Alcohol delirium: signs, treatment and consequences

Mankind is familiar with alcoholic beverages for many centuries. Previously, alcoholism was not considered as a disease, and therefore did not develop anti-alcohol measures. In most cases, they amounted to limiting the movement of the patient, reading prayers and various rituals to expel the evil from the body.

To date, alcoholism is considered a disease that requires special treatment. The therapy includes not only medications, but also psychological help.

Factors that contribute to the development of this disease, are divided into genetically predetermined and negative effects of the environment and environment. Unfortunately, in recent decades there has been a sharp jump in the incidence of alcoholism, often it becomes chronic and is accompanied by various mental disorders. The development of alcoholic psychoses began to register four times more often! And in fact alcoholic delirium, as one of the most frequent kinds of mental disorders, can lead to a lethal outcome.

It is also worth remembering that the transferred delirium always leads to very persistent and sometimes irreversible changes in the central and peripheral systems. The main consequences of alcoholic delirium are alcoholic encephalopathy, residual( residual) delirium.

Definition of alcoholic delirium

For a correct understanding of the causes of this pathological condition, it is necessary to understand the very definition of this term.

Alcoholic delirium is a disorder of the mind in which the state of delusions, hallucinations, fever and heavy sweats with chills develop. Hallucinatory pictures are aggressive, frightening in nature, in which there is an imaginary threat to the patient or those around him. Often visions are of a mixed nature, so visual images can be combined with auditory and tactile false hallucinations. The patient is very excited and can not adequately respond to others, while he does not consider himself a patient, and his behavior is strange. The main danger of this condition is that the patient can inflict life-threatening traumas.

It is worth saying that alcohol delirium rarely develops amid a state of intoxication, on the contrary, it usually develops as a reaction to the abolition, stopping the abuse of alcoholic beverages. The most typical development of this pathological condition in the second or third stage of chronic alcoholism, when a patient for any reason does not take the usual dose of alcohol for several days. Very often the first signs of a beginner delirium develop on the fourth day in the evening or at night.

In order to develop delirium, a combination of several factors is necessary: ​​

• Endogenous and exogenous poisoning;
• Failures in the metabolic processes of the body, especially in the central nervous system;
• Immune disorders;
• Craniocerebral trauma in the past;
• Expressed changes in homeostasis( constancy of the internal environment, changes in the acidity of the body's environment).

Alcohol delirium is classified as a meta-alcoholic psychosis, emphasizing that this complication develops at the peak of the withdrawal syndrome( abstinence syndrome), and not the mental changes, but the somatic( internal) diseases, which already lead to a disturbance of mental activity. That is, initially the metabolism and internal organs suffer, and then on the background of the failure of organs and systems, psychosis develops.

Systematic abuse of alcohol leads to a toxic destruction of brain cells, which is why the work of neurotransmitters, and in particular catecholamines( dopamine), is disrupted. The more this substance in the patient's blood, the more difficult the delirium develops.

Clinical manifestations of delirium

Acute alcoholic psychosis, and delirium in this case is not an exception, often occurs polymorphically and phasically. This means that in the clinical picture there is not only one characteristic symptom, usually the manifestations succeed each other and have some consistency.

So, alcoholic delirium can start with verbal pseudo-hallucinations, then go into oneyroid state and end with mental automatism. To clarify - pseudo-hallucinations differ from true hallucinations in that when a true vision the patient looks at the real object and identifies it with the fictitious, and with false distortions the real object is absent, it is only in the imagination of the patient.

As for the onyroid syndrome, it is also a complex distortion of perception, in which disorientation occurs in space and in one's own personality, and there are fantastic visions in which the patient himself becomes a direct participant. Thus surrounding people and subjects can be weaved in a pseudo-hallucination. Mental automatism - a common manifestation of delirium - the patient's movements are perceived by him as unnatural, imposed from the outside. Often, automatism is combined with delusions of persecution or jealousy.

In addition to changing the psyche of delirium, there are convulsions, cerebral edema and deep disorders in the internal organs.

To early signs include:

• Motor and mental anxiety, inability to sit still;
• Against the background of anxiety insomnia develops, fear, confusion, a sense of approaching danger;
• Signs of cardiovascular insufficiency - vasoconstriction and the subsequent arterial hypertension, pallor of the skin, sweating;
• Temperature rise to an average level;
• Later hallucinations and the rest of the psyche are joined.

In the classic course, the symptoms of alcoholic delirium grow for several days, then it is kept at a constant level and slowly regresses. A characteristic feature - unlike other types of alcoholic psychosis, delirium lasts an average of one and a half weeks. The result can be a recovery( usually after a long sleep) or transition to other forms of alcoholic psychosis. In many ways, this depends on the timeliness and adequacy of treatment.

Among the complicated delirious manifestations, delusional experiences and self-blame, persecution mania, complication of hallucinations come to the forefront. Also, signs of disorientation and incorrect self-perception can increase, motor anxiety can be replaced by inhibition of motor activity, stuporous state, the patient ceases to come into contact, may stop responding to all stimuli. At the same time, the temperature rises sharply, urination decreases greatly, the pressure drops to a critical level. Without timely-initiated therapy, a fatal outcome may occur.

Treatment of alcoholic delirium

There is no single regimen for the treatment of such conditions, primarily due to individual changes in organs and systems, the characteristics of the previous drinking-bout and the types of alcoholic beverages that the patient used before abstinence.

Treatment of alcoholic delirium is aimed at eliminating the tendency to aggravate psychosis. In the Department of Toxicology or Narcology, the patient is treated urgently with alcohol delirium, and then goes on to the complex treatment of internal pathology. Treatment, as a rule, lasts not less than three weeks.

• psychotropic drugs
• detoxification therapy( enterosorbents - activated carbon, parenteral administration of glucose, potassium chloride;
• plasmapheresis - removal of a certain amount of plasma from the patient's blood;
• tranquilizers - they reduce fear, remove anxiety and anxiety - diazepam, phenazepam, lorazepam;
• hypnoticsmeans appoint if tranquilizers do not help to remove the excited state. Phenobarbital, ivadal, reladorm, paglueferal is used;
• anticonvulsants- carbamazepine, midokalm;
• antipsychotics - neuleptil;
• with pronounced disorders of the autonomic nervous system prescribe benzodiazepine, sometimes in combination with pyrroxane;
• vitamin preparations of group B, C, nicotinic acid - at the initial stages of treatment as part of infusion solutions, later in tableted form- aerovit, complim, glutamevit, center;
• nootropics - semax, pantogam, picamilon, phenibut;
• for improvement of cerebral circulation - trental, instenon;
• hepatoprotectors - heptral;
• specific therapy consists of parenteral administration of methadoxyl.

With worsening, the patient's condition is transferred to the PIT - intensive care unit.

After discharge from the hospital, the patient continues treatment at home. Also, he must necessarily undergo a rehabilitation course for alcoholics, where he will be helped to finally overcome his dependence and overcome the psychological craving for alcohol.