Alcoholic delirium is a metal-alcohol psychosis that occurs a few days after a sharp withdrawal of alcohol. It is more often observed in patients with stage II and III alcoholism. Accompanied by impaired consciousness, visual, auditory and tactile illusions and hallucinations. It is characterized by a gradual onset with harbingers in the form of anxiety, tremor of the limbs, palpitations, insomnia or nightmares. It is diagnosed in the process of collecting anamnesis. Treatment is carried out with the help of detoxification therapy, the appointment of psychotropic, nootropic drugs.
F10.4 Withdrawal with delirium
Alcoholic delirium is the most common alcoholic psychosis. Usually develops no earlier than after 7-10 years of regular alcohol intake in patients with alcoholism of II and III degrees. In some cases, after violent alcoholic excesses, it may occur in people who do not suffer from alcohol addiction. Contrary to popular belief, the symptoms of alcoholic delirium always appear some time after a sharp withdrawal of alcohol and never in a state of intoxication.
Alcoholic delirium can be accompanied by aggressiveness, but patients are not always aggressive. Sometimes the opposite picture is observed: benevolence, enthusiasm, attempts to perform some noble actions for the benefit of others (for example, to expel the little green men before they breed and begin to bother other people). However, the patient cannot be considered safe, even if he behaves innocuously – his condition may change at any moment. Alcoholic delirium is a life-threatening condition – without treatment, about 10% of patients die as a result of suicides, accidents and complications from internal organs. If you suspect this disease, you should immediately seek help from specialists in the field of narcology and psychiatry.
The main cause of the development of alcoholic delirium is alcoholism. Long-term heavy drinking, the use of low-quality alcohol (surrogates, technical liquids and pharmacological preparations with a high alcohol content) and pronounced pathological changes in internal organs are identified as risk factors. Craniocerebral injuries and a history of brain diseases have a certain significance. The pathogenesis of this disease has not yet been clarified, it is assumed that chronic intoxication and metabolic disorders in the brain play a decisive role.
Often, alcoholic delirium develops against the background of severe mental or physical stress, for example, when a patient is injured in a state of intoxication and ends up in the trauma department. Abrupt cessation of alcohol intake in combination with a change of environment, physical pain and discomfort, as well as worries about trauma overlap and increase the likelihood of developing delirium tremens. A similar situation is observed when binge-drinking patients are admitted to gastroenterology, cardiology and other departments. At home, delirium usually occurs when patients abruptly come out of a binge due to an exacerbation of somatic pathology.
Classification of alcoholic delirium
There are several types of alcoholic delirium:
- Classic or typical delirium. The symptoms of the disease appear gradually. In its development, the disease goes through a number of successive stages.
- Lucid delirium. An acute onset is characteristic. Delirium and hallucinations are absent, coordination disorders, tremors, anxiety and fear prevail.
- Abortive delirium. Fragmentary hallucinations are observed. Delusional ideas are fragmentary, insufficiently formed. Marked anxiety is noted. Recovery or transition to another form of delirium is possible.
- Professional delirium. The beginning is like a typical delirium tremens. Subsequently, hallucinations and delusions are reduced, repetitive movements associated with performing professional duties, dressing, undressing, etc. begin to prevail in the clinical picture.
- Mussitating delirium. Develops from occupational delirium, less often from other forms of the disease. It is accompanied by severe confusion of consciousness, pronounced somatovegetative disorders and characteristic motor disorders.
- Atypical delirium. It usually occurs in patients who have previously suffered one or more alcoholic psychoses. The clinical picture includes symptoms characteristic of schizophrenia.
There are also several forms of alcoholic delirium, in which clinical manifestations typical of delirium tremens are combined with other disorders (oneiroid, mental automatism, etc.).
Symptoms of alcoholic delirium
Classic alcoholic delirium begins gradually. In its course, the prodromal period and three stages are clearly distinguished. This form of the disease is characterized by a continuous course, however, in about 10% of cases, 2 or 3 attacks develop, separated by short (up to 1 day) light intervals. Delirium usually ends acutely, after prolonged deep sleep. Less often there is a gradual disappearance of symptoms. The duration of classical delirium ranges from 2 to 8 days, in 5% of cases there is a prolonged course.
In the prodromal period, sleep disorders are observed (severe nightmares, often in combination with nocturnal or early awakenings). Patients feel weak and weak. The mood is lowered. In 1-2 days after stopping alcohol intake, some patients have abortive epileptiform seizures. Sometimes short-term auditory hallucinations become harbingers of delirium. There is no prodromal period in a number of patients.
At the first stage of alcoholic delirium, characteristic mood disorders prevail. Emotional states change rapidly, anxiety and anxiety are replaced by euphoria and high spirits, to be replaced by depression and despondency in a short time. Speech, movements and facial expressions are alive. All of these symptoms give the impression of inner anxiety and some “tension”. Patients react acutely to any stimuli: flashes of light, sounds, smells, etc. Patients can talk about some vivid images and memories that pop up in their minds. Fragmentary auditory hallucinations and visual illusions are possible. Sleep is superficial, there are frequent awakenings, accompanied by pronounced anxiety.
In the second stage, hypnagogic hallucinations appear (hallucinations at the moment of falling asleep). Sleep remains superficial, patients are tormented by nightmares. After waking up, patients have difficulty distinguishing their dreams from reality. In the daytime, visual illusions are noted, sensitivity to external stimuli increases even more. During the transition to the third stage, insomnia occurs. Hallucinations become vivid, numerous, almost constant.
Usually patients “see” small animals, less often – fantastic monsters or real large animals. Tactile hallucinations are often observed – there is a feeling of a small foreign body (for example, a hair) in the mouth. Some patients have auditory hallucinations – condemning or threatening voices. The condition of patients is gradually deteriorating, they are increasingly “immersed” in an alternative reality. At the height of delirium, all kinds of hallucinations are present: visual, auditory, tactile, olfactory, etc.
It seems to patients that the position of their body changes, foreign objects rotate, fall or swing. In the imagination of patients there are scenes with aliens, fantastic creatures or real animals. The perception of time is changing, it is subjectively lengthened or shortened. The emotional state and behavior of patients depends on the content of hallucinations. Patients may try to escape, collect something from clothes or from surrounding objects, conduct a dialogue with a non-existent interlocutor, etc.
Delusional constructions are observed, but delirium never reaches the degree of order characteristic of alcoholic hallucinosis. Another difference from hallucinosis is increased suggestibility. Patients can be convinced that they see written text on a blank sheet of paper, hear a voice on a disconnected phone, etc. During an active dialogue with a real interlocutor, psychotic manifestations often become less pronounced. In the morning and afternoon hours, light intervals appear, in the evening and at night, the condition of patients worsens.
At the end of the third stage, patients come out of delirium, usually abruptly, less often with a gradual wave-like reduction of symptoms. Severe asthenia develops, mood swings from enthusiastic sentimentality to depression and tears are observed. Patients remember their hallucinations well, but they hardly remember real events during the illness. Women often develop subdepression or depression, men – mild hypomania.
Other forms of delirium
Other types of delirium are diagnosed less frequently than classic delirium tremens. Especially severe deliriums are considered professional and mussing. With them, more often than with other forms of the disease, fatal outcomes are observed. Professional delirium is characterized by a gradual aggravation of the clinical picture with increasing monotony of affective and motor disorders.
In the case of the massifying form of the disease, simple rudimentary movements (picking, grabbing, etc.), incoherent speech, vegetative and neurological disorders prevail. There may be deafness of heart tones, increased breathing and palpitations, sharp fluctuations in blood pressure, increased sweating, severe hyperthermia, severe tremor, gross coordination disorders and changes in muscle tone.
Prognostically unfavorable signs are severe hyperthermia, intestinal paresis, acute cardiovascular insufficiency, eye muscle paresis, deep disturbances of consciousness, muscle twitching, urinary disorders, urinary and fecal incontinence and increased breathing over 48 breaths per minute. Even with a favorable outcome, it should be remembered that in all patients who have suffered alcoholic delirium, the risk of developing repeated psychosis increases sharply when taking alcohol.
Treatment of alcoholic delirium
Urgent hospitalization to a narcological or psychiatric department is indicated. Detoxification therapy and measures to normalize vital functions are carried out. At the initial stages, plasmapheresis and the method of forced diuresis are used. During infusion therapy, patients are transfused with saline solutions (including a solution of potassium chloride to prevent hypokalemia), glucose, saline solutions, etc. Vitamins and nootropics are prescribed.
Psychotropic drugs are often ineffective, so they are not always used. Indications for the appointment of psychotropic drugs are insomnia, severe anxiety and psychomotor agitation. Psychotropic drugs are contraindicated in case of exaggerating and professional delirium. Treatment of all forms of alcoholic delirium is carried out by a narcologist with constant control over the functions of vital organs.
The prognosis for alcoholic delirium depends on the form of the disease and the timeliness of treatment. With a typical delirium tremens, recovery occurs in most cases. Some patients may experience residual phenomena in the form of psycho-organic syndrome and memory disorders of varying severity. At the same time (especially in the absence of treatment), the possibility of severe complications from the internal organs cannot be excluded. The probability of death increases dramatically with severe psychoses.