chronic alcoholism -psihicheskoe disease caused by prolonged alcohol intoxication of the organism and, as a consequence, toxic brain damage and internal organs.It develops gradually from domestic drinking, contributing to pathological addiction to alcohol, and the heavier form of intoxication.
Alcoholic intoxication is characterized by mental, neurological and somatic disorders of varying depth.
There are three stages of intoxication.
first stage of slight intoxication: elation, cheeky behavior, talkativeness;flushing of the face, eyes shine, tachycardia, tremor of fingers, impaired coordination of precise movements.The subjective feeling of relief thinking processes.The disappearance of a sense of self-doubt, but the objective - reducing the productivity of thought and criticism.
second stage (moderately severe intoxication): euphoria, talkativeness, disinhibition of instincts, rudeness, anger, loss of control over their actions.The emergence of dysarthria, gait unsteadi
third stage (severe intoxication): sudden difficulty of mental processes, drowsiness, incoordination, pupillary constriction.May develop stupor, followed by amnesia (frequently in chronic alcoholism).
Alcoholism is characterized by the appearance depending on the mental and physical health of the consumption of alcohol, t. E. The desire to alleviate the condition of re-admission of alcohol.As a result, he lost his self-control over consumption, increased tolerance (sensitivity) to alcohol in the early stages of alcoholism and decreases in the third stage.Cessation of alcohol receptions leads to the development of abstinence syndrome (withdrawal) with an irresistible desire to get drunk.In patients with decreased mood until the depressed state of anxiety, fear, sleep disturbances, auditory and visual hallucinations often at night.There is weakness, sweating, tachycardia, dizziness, tremor of extremities, gastrointestinal, and in severe cases, cardiac disorders and liver function disorders.There are severe intoxication (soporous and coma), followed by amnesia (loss of memory), hard drinking and the degradation of the individual.
There are three stages of chronic alcoholism.
first stage -, increase tolerance, loss of control over alcohol consumption, the emergence of severe intoxication with amnesia, abnormal craving for alcohol, but without a withdrawal.Asthenia with fatigue, irritability, mood swings downward, self-doubt, reduced working capacity.
second stage: further increase tolerance to alcohol, the full development of dependence syndrome and the emergence of withdrawal with uncontrollable uncontrollable craving for alcohol, or many days psevdozapoi continual drunkenness.Employability is very low, they get tired quickly.Patients vary in nature: there are inconstancy, falsity, rudeness, selfishness.Reduced intelligence and criticism, memory deteriorates.Characterized by lack of restraint, the tendency to hysterical reactions.
In the third stage there are true binges (which is associated with a reduced tolerance to alcohol);due to the intolerance of alcohol a week the patient stops drinking and then starts drinking again.Intoxication is often soporose character followed by amnesia.Abstinence pronounced, severe intoxication accompanied with somatic-vegetative disorders.Reveals alcoholic degradation of the individual.There may be epileptiform seizures, alcoholic psychoses, somatic disorders: alcoholic cardiomyopathy, hypertension, liver disease and kidney failure, chronic gastritis.Neurological examination revealed uneven tendon reflexes, vegetative dystonia, sometimes polyneuritis.
alcoholism Diagnosis is based on the syndrome of alcohol dependence with the loss of self-control over the nature of alcoholism, the presence of an abstinence syndrome, as well as on the basis of changes in the alcoholic personality.History, from the words of the patient, must be supplemented by information from the family and from the place of work and residence.The course of chronic alcoholism, in most cases, a progressive, so you need early detection and active treatment.
alcoholism treatment is carried out in a hospital or outpatient drug treatment in drug treatment study.The drug therapy is started with a relief of intoxication or withdrawal.Carry detoxication and restorative therapy (40% glucose w / w, unitiol 5% 5 ml / m 3 times a week, vitamins B1, B6, B12, ascorbic and nicotinic acid / m, aloe extract, duplex n / amethionine orally) in combination with cardiac drugs (kordiamin, caffeine, pain in the heart - nitroglycerin sublingual validol).For relief of anxiety, restlessness, sleep disturbances after detoxification is prescribed neuroleptics: chlorpromazine, Levomepromazine (Tisercinum) seduksen diazepam 5 mg 3-4 times a day, trioxazine 0.3 g 2-3 times a day.
After the elimination of withdrawal phenomena and improve the physical health carried out anti-alcohol therapy.To suppress the craving for alcohol use conditional reflex apomorphine therapy for generating a negative reflex to the taste and smell of vodka.The course of treatment - 10 sessions.The first session introduced n / a 0.1-0.2 mL of 1% solution of apomorphine.The patient was given 80 ml of vodka, and offer a sniff, rinse mouth and then drink.With a weak vomiting reaction after 2 days session is repeated, increasing the dose of apomorphine.The maximum dose to the end of the course - 0.4 ml of n / k.To enhance the reaction emetic used large doses of apomorphine emesis in conjunction with the mixture of (castor oil and fish oil - 60 grams, copper sulfate - 0.6 g of sodium sulphate - 30 grams, distilled water - 200 ml).Patients taking 200 g of the mixture and washing it down with a few sips of vodka;were then administered 0.4 mg of & gt;1% solution of apomorphine n / a.Patients vomit and there is a pronounced autonomic response;at this time they are given to smell vodka and rinse her mouth.Reaction time 40 min.The most frequent complication - collapse.To prevent it after starting the reaction administered kordiamin vomiting - 2 ml and caffeine - 1 ml of 10% solution of n / k.After 2-3 days, causing repetitive reaction only 5-6 sessions.Some patients have an aversion to alcohol is detected after the first session.
After the formation of a conditioned reaction to alcohol (disgust, nausea, gagging, facial flushing, tachycardia) patients prescribed daily teturam by 0.25-0.5 g per day for 2 months, and then - 5 days of taking the drug and3 day break.At the same time carry out restorative therapy.Patients can be treated on an outpatient basis, but they should be kept under medical supervision.
In the last 3 decades in the treatment of chronic alcoholism sensitizing agents are used, under the influence who develop intolerance to alcoholic beverages, are fixed conditioned reflex method.By sensitizing drugs include teturam (Antabuse), tsiamid, metronidazole (Trichopolum), furazolidone, and pirroksan furadonin.The most common of these is the domestic product teturam (Antabuse).Treatment begins with a relief of alcohol withdrawal or intoxication.Next course is conducted alcohol-teturamovyh sessions, then the patient is prescribed maintenance therapy Teturamom at 0.25 to 0.3 g per day (no more than 0.5 g);6 days after administration of the drug make a break for 2-3 days.A few months later, the recommended mode of reception teturama: 2 weeks - reception, 2-3 weeks - a break.Sensitizing drugs used in new dosage forms - for intramuscular injection for subcutaneous implantation.For intramuscular injection teturam released into solution under the name "abrifid" and hypodermic implantation - "radoter" ( "Esperal").
In some cases, there is intolerance furadonina (itching, dermatitis).
conditioned reflex sensitization and treatment of chronic alcoholism can be successfully combined with hypnosuggestive therapy.Each type of treatment must be supported by the requirement of the categorical rejection of the use of alcohol throughout their lives.Systematic psychotherapeutic conversation with the patient.Relatives and friends of the patient is recommended to create in the home and in the workplace an environment that would exclude the use of alcoholic beverages.
anti-alcohol therapy is most effective during the first stage of alcoholism, and is less effective in the third stage, which is characterized by the degradation of the individual with the formation of organic changes in the brain (alcoholic encephalopathy).In the struggle with alcoholism are important preventive measures - active detection of patients with alcoholism and those immoderate drinkers, their registration and medical check-up to prevent the development of alcohol dependence syndrome or for timely treatment.This has been specially created in the country Drug Service (substance abuse hospitals, drug treatment clinics, drug treatment rooms at clinics, NFM, industrial plants).
Employment Drug Service is held in contact with the public, the administration of the enterprises, which are well-known bad habits of its residents or colleagues.We use sanitarnoprosvetitelnye events, lectures on the topic at the anti-alcohol plants, on radio and television.
alcoholic delusions of jealousy. Patients suspected his wife of infidelity, watching her, demanding recognition of adultery;intoxicated become aggressive, can make socially dangerous activity.He is hospitalized in a psychiatric hospital.Treatment - neuroleptics: chlorpromazine - 200-300 mg / day, triftazin - 20-40 mg / day, 20 to haloperidol 45 mg / day / m.
Alcoholic hallucinosis develops against the backdrop of withdrawal;dominated by auditory hallucinations without stupefaction.The patient hears voices (two or more), which are either scolding or protect the patient.He listens to voices, belongs to them at first uncritically, perceiving them as real.Often, patients are agitated, fear and hallucinations under the influence of different make, sometimes dangerous, action.
patients with acute alcoholic hallucinosis urgently stationing in a psychiatric hospital, where he should be under round the clock surveillance.
treatment. Apply detoxification agent: unitiol, glucose, Levomepromazine (Tisercinum) at 50-75 mg / day / m with a simultaneous injection of 2 mL kordiamina.After arresting excitation indicated drugs prescribed antipsychotics antigallyutsinatornogo steps: haloperidol - 10 mg / m 3 times a day, triftazin - 10-15 mg / m 3 times a day, at the same time appoint B vitamins and infusion / 20 ml40% glucose solution.Antipsychotics are administered intramuscularly to the disappearance of hallucinations, and then administered orally, with a gradual reduction in dose.Next, conduct anti-alcohol therapy.
In some cases, for chronic hallucinosis takes, hallucinations can be kept for years.Patients appear more critical attitude towards them.The need for hospitalization.
treatment - antipsychotics: haloperidol inside - 30 mg / day, trifluperidol (trisedil) - 0.25 mg / day, with a gradual increase in the daily dose to 2.8 mg, triftazin - 60 mg / day, and vitamins.
Delirium tremens (delirium tremens) develops after prolonged drinking bout or against withdrawal in the presence of additional hazards (physical illness, brain injury, psychogenic, the postoperative period).It is characterized by sleep disorders, delirious confusion, affect of anxiety, fear and motor excitation.Observed somatic disorders - tachycardia, drop in blood pressure, sweating, indigestion, general tremors, fever.Delirium tremens begins with visual hallucinations at night.As the psychotic hallucinations are frightening and fantastic.Dizziness comes in the form of delirium with disorientation in the environment while maintaining the self consciousness, with visual hallucinations bright stage, sometimes frightening nature.It is accompanied by feelings of fear, sometimes fragmentary delusions.Patients initiated, value talkative, protected by their "visions".In severe delirium observed uncoordinated movement (patients "fleeced" pull together "threads" with itself).
Often there micropsia: patients see small animals, small worms and men.The disease is an acute, lasts several days and ends with a way out of a morbid condition with incomplete memories or lethal in the presence of severe cardiovascular disease.Patients are subject to immediate hospitalization in a psychiatric hospital and should be on bed rest for around the clock surveillance.
treatment. Relief of delirium tremens is carried out with a solution of 0.3-0.4 g of phenobarbital in 20 ml of ethanol and 150 ml of water;solution given once, administered simultaneously kordiamina 2 ml n / k.Further detoxification agent used: unitiol - 5 ml of a 5% solution w / o, glucose - 20 ml of a 40% w / w, large doses of vitamins B, and B 6, nicotinic acid, cardiacs.The next day, administered Levomepromazine (Tisercinum) - 50 mg / day / m (under the control of blood pressure) or haloperidol - 30 mg / day / m.
Korsakov psychosis characterized by memory disorders and polyneuritis.It occurs most often after delirium tremens.There profound fatigue with a sharp exhaustion, weakness.Remembering abruptly broken when saving in the memory of the past.Patients are not oriented in time and in the surrounding, can not be the day to inform about the events that have been in the morning.Criticism is not a disease.The current long-term psychosis.
Treatment - large doses of nicotinic acid, nootropil (piracetam) of 0.4 g 3 times a day, vitamin B ,null, B6, restorative therapy, physical therapy, physiotherapy.
Pathological intoxication - a mental condition that occurs when taking alcohol in a particular state, associated with a change in environment, long-term insomnia, fatigue, emotional tension, recent myocardial disease.It may develop when flying on an airplane or in a train moving.Characteristically dizziness twilight type: perception of changes suddenly appear persecutory delusions, hallucinations, fear.Patients excitation occurs with anger, rage, aggression.A characteristic feature - the lack of motor coordination disorder (patients did not stagger, have a confident gait).It begins pathological intoxication suddenly occurs briefly and just as suddenly ends with a very deep sleep, accompanied by amnesia (loss of memory).
Methanol refers to narcotic substances aliphatic series.However, in addition to intoxication, it causes severe poisoning due to the formation in the body of formic acid and formaldehyde.
methanol toxicity varies greatly - may be fatal reception from 1 tablespoon to 50-100 ml;50-100 ml dose leads to death in 20-50% of cases.Blindness can occur already from taking 7-8 ml of alcohol.
After the initial intoxication observed 12-24-hour period of prosperity.Symptoms usually appear 3-4 days after receiving alcohol.Intoxication is weak.The phenomena of intoxication gradually develop (differentiate from poisoning atropine, botulism).
Headache.Dyspnea - air hunger.The feeling of heaviness in the head, eyes, breasts.Unsteadily.Nausea.Vomiting, often from each drop of water.Thirst.Impaired vision.Nystagmus.There may come a total blindness - always in both eyes.Pupils dilated.
excitement and restlessness arising at the beginning.Later, they are replaced by sleepiness.
When comatose form appear epileptiform convulsions.
Pulse frequent.The fall of the heart.Cyanotic skin.Extremities cold.
Blood pressure initially increased, then decreases rapidly.Collapse, coma.
Increased blood clotting.Severe acidosis.Detection of methanol in the washing waters and other biological materials is made either by the formation of formaldehyde from it (the distillate is mixed with sulfuric acid and potassium permanganate), or to obtain the methyl ester of salicylic acid.
1. Complete rest, heat, darkening the room.
2. Gastric lavage with plenty of warm water, 0.05% potassium permanganate solution, 4% sodium bicarbonate solution.
3. Introduction of competitive antidote - ethanol, maintaining its concentration in the blood within 0.7-1%.Writing drink 100 ml of 30% ethanol and again after 2 hours for every 50 ml up to 6 times per day.
When coma intravenously administered 5% ethanol at the rate of 10-12 g of pure 96% alcohol per hour.The first one-hour dose should reach 40-50 g of ethanol rectified.The daily dose of ethanol on average 100 g
4. As an antidote - 5% and 1 teaspoon of ammonium carbonate solution every 2 hours b 1 / g of water glass for 8-9 days.
antidotes, reducing functional impairment caused by methanol, are korazol, pentetrazole (1-1.5 mL of a 10% solution subcutaneously or intramuscularly), cyanocobalamin (250 - 500 - g intramuscularly), thiamine hydrobromide (1-1,5 ml5x solution subcutaneously or in the form of cocktails with glucose), pyridoxine (2 ml intramuscularly 2.5% solution).
5. Saline laxatives per os (after washing the stomach through a tube to introduce 30 grams of magnesium sulfate and 20 g of oxide, dissolved in 150-200 ml of water, magnesium).
6. Heavy drinking alkaline solutions.Intravenous 250- 400 ml (1000 ml) of fresh 4% sodium hydrogencarbonate solution (under control of the pH of urine).
7. Forced diuresis (up to 2 liters of isotonic sodium chloride solution, 5% glucose solution intravenously polyglucin on background intravenous 80-120 mg Lasix).
8. Bleed from the ulnar vein in an amount of 300 ml, followed by intravenous injection of 20-40 ml of 40% glucose solution, 2 ml of a 5% solution of ascorbic acid and 10 ml of 0.5% novocaine solution.Novocaine is administered for 10-15 days, then replace it with vitamin B2.Hydrocortisone
9. intravenously 125 mg 2-3 times a day.
10. Subcutaneous sulfokamfokain 2.4 mL and 2 mL of a 10% solution of caffeine.Aminophylline (aminophylline) - 5.10 mL of 2.4% solution intravenously with bronchospasm.
12. When the pain - subcutaneously 1 ml of a 1% solution of morphine.
13. Intravenous 10 ml of 1% methylene blue solution.
14. Lumbar puncture cerebral edema - release the 10 ml of cerebrospinal fluid (in severe cases, to release 15-20 ml).
15. Emergency hospitalization in hemodialysis.Transported lying on a stretcher.The most effective emergency extracorporeal detoxification - hemodialysis and hemosorbtion.
Ethanol is a narcotic substance, belonging to the group of fatty compounds.
In large doses, it leads to a weakening of excitation in the cerebral cortex, suppresses the activity of the spinal cord and the medulla oblongata, depresses the respiratory center and vasomotor center.
blood ethanol concentration of 1.5 g / L accompanied by a noticeable intoxication, 3.5 g / L corresponds strongly expressed intoxication.The concentration of 5.5 g / l is lethal.The lethal dose - 300-500 ml of 96% ethanol.
unconscious or semi-conscious state.Loss of sensation.Staggering gait.