What are Mental and Behavioral Disorders due to Alcohol Use?
During a lifetime, 95% of the population consume alcohol at least once in their life, 5% consume alcohol daily, but alcoholism develops in about 1% of the population. In women, alcoholism is less common, but more malignant. There are ethnic differences in the strength of the drinks consumed, for example, in an African country like Ghana, beer per capita per day is 10 times more than the average in Europe, in France there is 10 times more red dry wine than in Russia. The strength of consumed drinks generally increases from the equator to the North Pole, but does not increase from the equator to the South Pole.
Causes of Mental and Behavioral Disorders due to Alcohol Use
Alcoholism is based on biological, social, psychological reasons. Biological reasons are the genetic determination of alcoholism, the relationship between alcoholism and serotonin deficiency and insufficient ability of the brain to oxidize aldehydes. The level of alcohol dehydrogenase varies significantly among different ethnic groups and is clearly, for example, higher among the Slavs, in comparison with the Paleo-African and Turkic groups. It is also believed that a lack of norepinephrine and an excess of dopamine can contribute to alcoholic psychosis. Alcoholism is probably associated with a hypothetical alcoholic, an allele of the dopamine 2 receptor gene. There are families in which alcoholism is transmitted in a dominant, recessive manner, sex-linked, or arises like a mutation. In the blood of alcoholics, the level of tryptophan, a precursor of serotonin, is lower.
The social causes of alcoholism are stress, family maladjustment, a decline in the economic level, imitation of others in childhood and adolescence. The psychological reason is the use of alcohol as a drug that improves communication, as an antidepressant, to reduce the level of anxiety. Therefore, alcoholism is often a mask for affective disorders. In addition, some personality traits in themselves can be leveled by alcohol intake, although alcoholism usually sharpens them in the future.
Symptoms of Mental and Behavioral Disorders due to Alcohol Use
Inadequacy of behavior, euphoria, slurred, often accelerated speech, loss of fine coordination, unsteadiness of gait, nystagmus, redness of the skin of the body. To diagnose alcohol intoxication, methods for determining alcohol in exhaled air are used (Rappoport’s and Mokhov’s – Shinkarenko’s tests). Using gas-liquid chromatography and spectrometry, alcohol is determined in blood and urine, as well as in stomach contents. Light intoxication corresponds to 0.5-1.5 g / l [The constant endogenous background of alcohol associated with metabolism is a background of 0.02 g / l.] Alcohol in the blood, moderate – 1.5-3 g / l, severe intoxication – 3-5 g / l. Higher doses can be fatal. Distinguish between simple, atypical and pathological intoxication. The reason for atypical intoxication is an organic background, the coincidence of intoxication with an abnormal affective background or the reception, together with alcohol, of other psychoactive drugs, such as clonidine or tranquilizers.
Use with harmful effects
As a result of alcohol consumption, social decline and maladjustment are noted, symptoms of somatic changes in the liver, brain, cardiovascular system are more often found, personality changes, whose interests are fixed on the circle of alcohol intake. Usually, the symptoms of somatic disorders are masked by the intake of alcohol, but after stopping the use of alcohol, patients begin to complain about them.
Social maladjustment and decline are found in subtle behaviors. For example:
- the patient seeks to distance himself from former acquaintances who do not approve of his habit, especially in relation to colleagues at work, realizing that he may “smell not so good”;
- ceases to pay attention to the cleanliness of his clothes and body;
- ahead of the reception of alcohol at the table during the holiday, drinking before the first toast, and drinks during the toast;
- can drink different types of alcoholic beverages during the day;
- reacts to even minor stress with a desire to drink and “calm down”;
- explains the use of alcohol by the lack of prospects, failures;
- loses interest in social relations and is fixed on the circle of persons with whom one can sit perfectly.
Consistent formation of mental and physical dependence. A symptom of physical dependence is the formation of a withdrawal syndrome, which is stopped by the next dose of alcohol. Psychic dependence lies in the fact that any emotional stress associated with a minor impact is extinguished with alcohol. At the same time, increased and decreased moods are a sufficient reason for drinking. Loss of control over the amount of alcohol consumed and episodes of amnesia during the period of deep intoxication are possible. The patient usually denies the presence of mental dependence and compensates for his behavior with all sorts of tricks, for example, hides alcohol from loved ones who do not approve of his behavior or tries to involve them in his behavior. A symptom of physical dependence is withdrawal symptoms, usually in the morning, which can only be stopped with alcohol. Usually, after a while, physical dependence leads to binge drinking, which lasts for several days. In the former Russian classification, the formation of mental dependence was attributed to the 1st stage of alcoholism, and physical dependence – to the 2nd stage, the 3rd stage was attributed to alcoholism with encephalopathies and changes in other internal organs. Liver cirrhosis, alcoholic cardiomyopathy, polyneuropathy, feminization of men and masculinization of women are typical. In addition, patients with alcoholism have an increased risk of injury, suicide, and poisoning.
Tolerance in the 1st stage increases and reaches a plateau in the 2nd stage, in the 3rd stage it decreases significantly. If somatic disorders occur during the period of abstinence, they can decompensate and even lead to the death of the patient.
Withdrawal syndrome results in withdrawal symptoms. Tremor, nausea or vomiting, weakness, vegetative disorders, anxiety, decreased mood, headache, insomnia, hyperreflexia, convulsions (alcoholic epilepsy) as withdrawal symptoms occur 10-20 hours after stopping alcohol intake. Alcohol intake leads to a softening of abstinence, and therefore, with personal degradation, patients tend to find a new dose of alcohol. Withdrawal syndrome in juvenile alcoholism is an unfavorable predictor of rapid alcohol degradation. Convulsions during the withdrawal period can be in patients with dipsomania, that is, impulsive binges, after suffering head injuries or in intoxication with alcohol surrogates.
Alcoholic delirium (delirium tremens), alcoholic paranoid and hallucinosis are classics. Delirium occurs on the 2-3rd day, usually in the evening, after the cessation of binge, against the background of anxiety, fear, confusion, autonomic disorders. The patient is disoriented in place and time. There is an influx of frightening visual zooptic hallucinations that determine the patient’s behavior. When delirium is combined with somatic pathology, it is possible to increase the depth of disturbances of consciousness to exaggeration (muttering delirium) and amentia. Sometimes in the structure of experiences there is schizophrenic symptomatology with a symptom of openness of thoughts, delusions of influence and persecution. However, these cases need close attention, as they are often associated with a combination of schizophrenia and alcoholism (Greter’s schizophrenia).
Alcoholic paranoid can resemble an acute transient psychotic disorder, occurring against the background of abstinence with mental stress. In the clinic, ideas of persecution, relationships, and ideas of jealousy are typical. In the latter cases, the course of paranoid is chronic.
In acute alcoholic hallucinosis against the background of altered consciousness, true auditory hallucinations of commentary content, imperative hallucinations occur.
It manifests itself in the structure of Korsakov’s psychosis, Wernicke’s encephalopathy, hepatic encephalopathy. Korsakoff psychosis is characterized by fixation amnesia, retro-anterograde amnesia, confabulations, and pseudo-reminescences, which are associated with polyneuropathy. Staggering gait and polyneuropathy may precede amnestic disorders. Gaie-Wernicke acute alcoholic encephalopathy develops as a result of thiamine deficiency. Confusion, apathy and drowsiness appear, which turn into stupor and coma, acute and subacute ophthalmoplegia and gait instability. A combination of Wernicke’s encephalopathy and Korsakoff psychosis (Wernicke-Korsakoff syndrome) is possible. In hepatic enphalopathy: impaired sensitivity, tremor, hyperreflexia, sometimes convulsions, dysarthyria, choreoathetosis, ataxia and dementia with memory impairment. The severity of amnestic disorders is not always associated with alcohol experience and tolerance, but often with hypovitaminosis, age, additional somatic pathology.
Residual state and delayed onset psychotic disorder
Alcohol personality changes include emotional disturbances, including affective instability, depression, lying, self-centeredness, guilt, and anxiety. On the one hand, patients often readily respond to requests, but quickly forget about them and plunge into their egocentric world, the main value of which is drinking. This leads to the loss of trust of others and the deprivation of social support for the alcoholic. Trouble builds up like a snowball if the behavior conflicts with the law and the patient loses his family. Feelings of remorse can be profound and even lead patients to suicidal thoughts and actions, especially if they are socially maladjusted. Symptoms of a gramophone record are characteristic with a constant stereotypical return to the same standing turns in speech, the same stories from the past. In the residual period, chronic hallucinosis is also noted, which are accompanied by auditory commentary and threatening true hallucinations.
Diagnosis of Mental and Behavioral Disorders due to Alcohol Use
Diagnosis is based on medical history, blood alcohol levels, clinical symptoms of addiction and withdrawal, and alcohol personality changes. Psychological characteristics are characterized by a decline in cognitive status and success, constant thoughts about drinking, self-justification, guilt, depression and anxiety, bouts of rage and aggressiveness, and alcoholic dreams. On physical examination, the liver is enlarged, tremors, nausea, sweating, weakness and decreased sensitivity of the feet, heart murmurs and extrasystoles, pink acne (red nose), telangietasia, signs of dehydration with a decrease in skin turgor, accelerated involution, hypogonadism, androgenization in women and feminization in men.
Should be differentiated from mental and behavioral disorders when taking other psychoactive substances. For diagnosis, anamnesis data, laboratory determination of ethanol levels, an increase in the level of gamma-glutamyl transpeptidase, an increase in the level of transaminases, alkaline phosphatase and high-density lipoproteins are important.
Treatment of Mental and Behavioral Disorders due to Alcohol Use
In case of acute intoxication, thiamine and other B vitamins are introduced, detoxification is carried out. For detoxification, an abundant introduction of liquid is used (drinking, parenteral administration of glucose solutions with small doses of insulin and heart drugs, fortified saline solutions, hemodez, polyglucin), diuretics. Nootropics and agents that improve liver function (Heptral) are also introduced. Behavior correction is carried out with benzodiazepines. To remove from a coma, naloxone or antaxone are used. For alcohol withdrawal, benzodiazepines, small doses of haloperidol, and anticonvulsants, and sometimes beta-blockers (atenolol, propranolol), are prescribed. Similar measures are taken in the treatment of psychosis. Alcohol dependence treatment includes behavioral therapy, alcohol aversion is achieved with teturam (esperal) or hypnotherapy. For psychological correction, methods of provocative psychotherapy, group methods in clubs of alcoholics anonymous are used. Given that alcohol dependence can only be a screen behind which depression develops, medium doses of antidepressants (amitriptyline, melipramine, remeron) should be prescribed.