Alcoholic hallucinosis is one of the three most frequent alcoholic psychoses, yielding to the palm of superiority only to white fever. Like other disorders on the basis of alcoholism, a hallucinogenic syndrome usually begins with a severe hangover, but it can also appear during a drinking-bout, with insomnia and even in a break between binges. For example, in a stuffy line or in the subway. Treatment of hallucinosis is primarily a drug, the recommended drugs vary depending on the form of pathology.
Features and causes of alcoholic hallucinosis
Alcoholic hallucinosis is a psychosis based on the regular use of alcohol, the main symptom - bright auditory( verbal) hallucinations. With this syndrome, the alcoholic invariably retains clarity of consciousness, perfectly understands who he is, perfectly oriented in space and time.
Very often hallucinations overlap with delusions of persecution, invariably fixed affector disorders-anxiety, fear, growing into panic attacks. At the peak of the disease, an alcoholic can try to kill himself or harm his close people, defending himself against an imaginary danger.
All cases of alcoholic hallucinosis are divided on two grounds - the course of the disease and the clinical picture. Along the current, all the hallucinogenic disorders are divided into acute and chronic.
Classification of alcoholic hallucinosis according to the clinical picture is more diverse:
This is the easiest stage, an attack usually occurs during a severe withdrawal syndrome( hangover).The first "bells" of a beginning psychosis are typical for alcoholic disorders - a person is confused, feels an inexplicable anxiety, which soon flows into fear, down to horror.
Hallucinations occur before going to bed or during a painful sleepless night. At first the patient hears acoasms - these are the simplest, fragmentary hallucinations( knock, shot, hiss, rumbling, ringing, etc.), sometimes - individual words, short phrases, songs. A person usually understands well where the sound comes from, while experiencing a strong bewilderment and fear. To get rid of an attack of a hallucinosis, it is enough to just sleep - after waking up all the symptoms evaporate.
Such a pathology first manifests itself as mood problems. The alcoholic is depressed, feels anguished anguish, anxiety, soon fear increases, psychomotor agitation.
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Then comes the turn of symptoms in the form of deceptions of hearing. At first the patient hears broken neutral sounds( knocking, rustling, creaking, clear words) and can at first not pay special attention to them. Soon hallucinations become more complicated, turn into polyvocal. Unknown to the voices can discuss the misconduct of an alcoholic or speak with him, threaten with terrible torture, blame for terrible sins, demand something. The abortive hallucinosis continues to several days, the way out of it is critical, that is, after a deep sleep. Without treatment, such a pathology can develop into a full-fledged alcoholic psychosis.
Harbinger of the appearance of a classic hallucinosis - a painful hangover combined with anxious thoughts, paranoia, in women - with depression. Provoke psychosis is capable and protracted drinking, if it is complicated by severe insomnia.
Classical psychosis always begins with affective disorders( anxiety and anguish, panic attacks).Then the patient is heard different sounds, and soon add delusional thoughts.
Then begins the classic alcoholic delirium of persecution, less often - attitudes, accusations, etc. All delusional ideas are logically connected with the fact that they allegedly hear the patient. At the same time, the delirium is unstable, usually of a fragmentary nature. The attack of a hallucinosis lasts from a couple of days to 3-4 weeks, disappears after a long full sleep.
With pronounced delirium
The main sign of such a hallucinogenic syndrome is the combination of single auditory hallucinations( meager and monotonous threats) and severe delirium of persecution.
On the beginning of psychosis will say affector violations - a person feels depressed, rapidly growing anxiety, then fear. Soon the alcoholic can hear strange sounds, voices, almost immediately obsessing delirious thoughts. Hallucinations and delusions usually combine into one coherent theory of persecution. But individual, not logical delusions can be fixed. In the treatment, mood disorders go first, then auditory deceptions, then delusions disappear. In many cases, residual, residual, delirium is fixed in patients.
Combined with delirium
With this form of psychosis, classical signs of white fever( delirium) are added to the sounds and voices in the patient's head. This is anxiety, panic attacks, insomnia, vegetative disorders( tremor, tachycardia, high blood pressure), bright hallucinations( and sounds, and pictures, and touches) and delirium.
Such bells can appear suddenly, at any stage and at any time, more often at night. But deceptions of hearing are always the main symptom.
With the ONEIROID obscuration of consciousness
Oneiroid is a mental disorder in which real events and fabulous pictures are intertwined in the patient's brain in a single story. The person at the same time loses identification, feeling himself a participant in unreal events.
The main signs of a hallucinosis with an onyroid are anxiety attacks, then-auditory polyphonic hallucinations, growing into a powerful figurative nonsense. Alcoholics always seem to some unreal subjects - global cataclysms, interplanetary travel, battles with armies of fictional creatures.
With stupor disorders
Another name for this form of a hallucinogenic syndrome is an alcoholic stupor, that is immobility. This form of psychosis is rarely diagnosed.
Stupor on the basis of heavy alcoholism does not appear immediately, only at the peak of psychosis. The attack can begin at home, and in public, at any time of the day. Alcohol freezes on the spot, goes into itself, the surrounding people almost does not react. Sometimes stupor is combined with onyroid attacks. This state lasts from a couple of minutes to 2-3 hours and longer.
With mental automatisms
Mental automatisms are a phenomenon in which a patient feels that his own thoughts, emotions, experiences are imposed by some mysterious forces, in addition to his will.
In acute psychosis, the alcoholic has a syndrome of open mindedness( the feeling that everything that happens in his head is heard and known by others), violently imposed ideas, mentism - the feeling that his own thoughts do not depend on the "master" himself.
Subacute psychosis physicians consider mental disorders, which last from 1 to 6 months( usually 2-3 months).The attack begins as a classic acute hallucinogenic psychosis, in the future, additional syndromes can be added to deceptive hearing.
With the predominance of verbal hallucinations
This is the rarest variety. The syndrome begins with affective disorders, then sounds and voices "wake up", signs of delirium appear. But quite quickly the anxious mood and delusional ideas recede into the background. Remains the main symptom - verbal deceptions of hearing.
The patient can behave quite normally, perform daily duties, even go to work. Often he is well aware that he is sick.
With the prevalence of depressive affect
With such a hallucinosis at the peak of the disorder, affector and even motor disorders begin. Traditional anxiety for alcoholics is sharply increased, panic attacks can develop, mood is constantly lowered, people are depressed with depressive thoughts. Among obsessions, nonsense is leading.
With the predominance of delirium
This diagnosis is made when the highest point of the subacute hallucinously lowers the mood, rapidly develop crazy ideas, people are very afraid of physical violence by unknown persons. Usually they diagnose delusions of persecution and attitudes.
Chronic forms of hallucinosis in medical practice are found at times less often than acute. An acute hallucinogenic syndrome begins smoothly, as a typical acute. Sometimes the prodromal period is very short, and heavy hallucinations promptly replace the bad mood( the picture is complicated by symptoms of delirium, depression, etc.).The acute period lasts about 1-2 weeks, the chronic psychosis itself can last up to several years.
The most common variety. The initial stage is typical for all such psychoses( depression, inexplicable anxiety), a person begins to hear extraneous sounds and dialogues, so vivid that they take them for truth. Then, there may be visual deceptions( insects, frightening shadows, animals), less often tactile hallucinations. Often there is a persecution mania.
After a week and a half, all painful signals are smoothed out, only verbal hallucinations remain clear. Soon the patient gets used to them, returns to normal life, work. Sounds and voices he hears very rarely, usually after some external stimuli. But at the first drinking the attack of an acute hallucinosis can return in full.
The clinical picture of a hallucinogenic psychosis is typical, an obsessive persecution craze is added. Delusional theories are quite logical, but the same type - the alcoholic often repeats the same words. Delirium does not get complicated, it does not get confused, it can even be corrected.
With the course of chronic psychosis, all symptoms( including delirium) are smoothed, therefore, in the form of the flow, this pathology resembles the previous form.
Verbal with psychic automatisms
This diagnosis is the least likely. The disease develops as a classic verbal hallucinogenic syndrome. Soon, psychological automatisms interfere in the clinical picture( the patient is sure that everyone hears his thoughts, that someone imposes his own emotions and beliefs, etc.).
Often, such a hallucinosis is accompanied by paraphrenic delirium associated with megalomania. The patient is sure that soon he will receive a reward for unusual merits, he will reach a high position. Euphoria from future success is easily replaced by irritability.
Differential diagnosis and treatment
In the treatment of alcoholic hallucinogenic syndrome, it is very important to correctly determine the form and diagnose. Often, this psychosis has symptoms similar to paranoid schizophrenia against alcoholism, so differential diagnosis is required.
You can distinguish schizophrenia from a hallucinogenic psychosis by several features. Often the hallucinosis is clearly tied to the time for binge drinking or a heavy hangover - occurs either during binges, or immediately after them. In addition, hallucinations on the basis of alcoholism usually appear in a clearly marked time, in the evening and at night. Schizophrenic fantasies can arise at any time.
For the treatment of acute hallucinosis, neuroleptics and vitamins are used, equally great attention is paid to the treatment of both psychopathological and neurological disorders. In the treatment of chronic form, neuroleptics with a pronounced antipsychotic effect play a crucial role. In some cases, insulin therapy is used.
Drug therapy for alcoholic hallucinosis:
|Preparations||Form of the disease|
| ||Acute alcohol hallucinosis|
| ||Chronic alcoholic hallucinosis|
Forecast in the treatment of any form of alcoholic hallucinosis doctors give a favorable. Sketchy hallucinations can persist for up to 1 month, sometimes depression occurs( mostly in women).Minor deceptions of hearing sometimes occur with severe stress, overwork. The intellect is preserved completely, even after long chronic hallucinations.