Alcoholic delirium
Alcohol delirium is a subtype of obscuring the clarity of the consciousness of a person's personality. The cause of alcoholic delirium is absolutely always alcoholism, and it's not strange, because alcohol is a strong enough weak toxin. This subtype of delirium is more often represented in the section of alcoholism and even refers to the metal psychosis. This pathology is not uncommon, but even physicians confuse it with the diversity of other species. To help, it is most important to remember that an individual who has suffered such a deplorable state - an alcoholic who was recently in a drinking bout, but at a given moment he was sober and had not taken him for a long time. This state is typical for some people in such a measure that it became a participant of a considerable number of descriptions, stories, scenes, creative and real.
Alcohol delirium - what is it?
Alcoholic delirium is a pathological condition that occurs under the influence of alcohol abstinence. This condition is quite severe and belongs to the form of mental disorders and behavior as a result of alcohol use. The abstinent state with delirium is located in the ICD under the register F 10.4.To expose such a diagnosis, a psychiatrist needs to consult another specialist, a doctor-narcologist, because only he can establish a diagnosis of alcoholism, before this it will be a confusion of consciousness of an unknown genesis.
Alcoholic delirium is fairly common, manifesting itself, as a rule, after eight or more years of alcoholic anamnesis. Evidence already of neglected alcoholism of the second, perhaps the third stage. In more rare cases, it may occur in individuals who are not prone to alcoholism.
There is an opinion that alcoholic delirium may be acquired by drinking to a dump, but in reality this condition appears only in case of sudden and complete abolition of alcohol. Perhaps the presence of aggressiveness, but this manifestation is not necessarily always. There may also be enthusiasm, in the form of expressive benevolence, virtue. But it is worth remembering that depending on the experiences experienced, behavior changes, so these people should not be overlooked and relaxed. They can try to do a good deed, for example, to mow the mice that only they see and, without realizing the harm, poison the people around them. And even in the case of their very positive attitude, it's not worth releasing them from the mind, because with the change in mood, their behavior also changes.
Practical any kind of delirium has dangerous consequences. Ten percent of people with alcohol delirium are at risk of dying. The slightest suspicion with the presence of appropriate symptoms, requires treatment in a specialized medical institution.
Alcohol delirium is also subdivided into subtypes. The classic delirium has the name typical. It goes through a set of certain stages, quite typical for any subtype. The development of staging is carried out gradually. Lucic delirium is very acute. At the same time there are no characteristic clinical manifestations of delirium and hallucinations, but there is an affect in the form of fear, anxiety, tremor and coordination disorders. Abortive delirium is a subtype that arises when it is impossible to develop a full-fledged classical delirium, it is shorter, but it includes pieces of hallucinations and even fragments of delirium, but they are sketchy, not crystallized. Anxiety is very bright. This type mainly leads to recovery, well, or is transformed into other forms.
Acute alcoholic delirium manifests itself very sharply, all the symptoms and stages are accelerated, in the absence of treatment it quickly leads to serious consequences. Professional delirium is the hardest subtype of delirium, showing itself at a typical white fever. Subsequently, all the psycho-productive symptoms are reduced, and the personality begins to perform the prevailing actions, in the form of repetitive professional duties. The exaggerating delirium is even more severe, manifested by excitement in bed, an indistinct mumbling and a heavy obscuration of the clarity of consciousness. Atypical delirium occurs mainly as relapses of alcoholic psychoses. With such forms, clinical manifestations are blurred, other disturbances can be mixed, such as onyroid, automatism.
Causes of alcoholic delirium
There is already a reason in the very definition of this disease, therefore the main factor, the problem of this disease is alcoholism. The main danger for the development of alcohol delirium is considered to be binges that last for a considerable time, low-quality alcohol, especially surrogates, liquids for machine works, pharmacological agents with an elevated level of alcohols. Alcohol delirium also often develops if alcoholics have pathological diseases associated with organs of vital importance.
Also plays a role pathological intoxication, the cause of this is the different trauma of the skull and head disease, present in the anamnesis. Some pathologies of metabolism in the body, for example, chronic intoxication or pathology of metabolism in the brain also lead to the development of this pathology. Often, a person who likes to drink, getting into the hospital, where it is impossible to drink, triggers a mechanism for the development of this state. In the person's house, alcohol delirium occurs in the case of a sharp alcohol abatement.
To be aware of the problems of etiology of alcohol delirium, it is important to disassemble in detail alcoholism.
Alcoholism in the manifestation of the pathological is formed with a constant continuous intake of alcohol. In this case, the attraction to him exceeds normal, and he is accompanied by disorders of social relations. The first stage is manifested by one main feature - the primary craving for alcohol. In the primary manifestation, it arises in a mild form, depends on the cases when there is an opportunity to use it. At this stage, a person can influence himself with willpower, in some cases the circumstances that interfere with drinking play a role. Outwardly these people are constantly in a hurry with each toast, eager to drink everything, and they do not care what to drink. In such situations, the formation of alcoholic delirium is not yet characteristic. The duration of the second stage progresses for ten or more years. At this stage, alcohol-dependent individuals often turn to healers, as life becomes unbearable. Basically, the first thing that worries - conflicts in society, police institutions, absenteeism, scandals. Such persons are already able to drink things. All previous symptoms manifest themselves more. At the same time, people do not need feasts, he himself will find the reason to drink. Quantitative control is lost, the more he drinks, the more he wants. Tolerance to alcohol is also changing. But now there is a real abstinence syndrome, in which alcoholic delirium can develop. The form of taking alcohol changes, binges appear.
In the final stage, death can only be worse. The disease is run to the brim, all its characteristics are amplified to the worst possible. The reason to drink such people do not need. Loss of self-control is clearly manifested, any, even the minimal dosing of alcohol provokes the desire to consume more. Already no one has the opportunity to return the patient to another life, he steals, tortures relatives, gets into debt. Decrease in tolerance is in the form of intoxication already from scanty doses. There is a persistent picture of intoxication with the advantage of irritation, discontent, anger. A person lives half asleep with the presence of real binges, is not interested in anything, sailing through life. Here, already the alcoholic delirium becomes an integral companion to the life of such an individual.
Symptoms of alcoholic delirium
Acute alcoholic delirium, as a rule, is a worsening of alcoholism, so it is important to pay attention to the main disease. Classically, this is a complex and neglected alcoholism, and, perhaps, polyneuropathy. Feet and hands freeze cold, sometimes even ulcers appear, any instincts become weaker, a tremor appears. The skin becomes drained, in general alcoholics are quite sick people, there is also a symptomatology on the part of the liver. The brain also suffers, while memory, cognitive functions deteriorate.
Symptomatic of obscuration of consciousness is at the primary stage in alcoholic delirium. Disorientation, it makes sense to realize that the personality is oriented in itself, but with the location and time boundaries all the worse. It makes sense to require the individual to name himself with brief data, and after the name itself, ask the date and time. He, most likely, will not give the necessary answer to the last two. It is quite clear that a person does not have the ability to realize the events in which he resides, such people are detached from everything around, they are in a world of illusory realities. Amnesia is an important component of the symptoms of alcoholic delirium, but it is not full, some part of the survivors of events remembers.
Signs of alcoholic delirium manifest themselves in that memory remains stronger on illusory hallucinatory experiences, rather than on realities. Hallucinations with white fever, other terms of acute alcoholic delirium, are quite typical, manifest themselves in the form of small pesky creatures, sometimes really existing in nature, and often unreal, like mice, spider bugs. If this is something unreal, then it is basically also small, and the patients call them, like rust-coughshanks, kudyaplikov. Some individuals are reluctant to share their experiences, hide them, then it makes sense to turn to external manifestations. They create the kind of very enthusiastic people who wave off something that the rest can not see. All these manifestations become worse by the evening, and the duration may vary within a few days. If there is no possibility to collect an alcoholic anamnesis, it makes sense to look at the sight of a person, he trembles, flushes, sweats excessively. Such a bright vegetation can not be confused with anything. The whole volitional sphere is broken, these people have a bad dream and their appetite is broken.
Mutating delirium is characterized by unusual manifestations, the main of which is the inarticulate amalgamation of the individual. Excitement is kept within the boundaries of the bed, the movements are pretentious, meaningless. Professional delirium is very similar to the previous species, but remaining within the bed limits, the individual commits professional manipulations and they depend on the type of activity.
Signs of alcoholic delirium, characterized by such severe symptoms, arise in the case of deep intoxication. For more comprehensive diagnosis, you can use psychological scales.
Stages of alcoholic delirium
Acute alcoholic delirium is divided into several stages. The severity of alcoholic delirium depends on the stage and on their individual duration. Sometimes all periods may not manifest themselves, but more often one should expect a classic option. Symptomocomplex is completely individual, although there are general principles. When interviewing, it is important to understand that complete amnesia is absent, if the individual says that he does not remember anything, he either lies, or it is not delirium. A variant with simulated symptoms is possible, especially in the case of criminal individuals.
The initial stage of alcoholic delirium manifests itself mainly after sunset. At the same time, they look a little maniacal, they talk all the time, fuss, and every second they are distracted. Thinking is accelerated, like speech, in a conversation inconsistent. There is an incoherence, by simple disjunction, which is manifested in the complication of orientation. Mimicry and emotions do not fully correspond with the situation, they are often pretentious and theatrical. Such individuals do not move quite adequately, they make many unnecessary movements. An important symptom-complex is excessive sensitivity to any neutral stimuli for us. They do not see any products yet, but they are visited by their own memories, the brightness of which is enhanced at times. In this unpleasant state, it is better not to touch them. Their behavior goes even to contradictions, they are interested, but upset and hushed. There are unpleasant features of sleep, nightmares, lack of sleep and fear. Feeling of recovery after sleep is lost.
Signs of alcoholic delirium at the stage of illusions manifest themselves in excessive excitability and intensification of previous symptoms. To unambiguously understand the completion of the transition to this stage, it is important to calculate the presence of illusions, which are manifested by the appearance of some fantasy images over real objects. These people are very keen and interested in viewing their fantastic images, but at the time of their distraction, the images quickly disappear or fade. By evening, the orientation is significantly deteriorating. During these vicissitudes, hallucinations may occur, but only hypnagogic ones that appear when you fall asleep. Dreams are very colorful, brighter than reality. There is even a flickering of manifestations, in the type of lucid windows, periodically the individual is completely loaded and resides in the created world, and periods are fully conscious.
At the stage of true hallucinatory delirium, a person loses the ability to orient himself completely, but still the consciousness of one's self is preserved. Time flows unusually, constantly changing its duration. The nights are sleepless, they can only fall asleep in the morning and then it's more like a doze. Parajdolii alternate with hallucinations, patients observe vivid visual hallucinations. Sometimes these are whole scenes, in the nature of large-scale battles, but often they are separate moving images, devils, demons, animals. Since there are also possible whole pictures, they are integral with the presence of not only visual hallucinations, but also tactile, auditory, even sniffing.
Treatment of alcoholic delirium
This condition is quite menacing, so it's important to quickly stop it. Coping of alcoholic delirium is conducted in the appropriate profile establishments, depending on the severity, resuscitation, a psychiatric hospital or a narcodispensary are suitable. Delivery of such an individual requires special skills and equipment, in some cases it is better not to do it yourself.
To cure alcoholic delirium, it is important not only to stop the symptoms, but also to treat alcoholism itself.
Priority actions are directed to remove the cause, otherwise the output can be a reduction in the negative impact( elimination of oxygen shortage, detoxification).Treatment, which is possible in all medical institutions is limited to three components. The first part of the therapy is sanitary supervision, which means the restoration of the desired treatment regimen, as well as protection. The individual is placed in an isolated room, the light in it is close to daylight. The reason for this is the influence of light on the symptom complex of alcoholic delirium. Bright lighting, a type of resuscitation - a strong stimulus, and pitch darkness intensifies hallucination. The fixing of the person can not be avoided, especially in case of excitement and aggression. But you need to carefully examine such persons after a while, becauseThey can injure themselves.
Next in turn component - the use of medicines, the goal is to pick up the psychomotor agitation and bring the person to sleep.
The second component of the therapeutic effect is the treatment of alcoholic delirium with the use of medications, aimed at arresting psychotic stimulation, stimulating the individual's physiological sleep( this will be similar to the critical version of the outcome of delirium, through sleep).To achieve this result, low doses of benzodiazepines with a short duration of action( Diazepam - 3-9 mg) are well used. With expressive excitability and aggressiveness, neuroleptic drugs are prescribed( Aminazine 2.5% to 6.5 ml IM, Haloperidol to 49 mg is preferred, Azaleptin 100-210 mg per day, Clopixol 20-100 ml, Tizercin 215-305 mg per day, Olanzapine).The way of using all neuroleptics is chosen depending on the degree of preservation of self-consciousness and the person's contact.
The final stage of arresting alcohol delirium is the use of drugs to maintain the heart, which contribute to the normal functioning of the heart and all vessels. It is better to use small doses of cardiac glycosides - Digitalis( doses are minimal), Korglikon 0.6% 2.3 ml IV, Strofantin 0.0025 to 5.25 ml IV.With a confirmed decrease in blood pressure, use Cordiamine 3 ml IV, for additional flooding Polyglucin 320 ml IV.
With confirmed acidosis, conducted by electrolyte analysis, sodium bicarbonate 4% 330 ml is used. It is important to use the means that show the effect of mental excitement. Seduxen 0.5% to 130 mg IM, Amysulpiride to 205 mg through the mouth, Lamotrigine to 205 mg per day.
The relief of alcoholic delirium includes a couple of important complexes. For relief of excitability and insomnia in a complex application: tranquilizers Sibazon 0.5% to 8 ml IV or IM, Relanium up to 7 ml is similar. Sleep Stabilizers: Oxytobutyrate Sodium 20% to 45 ml IV, Ridazini 330 mg. Detoxification means: Cytoflavin 0,1% 25 ml twice daily or Lysine-L 4-10 ml stir with physiological solution. Glucose solution 10% 650 ml with Insulin-12 units. Sodium thiosulfate 30% 25 ml twice. Atoxyl 15 mg per 350 ml of liquid through the oral cavity in the length of the day is repeated three times. Vitaminotherapy Tiogam up to 845 mg per day.
When swelling of the brain tissue: Lasix 1% 3 ml once, Mannit 15%, Manitol 240 ml once. Controlling the body metabolism of electrolytes. Magnesia sulfuric acid 25% solution 10 ml.
It makes sense to carry out detoxification therapy of the body: Rheosorbylact 450 ml by droplet, Trisol 420 ml IV throughout the day. Physiological saline 600 ml, Glucose solution 5% 150 ml selectively.
For tranquilizers, tranquilizers are used for risk assessment: Trioxazine, Mebikar 0.4-0.8 mg three times a day, Nitrazepam 4-18 mg, Andaxin 2-3 g, Tazepam 3-9 mg four times per day, Librium 40-120 mg.
Consequences of alcoholic delirium
Alcoholic fever is a common cause of many diseases more seriously. The consequences of this delicate state are not so easy to predict, sometimes they are absolutely unexpected. But of the common pathological phenomena is pneumonia. In general, these persons are susceptible to very severe forms of pneumonia, since they often have vomiting, which leads to aspiration pneumonia, which is poorly sensitive to antibiotics.
Alcohol is a poison, accordingly it toxically affects our main pump and poisons it, so toxic alcoholic cardiomyopathy is not uncommon in alcoholic circles. Alcoholics have a very bad appearance, which is absolutely not surprising, they have a huge shortage of vitamin resources and completely disrupted their exchange. To the great horror of resuscitators, the alkaline-acid balance in these individuals is completely changed, mostly acidified, which can lead to irreversible changes in metabolism. Vodka is a strong stimulant for the release of enzymes, so alcoholism and pancreatitis are inseparable. This is a difficult species to be copied, which causes a lot of discomfort and leads to unbearable pain in the pancreas. With such conditions as white fever, the rejection of any organs is not excluded, but renal failure is a very formidable pathology, which is inevitably fatal. Since the liver is the main fighter with poisons, liver failure is also a common symptom. In rare cases, especially when taking alcohol with medications, rhabdomyolysis is possible. This is a terrible condition that manifests itself in the breakdown of muscles and the poisoning of the body with their decay products. Cerebral edema often accompanies alcoholic delirium, since neurons also suffer from this pathology.
