with amnesia. The syndrome of mental dependence: the severity of symptoms is insignificant in view of the severe mental changes that have occurred by this time. Syndrome of physical dependence: irresistible desire determines the life of the patient; The lack of quantitative control in combination with decreased tolerability often leads to fatal overdoses. An intense attraction is also manifested in the loss of situational control (there is no criticism of the place, circumstances, the company of drinking companions), which is facilitated by the loss of intellectual abilities that has come.

The abstinence syndrome is represented mainly by autonomic disorders: lethargy, immobility, a drop in cardiovascular tone, pallor, cyanosis, cold sweat, sunken eyes, pointed features, muscle hypotension, atactic disorders (even to the impossibility of moving independently). Syndrome of the consequences of intoxication: not only functional, but also organic injuries of vital systems, in the genesis of which, in addition to the actual toxic effects, the role of metabolic-trophic disorders, enzymes, neurotransmitter dysregulation, etc. is observed. The devastation of the psyche, loss of emotional scale, primitive affects Cruelty, anger), the manifestation of which is mitigated only by a drop in excitability and strong-willed impoverishment. The vibrations of the emotional background often look like dysphoria, rather than as depression. Dementia is often represented by pseudo-paralytic manifestations. Possible chronic hallucinosis, alcoholic paraphrenia and delirium of jealousy. The patient is not capable of organized productive activity, needs coercion and control. With a neurological examination, encephalopathy and polyneuritis; Up to 20% of old drunkards suffer from epileptic syndrome, sometimes develops acute Guy-Wernick syndrome, life-threatening. A somatic examination reveals the pathology of all systems and organs; Characteristic combination of cardiomyopathy and liver damage.

Diagnosis. Patients look older than their years, hair is disheveled, dull. The face at the beginning of a uniform pinkish color (which in combination with pastoznostyu gives the impression of "steaming"), over the years becomes hyper-mirovannym. With abstinence, hyperemia gradually disappears, and against the background of pallor appear telangiectasias on the wings of the nose, cheeks, neck, upper chest. The skin turgor is lost. Muscle tone is restored when taking alcohol. Relaxation of the circular muscle of the mouth gives a special look of mimic weakness, willful debauchery. Often there is negligence in clothes, uncleanliness.

The multiple system of lesions enables doctors of all specialties to diagnose alcoholism. According to European authors, from 20 to 40% of the total bed capacity is occupied by patients with alcoholism and persons whose condition is heavier due to the abuse of alcoholic beverages. Behavior of alcoholic in the hospital is characterized by: carelessness, frivolity, lack of adequate response to one's condition and feelings of distance in communication with staff, other patients, violation of the regime, including the use of alcoholic beverages; Visits of drunk visitors.

Not only frequent appeals of the patient to the doctor (with alcoholism up to 10-12 appeals per year), but also the peculiarities of his behavior and personality should help the district doctor to suspect alcoholism and send the patient to a consultation with a narcologist. The presence of psychosomatic disorders in the family, neuroticism and even psychopathy of the non-drinking spouse are encountered with high frequency in the families of alcoholics. Indicative pathology of children, which attentive pediatricians notice. Women alcoholics who continue to drink alcohol during pregnancy give birth to the so-called alcoholic fetus (alcoholic fetus syndrome) with gross morphological disorders: incorrect head sizes, head, body, extremities, facial and brain parts of the skull; Spherical or deep set eyes, broad bridge of nose, recessed base of nose, underdevelopment of jaw bones, shortening of tubular bones, etc.

Children of alcohol abusers often suffer from congenital small cerebral insufficiency (excessive mobility, lack of concentration, desire for destruction, aggressiveness), motor, mental development, and mastery of practical skills are slow or unsatisfactory. In all cases, when parents are drunk, children grow up in a psychotraumatic situation, they show signs of neuroticism (log neurosis, enuresis, night fears), behavioral disorders (stubbornness, aggressiveness, escape from home) and emotions (anxiety, depression, suicide attempts); Their mental development is violated, learning difficulties and contacts with peers are necessary.

Laboratory analysis confirms the fact of chronic alcohol intoxication: high and fluctuating at 2-3 times for 1 week -10 days activity of the complex of GGT, ACT, ALT (most often and significantly increases the activity of GGT in combination with ACT); Fluctuations in activity are evidence in favor of the intoxication nature of the deviations and make it possible to distinguish them from fermentopathy as a somatic pathology. With abstinence in the period of domestic drunkenness or prodrome, the activity of enzymes returns to normal; The formed disease keeps high activity of GGT, ALT and ACT up to six months. In far-reaching cases of alcoholism, enzyme indices are often within normal limits (depletion of functional responses), but at this stage of the diagnosis, the diagnosis does not cause difficulties. An indicator of chronic alcohol intoxication is the increase in the corpuscular volume of erythrocytes.

Treatment is carried out in narcological dispensaries and hospitals, in specialized departments and wards of psychiatric hospitals by doctors and narcologists and psychiatrists. The goals of treatment are withdrawal of the withdrawal syndrome, the consequences of intoxication, inhibition of attraction, the creation of impossibility (sensitization, conditioned reflex aversion) to drink alcohol, changing attitudes toward drunkenness (psychotherapeutic reorientation, hypnosis). Refusal of treatment requires compulsory referral to LTP. Treatment in the general medical network is ineffective. The exception is acute somatoneurological disorders, intercurrent diseases. Alcoholism is contraindicated symptomatic appointment of soothing and hypnotics due to the danger of polytoxicomania.

In the general medical network, cases of development of acute alcoholic psychosis are possible, which should be quickly stopped by the introduction of the patient into sleep (ivy of tizercin, seduxen, elenium, other benzodiazepines, 2-4 times the therapeutic dose of barbiturates, haloperidol, chloroprotoxen, trisedil, lytic Mixtures with aminazine, amitriptyline, sodium oxybutyrate orally and iv, chloral hydrate in enema); While dehydration and maintenance of cardiovascular activity is necessary.

The forecast depends on the prescription and intensity of abuse, the type of alcoholic drinks, the reception of surrogates, the nature of the consequences of intoxication. Death comes as a result of decompensation of vital systems in connection with drinking, kurtosis, abstinence, intercurrent diseases, in which the alcoholic death rate is 3-4 times higher than the average. Antialcohol treatment only at a certain stage stops the development of the disease. In advanced cases, mental and somato-neurological disability increases, despite abstinence from alcoholic beverages, due to the emerging deficiency of neuroendocrine regulation, deep metabolic disorders, nutrition, organ pathology (atrophy of the brain tissue, dysfunction of the liver, pancreas, etc.). The prognosis does not improve with the onset of abuse in adulthood, since somatoneurological disorders often outstrip the development of alcoholic drug addiction and mental disorders proper.