ALCOHOLIC PSYCHOYS.

ALCOHOLIC PSYCHOYS. The main factors leading to the occurrence of alcoholic psychoses are metabolic disorders caused by chronic (usually not less than 5 years) abuse of alcoholic beverages.

The white fever (alcohol delirium) usually develops against the abstinence syndrome with a sharp cessation of alcoholism or (more rarely) during abstinence from alcohol in cases of somatic diseases, trauma (especially fractures). The initial signs of white fever are deterioration of night sleep, individual vegetative symptoms (sweating and trembling of the hands), as well as the general fussiness of the patient. For a short time, you can note different shades of mood, while usually with a hangover syndrome the mood is monotonous, characterized by depression and anxiety. The condition deteriorates towards evening (with the onset of darkness), while during the day it can so improve that it allows the patient to fulfill his professional duties. Later, insomnia appears, against which visual illusions first appear, and then various hallucinations and delusions . Characteristic is the predominance of visual hallucinations, which are characterized by a multiplicity of images and mobility. More often it is insects (cockroaches, beetles, flies) and small animals (cats, rats, mice). Characteristic visions of devils, snakes, "little aliens," deceased relatives. Often simultaneously noted auditory, tactile, olfactory hallucinations . At the same time the mood of patients is extremely variable: within a short time you can observe fear, complacency, bewilderment, surprise, despair.

Patients usually move continuously, their facial expressions are expressive. The motor reactions correspond to the currently existing hallucinations and mood. So, with fear and intimidating hallucinations, the patient hides, defends, is excited, in a benign mood passive. The delirium is fragmentary and reflects the content of hallucinations, more often this is nonsense of persecution. Patients are usually misconstrued in the place (being at the hospital, they say that they are at home, at work, etc.), but are oriented in their own person. For white fever is characterized by the periodic disappearance of a part of the symptoms, i.e., marked "light" gaps, as well as a regular increase in symptoms in the evening and at night.

White fever is constantly accompanied by a variety of vegetative disorders - trembling of hands, sharp sweating, flushing of the skin, especially the face. Body temperature is often subfebrile. The pulse is rapid.

Without treatment, white fever lasts for 1 - 1.5 weeks, can be complicated by alcoholic encephalopathy. Recovering often occurs after a deep and prolonged sleep.

Alcoholic hallucinosis develops with an abstinence syndrome or at an altitude of a drinking-bout. In this case, the main disorder is abundant auditory hallucinations , combined with delusions of persecution. The patient usually hears the words "spoken" by a large number of people - "a chorus of voices". Often there is a conversation of "voices" between themselves about the patient, less often they are addressed to the patient himself. At the same time, "voices" are threatened, accused, insulted. Often, hallucinations are mockingly teasing, then amplified to scream, then weaken to a whisper. Delusional ideas (delusions of persecution, physical destruction) are closely related to the content of auditory hallucinations, they are fragmentary and unsystematized. Tense anxiety and fear prevail in the mood. At the beginning of an alcoholic hallucinosis, motor excitation is observed in patients, but soon there is some inhibition or an ordered, masking behavior that creates a false and dangerous idea of ​​an improvement in the condition. As a rule, the symptoms of the disease intensify in the evening and at night. The vegetative disorders common to the abstinence syndrome are noted. The duration of an alcoholic hallucinosis from 2-3 days to several weeks, in rare cases, it drags on for several months.

Alcoholic depression appears against the background of the withdrawal syndrome, characterized by a depressed-anxious mood, tearfulness, self-destruction ideas, and also by some delusional ideas of attitude and persecution. Duration from several days to 1-2 weeks. In a state of alcoholic depression, patients can commit suicide.

Alcoholic epilepsy is characterized by large convulsive seizures that occur at the beginning of the withdrawal syndrome (being a harbinger of the beginning alcoholic delirium), with white fever, less often - at the height of intoxication. Small seizures, twilight confusions of consciousness, auras (see Epilepsy) does not happen. With the cessation of alcohol abuse, seizures often disappear.

Alcoholic paranoid develops in a state of abstinence syndrome or at the height of a drinking-bout, characterized by the presence of delirium. The content of delusional ideas is exhausted by ideas of persecution or adultery. In the first case, patients believe that there is a group of people seeking to rob or kill them. In the gestures, actions and words of others, they see confirmation of their thoughts. Characterized by confusion, intense anxiety, often followed by fear. The patient's actions are impulsive: they jumped off the transport route, suddenly flee, seek help from the police, sometimes attack imaginary enemies. In a number of cases, delirium is accompanied by unpronounced verbal illusions and hallucinations, individual delirious symptoms that arise in the evening and at night. Alcoholic paranoid lasts from several days to several weeks, occasionally several months.

Alcoholic delirium of jealousy occurs almost exclusively in men, usually after 40 years, develops gradually. Initially, the patient notes that his wife began to treat him inattentively, and over time simply with dislike. Increasingly, in his opinion, she manifests a coldness in intimate relations and even simply shies away from them. At the same time, it seems to him that the wife starts to follow her appearance more carefully, more and more often she goes somewhere, constantly lingers, and when she comes home looks unusually lively and confused. The patient becomes rude, excitable, unrestrained, he demands "explanations", which entails more and more frequent scandals. However, his wife's behavior only worsens. Suspicions of her infidelity, initially vague and arising in connection with drunken states, become permanent and more confident. The patient usually claims that the wife is cheating him with someone from the men of the closest circle - young relatives, neighbors. If first "treason" is committed outside the house, then over time the wife "insolent" and betrays "debauchery" already in her apartment. The patient begins to follow his wife, seeks help from various authorities and can even use violence against his wife, often commits murder. With the progression of the disease, the patient begins to assert that the wife has betrayed him in the past, even before marriage, and that the children were not really born from him. Alcoholic delirium of jealousy usually takes a chronic course with periodic exacerbations.

Alcoholic encephalopathy occurs with alcoholism, accompanied by chronic gastritis or enteritis, mainly in people who drink a lot, but eat little. They develop usually against a background of hypovitaminosis in the spring months. The most common form of acute alcoholic encephalopathy is the encephalopathy of Gaia-Wernicke. It usually begins gradually, lasts 2 - 3 months, less often longer. There is a growing asthenia, manifested by weakness, exhaustion in combination with memory disorders. The appetite disappears, and then the appetite completely disappears, the night sleep is upset, the liquid stool, vomiting , headaches, dizziness, loss of balance are observed less often. The resulting psychosis is most often represented by professional or exaggerating delirium, less often by anxious and delusional conditions. A few days after the appearance of these disorders, there are stunned or symptoms of apathetic stupor, passing into coma. Neurological disorders are constant and expressed: an increase in muscle tone and sensitivity to pain, for example, to injections. Often there are various hyperkinesis. The appearance of paralysis of the oculomotor muscles, photophobia, nystagmus usually indicates a higher phase of the disease. Various phenomena of polyneuropathy are observed in terms of intensity and localization . Of the vegetative symptoms, there are usually violations of heart rhythm and respiration, central fever, urinary incontinence and feces; Skin pale or dark brown. The general physical condition of patients is characterized by progressive weight loss, up to cachexia. Disease without treatment often ends in death.

Chronic alcoholic encephalopathies include Korsakov's psychosis and alcoholic pseudo-paralysis. In some cases, they develop over a number of months, in others they are acutely, usually after a white fever.

Korsakov's psychosis develops against a background of chronic alcoholism, more often after severe alcoholic delirium. There are gross violations of memory for current events with the impossibility of memorization and reproduction (fixation amnesia). As a consequence of mnestic disorders, disorientation in place and time, disregard of others appears. Spaces in memory are replaced by false memories. Previously acquired skills and knowledge usually remain in sufficient volume. The mood can be a euphoric shade in combination with a complete or partial lack of criticism to your condition. In the neurological status there are ophthalmoplegia, nystagmus, ataxia , violations of tendon and periosteal reflexes in the upper and lower extremities, sometimes combined with muscle atrophy.

Alcoholic pseudo-paralysis is characterized by dementia with pronounced memory impairment: memory disorders combined with confabulation (see Amnesia), loss of acquired knowledge and skills, impaired judgment, lack of criticism for their disease. The mood background is determined by carelessness, in a number of cases the ideas of greatness are noted. The flow is long.

Pathological intoxication is a rare variant of acute psychosis, taking place with a picture of twilight consciousness disorder or acute paranoid syndrome, which develops after the use of small doses of alcohol and can come after the state of simple alcoholic intoxication. Pathological intoxication occurs more often in persons with organic CNS damage, epilepsy, oligophrenia, psychopathy and lasts from several minutes to several hours, followed by a deep sleep and an amnesia of all that has happened. The behavior of the patient is determined by delusional feelings of fear, hallucinations, in connection with which he commits inadequate aggressive actions, suicidal attempts. Outwardly, such a state is manifested by a chaotic motor excitement, often silent, accompanied by a sharp pallor of the face. Cases of pathological intoxication are almost always the subject of subsequent forensic psychiatric examinations.

Medical tactics . First of all, it is necessary to exclude (at examination of the patient) a traumatic psychosis. The increase in the severity of the condition, the deepening of the disturbance of consciousness, the appearance and strengthening of neurological disorders with meningeal symptoms, the lack of improvement during the day, and the persistence of delirious disorders lead to the assumption of a complex (alcoholic-traumatic) nature of delirium.

Taking into account the fact that psychotic disorders in acute alcoholic psychosis can be temporarily stopped by ingestion of alcohol, it is advisable to use a mixture of 0.3-0.4 g of phenobarbital dissolved in 30-50 ml of ethyl alcohol with the addition of 100-120 ml of water before starting the infusion therapy , Which they give to drink to the patient. Then it is necessary (especially in the first hours) to take care of the patient's mechanical fixation. You can use for this, for example, a grid from an ordinary country hammock, covering it with a patient: for all outward unattractiveness, this is the least traumatic means and is preferable to the generally accepted "mating".

Treatment of alcoholic delirium is based solely on pathogenetic principles. Intensive infusion therapy (the same as with alcohol withdrawal) should be combined with large doses of psychotropic drugs: intravenous or intramuscular injection of 3 to 4 ml of a 0.5% solution of seduksen to 2-3 times a day; Intramuscularly 1-2 ml of a 0.5% solution of haloperidol, 2 - 3 ml of a 2.5% solution of tizercin or aminazine (the latter in cases of severe psychotic symptoms can also be administered intravenously). You need large doses of vitamin B, (5 ml 3 - 4 times a day). The best prognosis is observed with the addition of large doses of nootropil (up to 5 g orally or up to 20 ml intravenously).

Infusion therapy for alcoholic hallucinosis is usually performed only once and only in cases of pronounced autonomic disorders. The main place in the treatment belongs to psychotropic drugs: tizercin, haloperidol, stelazin (triftazine), which in the early days are injected parenterally.

In the treatment of alcoholic encephalopathy, the main focus is on massive vitamin therapy (vitamins B and C) and nootropic drugs.

At all stages of the treatment of alcoholic psychoses, the average medical personnel must perform all the appointments with utmost care, closely monitor changes in the patient's condition and report them to the doctor. The importance of nursing care for a patient with alcoholic psychosis is equated with the importance of care for the post-operative patient.