Alcoholic psychosis - acute and chronic psychosis from alcohol

Alcoholic psychosis is a general concept that unites all psychoses that arise from the abuse of alcohol-containing drinks . Diseases in this group include hallucinosis, delirium, pathological intoxication, encephalopathy, and delusional psychoses.

Modern medicine has proven that the peculiarity of the development of such diseases is that they all form at the peak of withdrawal syndrome (abstinence syndrome). The patient does not experience psychosis during direct interaction with alcoholic beverages.

Several years before the development of alcoholic psychosis, patients experience all the symptoms of chronic addiction - a change in tolerance to alcohol, withdrawal syndrome, and characteristic personality degradation.

Types and classification

Alcoholic psychoses are classified as follows:

Delirium is an acute alcoholic psychosis, which is characterized by a narrowing of consciousness, accompanied by delirium and hallucinations . Delirium tremens is combined with preservation of self-awareness and motor excitement. The classic form of the disease develops at the peak of withdrawal syndrome.

Alcohol delirium can be:

• Moussitating - the patient performs monotonous simple actions, combining them with muttering.
• Professional - the patient experiences prolonged silent excitement within the bed. This form is characterized by the performance of movements associated with habitual professional activities and delirium of similar content.
• Atypical - the patient exhibits depersonalization, derealization, and may develop Kandinsky-Clerambault syndrome.

Hallucinosis is a form of psychosis characterized by the prevalence of verbal hallucinations , accompanied by affective (anxiety) disorders and sensory delusions.

Hallucinosis can be:

• Acute – formed during abstinence or at the height of binge drinking.
• Subacute - the initial symptoms resemble the acute form, but the patient begins to experience delusional and depressive disorders.
• Chronic.

Alcoholic delusional psychoses - delusional formation is considered a characteristic manifestation of this form.

Delusional psychoses can be presented in the following form:

• Paranoid is a delusion containing persecution mania.
• Protracted paranoid - delusional experiences acquire some systematization, the patient becomes depressed and distrustful.
• Delusions of jealousy - the patient experiences suspicions of infidelity, which may be accompanied by verbal illusions.

Encephalopathies are psychoses in which mental disorders are supported by a spectrum of somatic and neurological disorders.

Encephalopathy can be:

• Acute – Gaye-Wernicke syndrome.
• Chronic – alcoholic pseudoparalysis, Korsakov psychosis.

Pathological intoxication is a short-term disorder that develops while drinking alcohol, usually in small doses.

The disease may be as follows:

• Paranoid form - the patient’s behavior reflects a distorted perception of reality and the environment.
• Epileptoid - the patient does not feel contact with reality, suddenly loses orientation.

Some authors classify alcoholic depression and antabuse psychosis as a separate category . However, such forms of the disease rarely develop independently and accompany other forms of psychosis, including during treatment of alcoholism (Antabuse type).

Structurally complex forms of alcoholic psychosis occur against the background of a change in states typical for this type of addiction. An alternation of delirium and verbal hallucinosis is often observed. Between the symptoms of both diseases, the patient’s consciousness becomes clearer.

Encephalopathies

This group of alcoholic psychoses is detected less frequently, but you still have to deal with it and look for ways to cure it. Like delirium, they occur acutely, subacutely and chronically.

Symptoms include a combination of:

• Mental disorders.
• Neurological disorders.
• Signs of somatic diseases.

One of the most common forms is acute alcoholic encephalopathy Gaye-Wernicke. In its manifestations, it resembles the clinical picture of classical delirium, but it is severe with many specific disorders that make it possible to include it in a separate nosological unit.

The following forms of encephalopathy are also encountered in drug treatment practice:

• Protested.
• Super acute.
• Varieties of chronic (Marchiafava-Bignami syndrome, alcoholic pellagra, cerebellar atrophy, peripheral polyneuropathy, central pontine necrosis and others).

Each of them has specific disorders that require special diagnostics.

All alcoholic psychoses occur both once and repeatedly. Relapses are caused by continued drinking and significant destruction of nerve cells. Repeated attacks, as a rule, contain a “blurred”, simplified clinical picture, but have a longer course.

AP are an indicator of progressive personality degradation. Among alcoholics suffering from metal-alcohol psychotic symptoms, a very high mortality rate is detected. Death mainly occurs from complications in somatic organs.

Causes

Causal factors contributing to the development of the disease:

• Long-term addiction to alcohol-containing drinks, leading to metabolic disorders and unhealthy nervous excitability.
• Development of foci of inflammation in the body.
• Infectious diseases suffered the day before.
• Trauma and consequences of such conditions.
• Stress and factors contributing to mental breakdown.
• A sharp drop in blood alcohol concentration at the height of withdrawal syndrome.

What is alcohol psychosis?

Metal-alcohol psychoses are a group of severe complications that occur in the dynamics of stages 2-3 of the addiction syndrome. Violations can be either acute or protracted (chronic). According to WHO data, the incidence of this phenomenon among people suffering from alcoholism for a long time is about 10-35%.

When we talk about alcoholic psychoses, we mean psychotic states, the main and obligatory factor in the occurrence of which is long-term alcohol abuse over a number of years. Therefore, the concept of “alcoholic psychosis” is not equivalent to the concept of “psychosis in a patient with alcoholism” (endogenous, organic and other non-alcoholic psychoses may occur in a patient with alcoholism). A special group is formed by exogenous (alcoholic) psychoses in patients with endogenous mental illnesses (schizophrenia and schizophrenia spectrum diseases). This group of psychotic conditions should be considered separately from psychoses that occur in the presence of isolated alcohol dependence.

Gofman Alexander Genrikhovich, Orlova Maria Alekseevna, Meliksetyan Anait Sergeevna. Alcoholic psychoses: clinical picture, classification // Social and clinical psychiatry. 2010. No. 1.

Causes

Previously, the main cause of changes was considered to be the direct damaging effect of ethanol and its metabolites on the brain, which is reflected in the name “alcoholic psychoses.” Clinical studies have revealed the more complex nature of the phenomenon.

Psychoneurological disorders develop in situations where internal organs are affected due to prolonged intoxication. The combined insufficiency of their functions leads to a total metabolic disorder. Therefore, it is more correct to call psychoses metal-alcoholic.

The situation is aggravated by concomitant damage to the liver, which is responsible for detoxification and synthesis of many proteins. Encephalopathy of hepatic origin secondary to cognitive dysfunction. This is accompanied by hypovitaminosis (especially group B), electrolyte imbalance, and chronic diseases.

Among the exogenous (external) risk factors, traumatic brain injuries and the consequences of fights due to alcoholism or road accidents are significant. The role of genetic preconditions for alcoholism, complicated by neuropsychiatric symptoms, is also currently being studied.

Varieties

There is no single approach to the differentiation of alcoholic psychoses. The clinical classification used in the CIS includes the following types:

• delirium;
• encephalopathy;
• delusional form;
• hallucinosis;
• rare types.

The clinical course also differs:

• transient – ​​a one-time episode;
• recurrent – ​​repeated 2 times or more, including after remissions;
• mixed - recurrent or transient course turns into a chronic form of the disorder;
• continuous – periodically worsening chronic psychosis.

Often the symptoms overlap (mixed) or the complication is completely atypical. Structurally complex psychoses are complemented by severe neurological disorders, including motor ones. According to their duration, they are acute, protracted and chronic.

Symptoms

The manifestation of the symptoms of the disease is directly dependent on the form of psychosis.

Symptoms of alcoholic delirium

• Deterioration of night sleep, turning into insomnia. Dreams become intermittent, heavy with threatening and frightening plots.
• Repeated changes in mood over a limited period of time.
• Autonomic disorders.
• The emergence of pareidolia (a special form of visual illusions).
• The occurrence of true visual hallucinations, aggravated by tactile, auditory, and olfactory deceptions.
• Delusional behavior.
• Lack of orientation on the terrain, but within one’s own personality orientation is always preserved.
• Time perception disorder.

Somatic signs:

• Fever, tachycardia.
• Sweating.
• Redness of the sclera, skin hyperemia.
• Tremor – caused by movement disorders in the structures of the brain.
• Hypertonicity of skeletal muscles, accompanied by an absolute lack of coordination of movements.

Symptoms of alcoholic hallucinosis

• Verbal auditory hallucinations. As the disease progresses, the attitude towards hallucinations becomes calm.
• Delusions of persecution are fragmentary and unsystematized.
• The mood is tinged with an affect of anxiety. In complex forms, anxiety transforms into melancholy depression.
• At the initial stage, motor excitement is observed, which over time is replaced by retardation.

Symptoms of alcoholic delusional psychosis

• Delirium of persecution.
• Minor hallucinations, verbal illusions.
• Individual visual hallucinations.
• Fear, distraction, anxiety.
• Impulsive behavior.
• Limiting contacts with perceived ill-wishers.
• Aggression towards the spouse (delusions of jealousy).

Symptoms of encephalopathy

• Neurological disorders - hyperkinesis, muscle hypertonicity, skin hyperesthesia, polyneuropathy of various locations, photophobia, nystagmus (involuntary oscillatory movements of the eyeball), paralysis of the extraocular muscles.
• Autonomic disorders - unstable heart rhythm, fever, incontinence, stupor, turning into coma.
• Fixation, retrograde amnesia is a memory disorder.
• Confabulation is modified, false memories, a special memory disorder that occurs against the background of the patient’s clear consciousness.
• Motor reactions and speech are impoverished.
• Loss of skills and knowledge, impaired judgment.
• Carelessness, ideas of grandeur.

If alcoholic psychosis is associated with other mental or pathological conditions, the symptoms of the disease are modified, which is especially typical for organic diseases of the brain.

Symptoms of pathological intoxication

• The patient experiences a whole range of feelings - fear, rage, anxiety, anger.
• Motor excitement.
• Aggression directed towards others.
• Disorientation against the background of purposeful actions.

Delirium tremens

Of all types of psychosis, the most common is delirium tremens - delirium tremens. Signs of delirium tremens are tremors, increased sweating, arrhythmia, hallucinations, loss of space, and emotional swings.

This state continues for a week until, with the help of detoxification , the narcologist relieves the signs of alcoholic delirium and psychosis. After specialists carry out a series of procedures, a person’s sleep and eating patterns will improve, their psycho-emotional state will normalize and their well-being will improve.

Treatment and what to do

To develop appropriate treatment tactics, it is necessary to correctly diagnose the patient’s condition , for which it is advisable to invite a narcologist to your home:

• At the initial stage of therapy, the patient receives drugs that help eliminate toxins. Medicines allow you to remove the products of ethanol metabolism with minimal losses to the body.
• The water and electrolyte balance is restored and metabolic disorders are corrected.
• In parallel, if the patient’s condition allows, concomitant somatic diseases are treated, and measures are developed to prevent complications.
• Rehabilitation of a patient requires not only pharmacological but also psychological support.

Where should treatment be carried out: at home or in a hospital?

An invited specialist should assess the degree of development of the disease . A qualified physician will determine whether there is a risk of irreversible damage to brain tissue, internal organs and body systems. Based on the results of the examination, the issue of treatment at home or in a clinical setting is decided.

Drugs

Groups of pharmacological agents used:

• Detoxification – introduction of solutions of electrolytes, “Glucose”, saline solutions, “Magnesium Sulfate”.
• Diuretics.
• Enterosorbents - “Rekitsen RD”, “Enterosgel”.
• Sedatives, in severe cases antidepressants - Afobazol, Cipralex.
• Antioxidants – “Glycine”, “Limontar”, “Yantavit”.
• Hepatoprotectors – “Hepatofalk”, “Silibinin”, “Gepabene”.
• Tranquilizers - Bromazepam, Diazepam.
• Neuroleptics - Clozapine, Droperidol, Metophenazine.
• Nootropics – Piracetam, Gutamin, Euclidean.
• Vitamin complexes – vitamins B, C, E, K, PP.

Treatment of psychosis in the clinic

What is the advantage of treating alcoholic psychosis in a clinic under the supervision of specialists - any such treatment involves a medicinal approach, and the medications that the patient receives should not react with alcohol.
When taking pills for alcoholism, drinking alcohol is strictly prohibited. It is very difficult to follow recommendations at home, and not every relative can guarantee strict compliance with the recommendations of the treating staff. What guarantees treatment at the clinic:

1. Diagnosis of the patient and first emergency care for acute attacks of psychosis
2. Individual selection of treatment method
3. Soothing and restorative droppers
4. 24-hour monitoring and medication support
5. Psychological assistance for the patient and his relatives
6. Consultation on further treatment methods
7. Remote or inpatient patient supervision

If you want to receive quality treatment, then seek qualified help from our specialists.
Consultations via hotline and during the initial consultation at the clinic. Treatment, effective methods and patient support

Consequences

It is not always possible for a person dependent on alcohol to recover from psychosis . The main consequences that develop even against the background of abstinence from drinking alcoholic beverages are the following:

• Decreased mental abilities.
• Difficulty remembering new information, memory problems.
• Patients exhibit simple and primitive mental activity.
• Complete/partial loss of ability to work.
• Clear personality degradation.
• Psychosis becomes chronic.
• Development of alcoholic epilepsy.

When timely treatment is prescribed, alcoholic psychoses have a favorable prognosis and result in almost complete recovery. The main danger lies in severe delirium.

Psychosis from alcohol: one-time and permanent

As a rule, external factors are the cause of one-time psychoses, but they also require complex treatment.
Well, if they happen all the time, and the reason for this is severe alcohol intoxication, then you need to think about complex treatment of alcoholism: a narcologist, a psychiatrist, a psychologist. Psychological help for alcoholism is available in rehabilitation programs that last from 28 days to 6 months. It is during this time that you can restore your mental state and think about the topic: a sober life. In any case, these are symptoms of trouble and a combination of a number of factors that the alcoholic himself and the psychologist will have to understand. Usually these are inpatient programs far from the bustle of the city, where the alcoholic tunes in to change the quality of his life and begins from scratch to analyze the reasons for drinking alcohol and the occurrence of psychoses against this background. We begin this stage of treatment only after cleansing the body and diagnosing the physical condition in a drug treatment clinic with round-the-clock supervision by specialists.

Nervous breakdown from alcohol?

Doctors' recommendations

Persons with alcoholism and in a state of psychosis often commit serious offenses and acts . Therefore, at the first signs of a mental disorder, there should be an immediate reaction from relatives.

Calling a qualified addiction psychologist to your home will help avoid the progression of the disease and keep your loved one in good health.

Experts will tell you more about alcohol psychosis in the video below:

Alcohol delirium: signs

One of the groups of psychopathologies characterized by the formation of delusions is alcoholic delusions . Delusional disorder manifests itself in groundless attacks of aggression, jealousy, paranoia, and persecution mania.

An inadequate reaction to what is happening is provoked by chronic alcoholism . At the same time, the alcoholic experiences fear, anxiety, and worry. The behavior of an alcoholic is impulsive and unpredictable, devoid of any logic. Attacks of delusional psychosis can have varying intensity, worsen and subside over the course of the day, or appear evenly over a long period of time.

Alcoholic psychosis in any form is a borderline state with many other mental illnesses. Only a narcologist-psychiatrist at a medical center can diagnose the type of alcoholic delusional disorder and select the necessary course of treatment.

Pathological alcohol intoxication

Alcoholic psychosis with the most paradoxical symptoms is a state of pathological intoxication. The paradox is that this condition is not affected by the duration or amount of alcohol taken.

, pathological alcohol intoxication may appear . Its manifestations are not influenced by the environment, and the exact causes of its manifestation are not known. Pathological alcohol intoxication goes away on its own after a person’s sleep patterns are adjusted.