Humanity is familiar with alcoholic drinks for centuries.Previously, alcohol was not considered as a disease, and therefore did not develop anti-alcohol measures.In most cases, they were reduced to limit the movement of the patient, reading prayers and various rituals to expel evil spirits from the body.
Today, alcoholism is considered a disease that requires special treatment.The therapy includes not only medication drugs, but also psychological support.
Factors that contribute to the development of the disease, are divided into genetically predetermined, and the negative impact of the external environment and the environment.Unfortunately, in recent decades there has been a sharp jump in the incidence of alcoholism, often it becomes chronic and accompanied by various mental disorders.Development of alcoholic psychosis was recorded four times more often!But delirium tremens, as one of the most common types of mental disorders, can be fatal.
also worth remembering, and that brought delirium always le
definition of delirium tremens
For a proper understanding of the causes of the disease state is necessary to understand the definition of this term.
called delirium tremens is a mental disorder in which the developing state of delirium, hallucinations, fever and heavy sweats with chills.Hallucinatory paintings are aggressive, intimidating character, in which there is an imaginary threat to the patient or the people around him.visions are often mixed, so visual images can be combined with auditory and tactile hallucinations false.The patient is very excited and can not adequately respond to the others, while he does not consider himself sick, and their behavior strange.The main danger of this condition is that the patient can put yourself injury threatening to life.
It is said that delirium tremens rarely develops in the intoxicated state, on the contrary, it usually develops as a reaction to the cancellation, termination of alcohol abuse.Most typically, the development of the pathological condition in the second or third stage of chronic alcoholism, when the patient for some reason does not accept the usual dose of alcohol for several days.Very often the first signs of budding delirium develops on the fourth day in the evening or night.
order to develop delirium, a combination of several factors:
- endogenous and exogenous poisoning;
- failures in metabolic processes of the body, especially in the central nervous system;
- Immune disorders;
- Head injuries in the past;
- Pronounced changes in the homeostasis (constancy of internal environment, changing the acidity of body fluids).
Delirium tremens referred to metaalkogolnym psychoses, thus emphasizing that this complication develops at the peak of withdrawal (abstinence syndrome), and not primarily mental changes, and somatic (internal) of the disease, due to which already there is an infringement of mental activity.That is, initially suffering metabolism and internal organs, and then on the background of failure of organs and systems of developing psychosis.
systematic abuse of alcohol leads to toxic destruction of brain cells, which is why the neurotransmitter disrupted, in particular, catecholamines (dopamine).The more of this substance in the patient's blood, the harder it is developing delirium.
Clinical manifestations of delirium
acute alcoholic psychosis, and delirium in this case is no exception, and often proceeds polymorphic phase.This means that the clinical picture is not a single characteristic symptom manifestations usually follow each other and have some consistency.
So, delirium tremens can begin verbal pseudohallucinations, then move on to the oneiric state and end with psychic automatism.To clarify - pseudohallucinations differ from true hallucinations that if true visions patient looks at the real object and identifies it with the false and the false with the distortions of the real object is not available, it is only in the imagination of the patient.
With regard oneiric syndrome, it is also a complex distortion of perception, in which there is a disorientation in space and in the self, and the present Dreamscapes, which becomes a direct participant in the patient himself.At the same time the surrounding people and objects can be woven into pseudohallucinations.Psychic automatism - a common manifestation of delirium - made patient movement perceived them as unnatural, imposed from the outside.Often automatism combined with delusions of persecution or jealousy.
addition to mental changes in delirium present seizures, brain swelling and deep disturbances in the internal organs.
The early signs include:
- motor and mental restlessness, inability to sit still;
- Amid growing anxiety insomnia, there is fear, confusion, a sense of impending danger;
- increasing signs of cardiovascular disease - vasoconstriction and following this hypertension, paleness of skin, sweating;
- Raising the temperature to medium;
- later joined by hallucinations and the rest of mental disorders.
When classic symptoms of delirium tremens for picking within a few days, then held at a constant level and regresses slowly.A characteristic feature - unlike other types of alcoholic psychosis, delirium lasts an average of one and a half weeks.The result can be cured (usually after a long sleep) or transition to other forms of alcoholic psychosis.This is largely dependent on the timeliness and adequacy of treatment.
Among complicated delirious manifestations to the fore delusional experiences and self-blame, persecution mania, hallucinations complication.Also can increase symptoms of disorientation and incorrect self-perception, motor restlessness may be replaced inhibition of motor activity, stuporous state, the patient is no longer come into contact, may become unresponsive to all stimuli.This dramatically increases the temperature, urine output is greatly reduced, reduced to a critical level of pressure.Without early treatment can occur death.
Treatment of delirium tremens
No single treatment regimen of similar states, first of all it is connected with individual changes of organs and systems, especially prior binge and varieties of alcoholic beverages that the patient tried to abstinence.
delirium tremens Treatment is aimed at eliminating the tendency to exacerbate psychosis.The toxicology department or Addiction patient is first aid in alcoholic delirium, and then move on to a comprehensive treatment of internal diseases.Treatment usually takes at least three weeks.
- psychotropic drugs
- detoxication therapy (chelators - activated carbon, parenteral administration of glucose, potassium chloride;
- plasmapheresis - removal of a certain amount of plasma from the blood of the patient;
- tranquilizers - they reduce the fear is removed anxiety and worry - diazepam, Phenazepamum, lorazepam;
- hypnotics prescribed if the tranquilizers do not help remove the excited state used phenobarbital, ivadal, reladorm, paglyuferal;
- anticonvulsants - carbamazepine, Mydocalmum;.
- neuroleptics - neuleptil;
- when expressed disorders of the autonomic nervous system is prescribedbenzodiazepine, sometimes in combination with pirroksanom;
- vitamins B, C, niacin - in the initial stages of treatment in the infusion solution composition, later in a tablet form - Aerovit, komplivit, Glutamevit, Centrum;
- nootropics - Semax, Pantogamum, pikamilon, Phenibutum;
- to improve cerebral circulation - trental, instenon;
- gepatoprotektory - Heptral;
- specific therapy consists of parenteral administration metadoksila.
With deteriorating condition of the patient is transferred to the ICU - intensive care ward.
After discharge from the hospital the patient continues treatment at home.Also, he must be sure to go through rehabilitation of alcoholics, where he will help to finally overcome the psychological dependence and overcome the craving for alcohol.