Alcoholic delirium
What is it?
Alcoholic delirium (delirium tremens, metal alcohol psychosis) is a serious mental condition that requires urgent medical attention.
Who can develop alcoholic delirium?
It occurs only in persons suffering from stages 2-3 of alcoholism, when the duration of alcohol abuse is more than 10-15 years. Much less often, alcoholic delirium can occur in people who do not suffer from chronic alcoholism, but after an episode of long-term alcohol consumption in large quantities or the use of alcohol substitutes.
Alcoholic delirium develops against the background of withdrawal symptoms, i.e. after stopping alcohol intake (after a binge).
The risk of developing alcoholic delirium is greater in people who have had a previous traumatic brain injury, severe diseases of the central nervous system, including an inflammatory one, in people who have already had an episode of delirium tremens.
Clinic for alcoholic delirium. Symptoms and syndromes
Alcoholic delirium often develops 2-3 days after stopping alcohol intake. Sleep disturbance can be a harbinger of the main symptoms of alcoholic delirium. Restless sleep, accompanied by nightmares, does not lead to rest. Symptoms such as headache, nausea, vomiting, speech impairment, etc. may also appear. However, they are not specific and most often accompany any withdrawal syndrome.
In the clinic of alcoholic delirium, 3 groups of syndromes can be distinguished:
-psychotic;
-vegetative;
- organic brain damage.
The early symptoms of alcoholic delirium are anxiety, feeling of unexplained threat, fear. General somatic symptoms appear: increased sweating, hand tremors, heart palpitations, high blood pressure. Sleep disturbance gradually turns into insomnia. The patient is haunted by vivid auditory and visual hallucinations. Most often, they contain small insects: cockroaches, beetles or animals. There may also be tactile hallucinations: the sensation of insects crawling over the body, so such patients try to drive away or crush them.
During alcoholic delirium, the patient can “hear” voices ordering something to him, scolding him, calling names, teasing. Human behavior becomes inadequate. He is completely overwhelmed by hallucinations: he “talks” with someone, shouts, tries to escape, “catches” “insects” on himself and his clothes, etc. Sometimes boastful behavior is manifested: in a state of excitement, the patient talks about his "exploits".
The state of arousal can be replaced by periods of apparent well-being, during which the behavior becomes calmer and more adequate. However, after a short period of time, the symptoms of alcoholic delirium return.
Of the somatic symptoms in a detailed clinic of delirium tremens, one can distinguish: hyperthermia (up to 38-39 ° C), high arterial hypertension (160-180 / 110 mm Hg), tremor, increased tendon reflexes, increased sweating. The work of all internal organs is disrupted.
Typical alcoholic delirium lasts 3-5 days. The first positive symptom of recovery from delirium tremens is improved sleep.
Stages of alcoholic delirium
1. Threatening delirium.
General symptoms of alcohol withdrawal are characteristic. The patient may have all the symptoms described earlier, but the severity is insignificant. In an expanded clinic, disorientation in time and space may appear, but awareness of one's own personality remains. The body temperature does not exceed subfebrile figures. This stage is reversible and can end arbitrarily.
2. Complete delirium.
All symptoms are pronounced. Auditory, visual and tactile hallucinations increase. Delusional experiences occur, often of an unpleasant nature. The general somatic state is deteriorating: shortness of breath appears up to 22-24 breaths per minute, blood pressure (blood pressure) and pulse increase. At this stage, spontaneous resolution of alcoholic delirium is impossible. Without timely assistance, this stage quickly turns into 3.
3. Life-threatening delirium.
All mental symptoms persist, along with an obvious burden of somatic ones. Lethargy appears, speech is slurred, quiet (mumbling), the reaction to external stimuli decreases. Blood pressure drops sharply, the filling of the pulse weakens, and shortness of breath increases. The depression of consciousness gradually increases to a coma. At this stage, irreversible changes in internal organs and systems can occur, decompensation and, possibly, death occurs.
Complications of alcoholic delirium
- acute pancreatitis;
- pneumonia (development rate is about 30%);
- alcoholic myocardiopathy;
- liver failure;
- swelling of the brain;
- acute renal failure;
- violation of water-electrolyte balance and acid-base balance;
- rhabdomyolysis, etc.
Treatment for alcoholic delirium
Delirium tremens is a condition that requires not only monitoring the patient in order to ensure the safety of himself and those around him, but also requiring a fairly intensive drug therapy. In some cases, even resuscitation measures are necessary. It is advisable to treat alcoholic delirium on the basis of a neuropsychiatric hospital with the obligatory involvement of a resuscitator and a therapist.
Many drugs have been proposed, but at the moment there is no single point of view on the algorithm for the treatment of alcoholic delirium.
In Europe, the standard treatment for alcoholic delirium is the prescription of clomethiazole. In Russia and the United States, benzodiazepines have been and remain the drugs of choice. Their disadvantages include respiratory depression, cumulation of a sedative effect.
In most cases, intravenous combination therapy with benzodiazepines and haloperidol (or droperidol) is the treatment for alcoholic delirium.
In parallel with the relief of mental symptoms for the treatment of alcoholic delirium, all intensive measures aimed at eliminating somatic disorders are shown. When prescribing all drugs, it is necessary to remember the degree of their influence on the nervous system and the possibility of prescribing this group to patients with chronic alcoholism.
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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
