Alcoholic delirium of jealousy is a chronic metal-alcohol psychosis characterized by the predominance of ideas of adultery. Develops gradually, can remain unnoticed for a long time for others. It is accompanied by the formation of a system of delusional ideas that gradually lose touch with reality more and more. Patients can monitor their spouse, make unreasonable claims, force confessions and show sadistic behavior towards their wife. Delusional ideas persist even after giving up alcohol, with qualified treatment and prolonged abstinence, there is a reduction of delirium.
F10.5 Psychotic disorder
Alcoholic delirium of jealousy is a psychosis that occurs against the background of prolonged alcohol consumption. Accounts for 1-3% of the total number of alcoholic psychoses. It is characterized by a gradual, implicit increase in symptoms, which is why the disease remains invisible to others for a long time (with the exception of family members). Usually develops in the II-III stages of alcoholism. Men aged 40 and older suffer, the average age of the first symptoms is 49 years. In women, this pathology is diagnosed extremely rarely.
The distinctive features of this alcoholic psychosis are a high degree of systematization and gradual progression, accompanied by an aggravation of psycho-organic disorders, an increase in the level of aggressiveness and violations of social behavior. During alcoholic excesses, patients often show cruelty towards their wives or cohabitants, beatings and even murders are possible. The course of psychosis is chronic, periodic exacerbations are observed. Treatment of alcoholic delusions of jealousy is carried out by specialists in the field of narcology and psychiatry.
The main reason for the development of psychosis is prolonged alcohol abuse, accompanied by the development of a psycho-organic syndrome. Usually the disease occurs in patients with epileptoid or paranoid character accentuation. Even before the onset of the disease, such patients are egocentric, distrustful, suspicious, tend to rigidly regulate the lives of others and demand strict compliance with the rules they set.
In the premorbid period, a tendency to form super-valuable ideas is often revealed. Most patients have a continuous long-term course of alcoholism (ten years or more). Signs of alcoholic degradation of personality are often revealed. There is a history of delirium tremens and other alcoholic psychoses. Severe disorders of the functions of internal organs, alcoholic encephalopathy, alcoholic polyneuritis and other diseases caused by chronic alcoholism can be detected.
Symptoms of alcoholic delirium of jealousy
The delirium of jealousy develops gradually. Initially, patients express suspicions or make claims episodically, while intoxicated or against the background of withdrawal syndrome. After a while, a delusional interpretation of real events occurs not only when taking alcohol, but also when sober. At the initial stages of the disease, a certain role is played by the actual deterioration of the relationship between the spouses, due to prolonged drunkenness of the patient.
Since the patient forms delusions, partly based on the current situation in the family (conflicts, details of relationships, etc.), at first his ideas and statements look quite plausible to others. Subsequently, delirium increasingly loses touch with reality, is systematized, crystallized and “overgrown” with a lot of details. During this period, illusions often arise in the form of ironic or sarcastic hints, fragments of conversations and random phrases in which others allegedly discuss the patient’s family situation.
The patient is activated. His verbal reproaches are complemented by actions to “expose” the allegedly unfaithful spouse. The patient arranges surveillance, provokes his wife, creates situations in which infidelity “comes out” and will be proved.
Subsequently, the situation is further aggravated, confabulations (false memories) about past events arise. The patient claims that the spouse not only does not remain faithful at the present time, but also cheated on him throughout his family life. He believes that joint children are not born from him, but from a lover (or lovers), which has the most negative effect on his attitude towards children. In confirmation of his delirium, the patient cites numerous “facts” generated by false memories (stories of other people, personal presence at the fact of treason). At the same time, the patient never talks about his behavior at the moment when he was found to be unfaithful to his wife, even if he talks about how he was a direct witness of his wife’s sexual relations with another man.
Sometimes the delirium of jealousy becomes more complicated and connects into a single system with other delusional ideas (damage, poisoning, divination). The patient’s behavior is becoming more aggressive, often sadistic. Acts of physical violence against other family members are becoming more frequent (allegedly unfaithful wife, “other people’s” children, “mother-in-law” covering” the spouse, etc.). There is a real danger of killing the wife. Aggression towards a rival occurs much less often, even if the “spouse’s lover” is well known to the patient. Sometimes the disease remains undiagnosed for a long time, because patients outwardly continue to behave as usual and “keep suspicions to themselves” until the delirium is fully registered. In such cases, the first evidence of the disease may be a pre-planned murder of his wife.
Patients suffering from this alcoholic psychosis pose a great danger to others. Since such patients tend to hide their condition from medical professionals, if they suspect alcoholic delusions of jealousy, they conduct an extended survey or use a sample with ethyl alcohol. A 20% solution of ethyl alcohol is administered intravenously, after 10-15 minutes alcoholic intoxication occurs, accompanied by an exacerbation of delusional ideas. As a result, the patient shares with the doctor his suspicions and problems related to the “infidelity” of his spouse.
Treatment of alcoholic delirium of jealousy
Treatment of psychosis is long-term, carried out in a psychiatric or narcological department. Patients are given detoxification therapy, large doses of vitamins are administered, and antipsychotics are prescribed. In the initial stages, especially with persistent deep delirium, insulin comas are used. Drug therapy is supplemented with psychotherapeutic effects. Alcohol addiction is being treated. Patients are discharged only after the reduction of delusional ideas and the disappearance of aggressive tendencies.
It should be borne in mind that patients can mislead relatives and health workers by dissimulating the symptoms of the disease, assuring other people of their recovery and demanding discharge. In order to prevent danger to others, an extract in such cases is issued only by the decision of the medical commission. Within 3 years after discharge, patients are monitored by a narcologist and a psychiatrist. If the delirium worsens, they are immediately hospitalized. If the patient refuses treatment, forced hospitalization is indicated.
The prognosis for this pathology is doubtful. In many patients, delusional ideas persist even after complete abstinence from alcohol. However, with qualified treatment and observance of a sober lifestyle, delirium gradually weakens, although it does not always disappear completely. Patients say that they “forgive” their spouse, consider the past unimportant and want to improve relations. In about 30% of cases, within a few years after the cessation of alcohol consumption, almost complete recovery occurs.
If the patient continues to take alcohol, the symptoms of psychosis persist. The only reason for the decrease in the intensity and value of delusional ideas as the patient ages is an increasing intellectual and cognitive decline due to organic changes in the brain. In elderly patients, the number of false memories increases, while the delirium of jealousy somewhat loses its sharpness and is partially replaced by delirium of damage.