Delirium tremens
The content of the article:
- Causes and risk factors
- Forms of the disease
- Stages of delirium tremens
- Symptoms of delirium tremens
- Treatment for delirium tremens
- Possible complications and consequences of delirium tremens
- Forecast
- Prevention
Delirium tremens (alcoholic delirium) is an acute psychosis that develops against the background of prolonged use of alcoholic beverages and belongs to the group of metal-alcoholic psychoses. It proceeds with impaired consciousness, tactile, auditory, visual hallucinations or illusions.
Delirium tremens is a complication of alcoholism
Delirium tremens is the most commonly observed alcoholic psychosis. In most cases, it first occurs in patients suffering from stage II or III alcoholism, that is, not earlier than 8-10 years after the start of their regular consumption of alcoholic beverages.
In very rare cases, delirium tremens develops in non-alcoholic people after significant alcohol abuse.
Unlike the opinion widespread among the inhabitants, signs of delirium tremens are never observed in persons in a state of acute alcoholic intoxication, but develop only a few days after the abrupt end of the binge.
The symptoms of delirium tremens vary widely. In some cases, patients become aggressive, and in others, on the contrary, benevolent and eager to perform noble actions for the benefit of loved ones. The transition from one condition to another can occur quickly, so patients with delirium tremens should never be considered safe and left without medical attention.
Delirium tremens is a life-threatening condition. Without appropriate treatment, approximately 10% of patients die from the development of complications from the internal organs, accidents or suicides.
Causes and risk factors
The only reason for the development of delirium tremens is the abuse of alcoholic beverages that lasts for many years. Factors that increase the risk of alcoholic delirium are:
- the use of low-quality alcohol (pharmaceuticals and technical liquids containing alcohol and its surrogates);
- long drinking binges;
- expression of pathological changes on the part of internal organs, primarily on the part of the liver;
- diseases of the brain and traumatic brain injury in history.
Long-term alcoholism is the only cause of delirium tremens.
The pathological mechanism of the development of delirium tremens is still not fully understood. It is assumed that metabolic disorders and long-term chronic intoxication of brain tissues play the main role in the onset of acute psychosis.
Forms of the disease
Depending on the characteristics of the clinical course, several forms of delirium tremens are distinguished:
- Typical or classic. While progressing, the disease goes through certain stages, the clinical picture develops gradually.
- Lucid. Psychosis occurs acutely. Patients have a feeling of fear and anxiety, impaired coordination of movements. There are no hallucinations and delusions.
- Abortive. Hallucinations are fragmented. Delusional ideas are not fully formed, fragmentary. Anxiety is strongly expressed.
- Professional. Patients perform only stereotyped, repetitive movements associated with dressing, undressing, performing professional duties, the behavior is automated. It is accompanied by amnesia.
- Musical. Is the outcome of the professional version of the course of delirium tremens. The patient has severe clouding of consciousness, movement disorders and severe somatovegetative disorders.
- Atypical. The clinical picture has much in common with schizophrenia. It develops in patients who have previously suffered one or more episodes of delirium tremens.
Stages of delirium tremens
During classic delirium tremens, there are three stages:
- Initial. The patient has mood disorders. The psycho-emotional state changes quickly and unmotivatedly, the uplifted and cheerful mood is replaced by anxiety and anxiety, and after a while the patient again falls into an anxious state. These mood swings, combined with active movements, facial expressions and speech, create the impression of being agitated, nervous. Superficial sleep, accompanied by frightening dreams and frequent awakenings. Intermittent visual and auditory hallucinations may occur. Patients tell others about memories, vivid images that come up in their minds.
- Hypnagogic hallucinations. The appearance of hallucinations at the time of falling asleep is characteristic. Sleep remains superficial, with nightmares. Upon awakening, patients cannot distinguish reality from dream. During the day they are haunted by visual hallucinations.
- Insomnia. With the transition of the disease to this stage, sleep disorders develop. The hallucinations become almost constant and very bright. Patients "see" fantastic monsters, large or small animals. Tactile hallucinations are often observed (sensation in the oral cavity of small foreign bodies, insects crawling over the body, etc.). Auditory hallucinations manifest in threatening or judgmental voices.
All stages of delirium tremens are characterized by hallucinations
Symptoms of delirium tremens
The classic form of delirium tremens begins to develop gradually. The course of the disease is often continuous, but in 10% of patients it is paroxysmal in nature: there are several attacks, separated by light intervals that last less than 24 hours. After prolonged sleep, delirium tremens abruptly ends. Much less often, the symptoms of psychosis regress gradually. The duration of the classic form of delirium tremens is usually 2–8 days. In about 5% of cases, the disease takes a protracted course.
In the prodromal period, which begins from the moment of the abrupt end of the binge and lasts until the appearance of an obvious clinical picture of the disease, patients have sleep disturbances (frequent night and early awakenings, nightmares, heavy dreams). Waking up in the morning, they notice a loss of strength and severe weakness. The mood is lowered. In the first 48 hours after the end of the binge, epileptiform abortive seizures may occur. In some cases, the development of delirium tremens is preceded by auditory short-term hallucinations. Sometimes the prodromal period is so weak that it proceeds imperceptibly for the patient himself and those around him.
Sleep disturbances, frequent awakenings at night - symptoms of delirium tremens
At the height of the development of psychosis, colorful scenes with fantastic or real animals, aliens, fairy-tale characters appear in the imagination of patients. Patients cease to adequately perceive the space and time around them, it seems to them that the flow of time is either accelerating or slowing down, and the surrounding objects are in constant motion. Patients become restless, tend to hide or run away, shake off "insects" from their clothes, conduct dialogues and disputes with invisible interlocutors.
Patients with delirium tremens are characterized by increased suggestibility. They can, for example, be convinced that they hear music from a switched off radio or see text on a sheet of completely white paper.
The condition of patients worsens at night, with the onset of dawn, the severity of hallucinations decreases and a light interval is formed. A decrease in hallucinations is also noted when the patient is involved in an active dialogue.
After the patient manages to fall asleep and sleep for a long time, the symptoms of delirium tremens abruptly cease. Less often, the exit from the state of acute psychosis occurs gradually.
After stopping the attack, patients do not remember or remember with difficulty the real events in their lives that occurred during the period of illness, but they clearly remember their hallucinations. They have significant mood swings, asthenia develops. Men often develop a mild degree of hypomania, and women - depressive states.
Other forms of delirium tremens are much less common than classic delirium tremens.
With the professional form of delirium tremens, the condition of patients is gradually getting worse. They have monotonous increasing movement and affective disorders.
In the clinical picture of exaggerating delirium tremens, the following symptoms are present:
- incoherent speech;
- rudimentary simple movements (grabbing, grabbing);
- deafness of heart sounds;
- tachycardia;
- rapid breathing;
- significant fluctuations in blood pressure;
- hyperthermia;
- excessive sweating;
- severe tremor;
- changes in muscle tone;
- impaired coordination of movements.
Treatment for delirium tremens
Patients with delirium tremens must necessarily be hospitalized in a psychiatric or drug addiction clinic. They are given detoxification therapy (plasmapheresis, forced diuresis, intravenous administration of saline solutions and glucose), as well as correction of impaired vital functions. The appointment of potassium preparations, nootropics and vitamins is shown.
Psychotropic drugs in the treatment of delirium tremens are ineffective, therefore they are used extremely rarely and only in the presence of strict indications (psychomotor agitation, severe anxiety, prolonged insomnia). Psychotropic drugs are contraindicated in occupational and exaggerating forms of the disease.
A person with delirium tremens is hospitalized in a psychiatric or drug treatment clinic
Possible complications and consequences of delirium tremens
The consequences of delirium tremens can be memory impairments of varying degrees of severity, as well as the formation of a psychoorganic syndrome, severe damage to internal organs. An altered state of consciousness with preserved, and sometimes increased motor activity, makes the patient with delirium tremens dangerous both for others and for himself.
Forecast
The prognosis for delirium tremens is determined by the timeliness of the initiation of therapy, the form of the disease. In most cases, the classic form of delirium tremens ends with recovery. With severe psychosis, the risk of death increases. Prognostically unfavorable signs are:
- respiratory rate over 48 breaths per minute;
- incontinence of urine and feces;
- muscle twitching;
- deep disturbances of consciousness;
- paresis of the eye muscles;
- acute cardiovascular failure;
- intestinal paresis;
- an increase in body temperature to febrile values (above 38 ° C).
After suffering from delirium tremens, there is a high risk of re-development of psychosis against the background of continued alcohol abuse.
Prevention
Prevention of the development of delirium tremens consists in the active treatment of alcoholism, as well as in carrying out extensive sanitary and educational work aimed at preventing the formation of alcohol dependence in the population.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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!
