Alcoholic paranoid( or delirium) is in third place among all alcoholic psychoses, after white fever and hallucinations. This diagnosis is received by 10-25% of patients entering the clinic with psychoses on the basis of alcoholism. For a long time the paranoid was not considered an independent disease. But today he is recognized as a serious disorder that requires immediate hospitalization and long recovery therapy.
Alcoholic paranoid - causes and clinical picture
Alcoholic paranoid is one of the varieties of alcoholic psychosis, the main symptom of which is the strongest delusion of persecution.
The only reason for this psychosis is alcohol abuse. The disorder usually occurs in people only in the second and third stages of alcoholism, the main part of patients - people who constantly take alcohol for more than 7-8 years.
There are also several risk groups - the paranoid is more often diagnosed in alcoholics who have suffered head trauma, with severe heredity and in patients with epileptoid psychopathy.
Clinic of alcoholic paranoia consists of 3 main phenomena. These affective disorders( sudden mood swings), sensual( figurative) delusions and inadequate behavior.
Species
Alcoholic paranoid diagnoses exclusively in alcoholics "with experience" It develops either in a state of intoxication, after a long drinking-bout, or during a severe withdrawal syndrome. The second case occurs more often - usually delirium of persecution begins precisely during a period of painful hangovers.
The duration of the disease and its course largely depend on the form of psychosis. Scientists identify 3 main types of alcoholic delirium.
Abortive
Lasts from 3 hours to 24 hours, begins mainly in a state of intoxication. First there are affective disorders( bad mood, feelings of anxiety, then fear), which dramatically grow into a delusion of persecution.
OPINION OF SPECIALISTS!
Elena Malysheva:
"Is Alcoholism Cured? Yes! Use an effective home remedy. .. "
Read more. ..
Acute
Lasts from 2 to 25 days and is diagnosed most often. This form of psychosis develops only during a hangover. First, there are prodromal phenomena that last for several days. These are classical withdrawal symptoms - depressed mood, problems with sleep and appetite, arrhythmia, trembling of the limbs, feelings of anxiety, confusion, etc. Soon confusion develops into a strong fear, begins delirium, sometimes - hallucinations.
Extended
Such psychosis can be delayed from 1.5-2 months to several years. It begins as a typical acute alcoholic paranoid, but over time, the feeling of fear weakens, a steadily lowered-alarming mood comes on. The specificity of delirium changes - the motives and suspicions of the alcoholic become more logical and selective. This form of alcoholic disorder often occurs with recurrent relapses that last for several months.
Some narcologists and psychiatrists divide the lingering alcoholic paranoids into subacute( lasts up to 6 months) and chronic( from 6 months to several years).
Symptoms and signs
The symptoms of an alcoholic paranoid are similar for all types of disease, the only difference is their stretch in time. Provoke the first paranoid attack in the alcoholic can very long binge or a sharp increase in the dose of alcohol.
The very first stage of psychosis is the withdrawal symptoms( somatovegetative symptoms, insomnia and nightmares, bad mood).Then the affective disorders come on. There is a painful longing, an unreasonable anxiety, a fear that rapidly escalates into panic.
Soon the alcoholic delirium develops, which can take many forms:
- delusions of persecution( the most common form);
- nonsense relationship;
- delirium of jealousy;
- delirium self-blame;
- delirium poisoning, etc.
At the first stage of psychosis hallucinations can begin - auditory and visual, they last no longer than 1-2 days. The main sign of alcoholic paranoid is always nonsense, which is based on a single thought - that the patient is threatened with physical violence.
The alcoholic is convinced that they want to kill him, and in a very concrete way - poison, kill, hang, shoot, quarter, torture, etc. Sometimes the patient believes that the danger is also threatened by members of his family.
If you connect nonsense relations, it seems to the person that all people in advance treat him with contempt or hatred, especially arrange various mucks.
The flow of alcoholic delirium is traditionally accompanied by a strong sense of fear. The patient constantly performs impulsive actions: tries to escape, grabs people by the hands, asks for help, loudly screams, hides in the apartment, in attics, in sewers, etc.
Differential diagnostics
One of the most difficult moments in the therapy of alcoholic paranoia is still onstage of diagnosis. It is often difficult to distinguish between alcoholic psychosis and paranoid schizophrenia, complicated by alcoholism. The most severe cases are when the patient suffers from a schizotypic disorder against a background of alcoholism, in which personality changes are rather insignificant.
To make a correct diagnosis, you need to collect a complete history of the disease. If a person's psychosis is not associated with drinking, hangover or appears at an early stage of alcoholism, it is a question of paranoid schizophrenia.
There are several other signs that can clearly distinguish between two disorders:
| Alcoholic paranoid | Paranoid schizophrenia against the background of alcoholism |
|---|---|
| Always formed on the basis of alcoholism exacerbation - during a drinking-bout or a powerful withdrawal syndrome | There is no clear clinical picture of alcoholism, the withdrawal syndrome is not expressed |
| There is no dissociation( bifurcation) in behavior, but there are signs of antisocial behavior, the patient provokes quarrels and conflicts | Open conflict practicallythere is a split personality |
| The patient is harsh and rude in communication, can be cruel to relatives, especially in a fit of jealousy | The main features - detachment, estrangement, suspicion, emotional coldness to close |
| Delusions are very specific, based on fear or jealousy, are always logically justified. Hallucinations rare and very simple | Delusional thoughts often change, do not give in to any logic, all ideas are very strange. Hallucinations are permanent, closely related to delirium |
| After an attack of psychosis in alcoholics, the emotional sphere is completely restored, they often with humor refer to their delusional thoughts | In patients with schizophrenia, obvious emotional disorders are observed - there is a decrease in interest in the environment, developing and growing problems with thinking |
Treatment
Treatment of alcoholic paranoids is carried out exclusively in stationary conditions. With mild forms of psychosis after hospitalization and removal of the first symptoms, the patient can be observed and treated out-patient. In severe cases, the patient is left in the hospital for several days.
Drug treatment is carried out by several groups of drugs:
- antipsychotics;
- tranquilizers;
- antidepressants;
- vitamins, etc.
Immediately after hospitalization, intravenous drug antipsychotics are needed to relieve fear and eliminate behavioral disorders( chlorpromazine, haloperidol, diazepam).If the attacks of delirium are combined with a depressed mood, antidepressants are prescribed. An extract from the hospital is possible only after the complete disappearance of delusions and signs of aggression.
Alcoholic paranoid usually has no serious consequences and does not provoke personality changes - provided that the course of treatment has been passed completely and the patient no longer abuses alcohol. If the patient continues to regularly alcohol, against the background of a paranoid, hallucinosis and prolonged psychosis may develop.