Delirium tremens: when addiction gets out of control

Delirium tremens, or, in scientific medical terms, delirium tremens, occurs in a person suffering from chronic alcoholism most often, oddly enough, precisely in the period after the cessation of binge drinking. The risk of alcoholic delirium may persist for up to 15 days after alcohol withdrawal.

The specialists at the Preobrazhenie Clinic have extensive positive experience in treating delirium tremens and preventing it. In addition, we provide rehabilitation therapy for patients who have suffered this serious condition.

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Content:

1. Useful information about the disease
2. Why does it occur
3. Classification of the disease 3.1. Classic 3.2. Hypnagogic 3.3. Abortive 3.4. Delirium without delirium 3.5. Mixed 3.6. Mussitating 3.7. Professional
4. How to understand that a relative has alcohol psychosis
5. What will happen if left untreated?
6. Treatment in hospital

By alcoholic delirium, narcologists mean metal-alcohol psychosis, which develops a few days after an abrupt cessation of drinking. This condition is popularly known as “delirium tremens.”
Addicts who are in the second and third stages of alcoholism periodically encounter it. The disease manifests itself with visual, tactile and auditory hallucinations and causes impaired consciousness. The patient becomes very nervous and restless. He cannot sleep and constantly complains of nightmares. Capable of showing cruelty towards others.

Treatment of alcoholic delirium is carried out in a hospital. It is unacceptable to try to stabilize a drinker’s condition at home. This could lead to even more negative consequences.

Memoirs of survivors of delirium delirium

The most interesting thing about this diagnosis is that any patient clearly remembers everything that happened to him during the attack. Terrible visions that appear to a person during psychosis often continue to haunt him for the rest of his life. Devils, ghosts, terrifying illusions are etched into the memory for a long time. And it’s good if alcoholic delirium ended at the stage of hallucinations, and the patient did not have time to injure himself or his loved ones. In most cases, acute alcoholic psychosis is the fundamental reason why an alcoholic is cured of his illness. Many patients believe that what is happening to them is some definite sign from above, informing them that they have reached the final stage in their bad habit. Patients especially vividly remember deceased relatives who appeared to them, scolded, shamed them and called on them to return to normal life.

Social consequences of alcoholic psychosis.

It's no secret that an incorrect, antisocial lifestyle leaves its mark on areas of human development. Long-term alcohol consumption not only undermines health, but also affects an individual’s social position. Disturbances in the functioning of the nervous system, manifested in the form of depression or sudden mood swings, in any case remain even in a completely cured person and negatively affect the quality of his life: ability to work, communication with others and the ability to achieve his goals. On the other hand, it is often the very point of crisis that sometimes serves as a springboard that gives the starting impetus to positive changes. It is not for nothing that psychologists say that a crisis is given to a person as a chance to change something for the better. But from a medical and general social point of view, it is better not to reach crises expressed by deviant symptoms. In order to minimize negative consequences at the rehabilitation stage, the patient is recommended to undergo a course of group or individual psychotherapy.

Useful information about the disease

Delirium tremens is the most common type of alcoholic psychosis. As a rule, it occurs for the first time after seven to ten years of chronic drunkenness. But sometimes pathology develops in people who do not suffer from alcoholism.

It is important to know that signs of delirium appear several days after drinking the last dose of alcohol. They never occur in addicts who are intoxicated. Therefore, if a drunk person destroys everything in his path, the matter is definitely not “delirium tremens”.

As a rule, the pathology is accompanied by a high level of aggression. However, it also happens that the patient, on the contrary, becomes unusually polite, sociable, and smiling. He tries to do something good for those around him - bury a non-existent hole in the middle of the road, destroy aliens, etc.

In any case, it is not safe to be around such a person. Even if it seems that he is absolutely harmless, it is impossible to predict his further behavior. It can only take a few minutes to go from smiling to uncontrollable rage. That is why narcologists insist on inpatient treatment for patients with the described diagnosis.

Consequences and prognosis

“Delicate tremens” is a fatally dangerous alcoholic psychosis, in which the alcoholic becomes dangerous not only to himself, but also to others. If the patient’s symptoms of the disorder do not go away and treatment is not provided on time, then hallucinations can become exaggerated and drive the patient to madness or suicide. Drug treatment is a mandatory and necessary measure to neutralize this condition; in its absence, sudden death can occur not only due to mechanical reasons, but also on its own, for example, from cardiac arrest or other concomitant diseases. However, it is quite difficult to say how long a patient will live after an attack of delirium tremens.

The consequences of alcoholic psychosis depend on many combined factors that should be considered together, for example, taking into account: how quickly professional help was provided, and how qualified and relevant it was to the specific case, the presence of other diagnoses in the patient and, of course, his lifestyle after therapy. According to statistics, delirium delirium does not have a very good prognosis. The mortality rate is about 10%, and can occur from a variety of causes. Often this disorder leads to alcoholic dementia and other forms of dementia that cannot be completely cured. On the other hand, the prognosis largely depends on the patient himself.

With proper treatment of mild to moderate disease and the patient’s compliance with recommendations, his life is not in danger.

Why does it occur

Chronic alcoholism leads to delirium tremens. A high risk of encountering it is recorded when:

• multi-day drinking bouts;
• use of low-quality alcohol and its substitutes;
• severe diseases of internal organs;
• history of traumatic brain injury;
• pathologies of brain activity.

Doctors are convinced that the disease occurs due to metabolic disorders and chronic intoxication. The situation can be aggravated by severe stress and depression.

Is it possible to cure a sick person at home?

The only thing loved ones can do to help a person with delirium tremens is to call a doctor as quickly as possible. Suggestion and folk methods will not help in this case. You cannot disturb the patient or slap him in the face so that he comes to his senses. You shouldn't shout and prove to him that he has schizophrenia. At best, the patient will not perceive the information.

It is advisable not to let the patient go outside and constantly monitor his behavior until the doctors arrive. In this state, he can harm himself, get lost or freeze. Self-medication can be dangerous if you give drugs to a patient without consulting a doctor. An overdose of sleeping pills or sedatives will only worsen the situation. If you do give a patient a sedative, read the instructions carefully first and do not exceed the recommended dosage.

Despite the fact that delirium occurs against the background of withdrawal syndrome, the patient should not be given alcohol. This will not help return him to a normal state, but will only complicate the detoxification procedure for doctors, since the IV is placed on the condition that there is no alcohol in the stomach.

Giving water to a person with delirium is also useless. You can give him something to drink to reduce the effects of dehydration, but in small portions. Large amounts of water will cause vomiting.

Herbal decoctions will calm you down a little, but will not solve the problem completely. You can give an infusion of yarrow, wormwood, but not alcohol tinctures. First you need to make sure that the patient does not have an allergic reaction to these herbs.

Classification of the disease

The disease can progress in different ways. Most alcohol addicts face its classic scenario. In rare cases, hypnagogic, abortive, mixed, excruciating and professional “delirium tremens” develops. There is even such a thing as “delirium without delirium.” Let us dwell on all these types of pathology in more detail.

Classical

Occurs after seven or more years of alcoholism. It is a consequence of withdrawal syndrome. The drinker’s condition worsens on the second to fourth days of sobriety. Symptoms worsen in the evening and at night.

Classic delirium proceeds through three stages:

• prodrome;
• stage of obvious clinical manifestations;
• exit.

To make a diagnosis, the doctor examines the patient and talks with him. It is important that the addict is under medical supervision both day and night.

Hypnagogic

A sluggish type of the disease. Characterized by:

• vivid dreams reminiscent of scenes from films;
• visual hallucinations that appear at the moment of falling asleep or waking up;
• causeless fear;
• frequently repeated surprise;
• negative somatovegetative symptoms;
• periodic disorientation in one’s own personality.

A person is not able to adequately assess what is happening around him and think critically.

Abortive

The patient's condition is unstable. Hallucinations occur rarely and do not last long. The drinker hears a non-existent knock, clicks, ringing, whispering. It is difficult for him to navigate the time of day. Neurological and autonomic symptoms are moderate.

Consciousness during abortion delirium is slightly darkened. An alcohol addict is capable of critically evaluating other people. If he is provided with qualified medical assistance, he will quickly get out of the “delirium tremens”,

Delirium without delirium

This is an unusual name given by narcologists to a sluggish “fever” that occurs in response to refusal to further use alcohol. The onset of pathology is always acute. The prodrome period is completely absent. No hallucinations or delusions. In this case, the patient is faced with:

• uncontrollable trembling of fingers and face;
• difficulties when trying to maintain a specific body position for a long time;
• problems related to orientation in space and time;
• increased level of anxiety;
• unreasonable fear;
• profuse sweating.

The person behaves fussily and worries. He is overexcited, as evidenced by his motor skills. Signs of such delirium may go away on their own, but one can never rule out the transition of this form of the disease to a more severe one.

Mixed

The symptoms of alcohol psychosis do not always fit into its specific type. Narcologists also have to work with mixed forms of the disease. These include:

• Systematized psychosis. Its peculiarity is the appearance of massive visual hallucinations. The patient is delirious, it seems to him that someone wants to kill him. Behavior matches vision.
• Delirium with predominance of verbal hallucinosis. This is where auditory hallucinations come to the fore. Alcohol addicts hear non-existent voices. It may seem to him that otherworldly forces ordered someone to be killed. Then the life and health of people nearby will be at risk.

Mussitating

Severe delirium. Capable of causing death. Differs in mild severity of psychotic disorder. Negative somatic and neurological symptoms dominate. Motor overexcitation is clearly expressed. Speech and movements become severely limited.

Negative symptoms persist constantly. The patient behaves inappropriately and does not understand what is happening in the area. Gradually he loses the ability to serve himself. If it is possible to cure a person with persistent psychosis, then the events associated with “delirium tremens” will be erased from his memory - he will not be able to remember absolutely nothing about them.

Professional

At first it proceeds like the classic version, but after that the symptoms become more vivid and severe. Hallucinations are mild, as are delusions. The patient constantly makes senseless movements of the same type. For example, he can draw something, put on and take off clothes.

The emotional sphere becomes critically poor. Memory deteriorates. Under no circumstances should such a person be left alone with himself, since he is not aware of his actions.

The presence of a threat to life in occupational delirium is indicated by severe muscle weakness, uncontrolled bowel movements, surges in blood pressure, abnormal heart rhythm, high body temperature, and shortness of breath. It is necessary to deliver the alcoholic to a specialized hospital as soon as possible. Otherwise, he may soon die.

Symptoms of the syndrome

To establish a diagnosis, the patient is admitted to a hospital for the purpose of a formal assessment of mental status. When making a diagnosis, three repetition tests are used. Testing and behavioral monitoring can help identify symptoms of delirium. These include:

• Manifestations of clouding of consciousness. Expressed in a violation of perception and cognition of the surrounding world. They suggest detachment from what is happening, incoherent judgment, meaningless speech, slow reactions, disorientation, complete or partial loss of memory.
• Hallucinations. The intensity of visual images that occur without external stimuli depends on the causes of delirium. The most vivid delusional pictures that distort real life are characteristic of withdrawal syndrome, delirium tremens, and hysteria. May manifest in different forms, depending on the patient; some see those same little green men, others see insects or strangers. Illusions on religious themes are not uncommon.
• Unusual motor activity. Manifested by excitement and reproduction of various actions. Sometimes the patient may think that he is at his workplace and perform characteristic movements.
• Inarticulate muttering (delirium delirium). Occurs in patients with infectious diseases, brain damage, and recovery after surgery. Accompanied by hand movements, speech contact is impossible. Sometimes it manifests itself in an abortive form - lasts less than a day and is not accompanied by disorientation.
• Tremor and tic. The anxiety state is aggravated, random movements gradually become constant and obsessive.
• Change in facial expressions. The mental state can be determined by increased emotionality, pantomime and a characteristic grotesque facial expression.
• Strange behavior. In patients, delirium can cause panic, uncontrollable anger, prolonged laughter, tears, sexual arousal, and screaming.
• Sleep disturbance. There are difficulties falling asleep, nightmares, and some fear of sleep.

The clinical picture depends on the etiology of the syndrome. Diagnosis of the condition can only be carried out by specialists. Often the manifestations are similar to those of other diseases, for example, dementia occurs in a similar way.

How to understand that a relative has alcohol psychosis

Making a diagnosis does not cause problems for qualified narcologists, but people far from the field of medicine do not always understand what is happening to their relative. Pathology can be recognized by the following signs:

• Convulsive seizures. During them, the drinker falls to the floor. His body contracts, his face contorts in pain.
• Frequent awakenings at night. If you ask an addict why he sleeps poorly, he will talk about frightening nightmares that repeat day after day.
• Increased psychomotor excitability. A person moves a lot and finds it difficult to sit still. He also makes the same type of movements.
• High level of anxiety, fear. The addict worries about little things. Even in ordinary everyday situations, he sees himself as a threat.
• Paleness of the skin. The sight of an addict becomes painful.
• Blood pressure surges. If you measure your pulse, it will most likely be elevated.
• Muscle weakness. Doing light physical work becomes impossible at some point. An alcohol addict tries to lie down as much as possible, because he cannot find the strength to move.

• Decreased concentration. It is impossible to concentrate on something important. Speech becomes incoherent and unclear. Facial expressions change.
• Hallucinations. They can be both visual, tactile and auditory. It can get to the point that an alcoholic will constantly communicate with otherworldly forces. There is no point in convincing such a person of the need to start treatment - he does not realize the danger of the disease he is faced with. We need to call him an ambulance as soon as possible.
• Increased sweating. Manifestations of hyperhidrosis are present even in a state of complete rest.
• Inability to navigate in space. The patient cannot even reach the store located near the house. He may forget where his bed is and other primitive things.

There are psychiatric tests that can help clarify the situation if there is a suspicion of alcoholic delirium:

• If you give a patient a white sheet of paper with absolutely nothing on it and ask him to read what is written there, he will begin to read.
• If you invite a person to use a disconnected telephone, he will pretend that he called someone and will talk for a long time with a non-existent subscriber.

Of course, the relatives of an alcohol addict should not diagnose him - this is the responsibility of a psychiatrist and narcologist. Moreover, they cannot treat it on their own. Therefore, if the drinker’s behavior has become strange or inappropriate, it is imperative to take him to a medical center.

Three stages of delirium tremens

Classic delirium tremens includes three stages.

At the first stage , also called “Korsakov psychosis,” you can notice a sinusoidal hysterical mood of the patient; attacks of anxiety, fear and anger can be replaced by euphoria. Another symptom of the initial stage is excessive talkativeness of the patient, who may chatter incessantly, talking about his experiences, or remembering the past.

Hallucinosis usually occurs in the second stage of the disease. Especially at night. Since the patient’s sleep is very superficial, the visions are mixed with dreams seen by a person in a state of drowsiness, after which he can confuse the events of the dream with reality. Hallucinations are usually terrifying in nature.

At the third stage, visions and illusions become extremely clear. A person no longer just hears and sees strange creatures, but can also feel them physically, as mentioned earlier.

What will happen if left untreated?

Delirium caused by chronic alcoholism can lead to:

• acute cardiovascular failure;
• intestinal paresis;
• hyperthermia;
• cramps, muscle paresis;
• enuresis;
• uncontrolled bowel movements;
• disability;
• lethal outcome.

Even if the patient receives medical help in a timely manner and manages to avoid complications, this does not mean that he can continue to drink. Having experienced alcohol psychosis once, a person runs the risk of encountering it again soon. And for this it is not at all necessary to go into a state of multi-day binge - a single dose of alcohol may be enough.

Methods for correcting behavioral deviations due to the syndrome

• Timely changes in diet (refusal of foods that cause drowsiness or alertness), discontinuation of psychostimulant drugs. Creating a favorable and calm atmosphere. Refusal of medications that can be avoided at this stage. In case of persistent sleep disturbance, take sedative medications.
• Illusions, delusions, auditory and visual hallucinations. Symptoms require the use of antipsychotics (aloperidol, chlorpromazine, clozapine)
• Increased emotionality in delirium. Psychotherapy usually helps. If the patient has become depressed, then it is permissible to use mood stabilizers or antidepressants.
• Excessive excitement. Recovery is facilitated by the presence of loved ones. Fixation of the limbs leads to aggravation of the condition. Possible use of sedatives or antipsychotics
• Confusion. In most cases, setting reference signals helps. For example, a clock, a calendar, familiar objects. The patient is forced to count, characterize shapes, name the days of the week
• Anxiety. Benzodiazepines are used. If the course of the disease is complicated by psychotic disorders, then antipsychotics are recommended.

The acute stage of delirium lasts about 2 weeks. Improvement is evidenced by sound, healthy sleep. The patient often treats the incident as a nightmare or does not remember anything.

Treatment in hospital

In case of mental disorder, urgent hospitalization is indicated. To remove the effects of an ethanol attack, the patient is given a cleansing drip. It helps normalize water and electrolyte balance, eliminates manifestations of hypovitaminosis, dehydration, and intoxication.

Doctors use neurometabolic stimulants to support the brain. These are drugs that enhance metabolism in brain tissue. They have a positive effect on focus, memory, and thinking processes.

Means for correcting mental disorders are selected on an individual basis. These can be sedatives, hypnotics, psychotropics, antidepressants.

It is important that the alcohol addict strictly follows all the prescriptions of the narcologist and psychiatrist. Only then can one count on obtaining positive dynamics.

Stationary

The first aid for delirium is 24-hour hospitalization. In Moscow and other Russian cities, doctors are successfully fighting the condition and its consequences. Recovery is mainly achieved through a combination of medication and psychotherapy. The following stages are expected:

• Detecting causes and prescribing appropriate therapy;
• Minimizing the amount of medications taken;
• Detoxification is carried out if necessary;
• Creating a favorable and calm environment;
• Relieving disorientation in space, time and society;
• Drawing up a recovery plan for the body.

Before starting therapy, it is necessary to diagnose the brain using X-rays. The method of magnetic resonance or computed tomography allows identifying a condition of traumatic, organic etiology, as well as vascular, the treatment of which is important to begin immediately. Additionally, it is necessary to conduct a general blood and urine test. Laboratory tests make it possible to assess the patient’s condition, detect intoxication, inflammation, and symptoms of renal failure. The department of the hospital that treats delirium becomes specialized for the main diagnosis: narcology, gastroenterology, urology, nephrology.

Securing the patient should be strictly avoided. This leads to aggravation of the stage, the patient suffers and becomes nervous. Limb binding is used only in cases of life-threatening situations (suicide attempt) or during periods of aggression.

Literature:

1. Abramova T. A. Dynamics of intellectual-mnestic, emotional disorders and asthenic disorders in patients who have suffered from alcoholic delirium. Thesis. candidate of medical sciences, 14.00.18. Place of defense: Federal State Institution "Moscow Research Institute of Psychiatry". - Moscow, 2006. - 270 p.
2. Danielyan K. G. Alcoholic delirium and delirious-oneiric psychoses of complex structure. - Yerevan: Hayastan, 1977. - 132 p.
3. Kekelidze Z. I., Zemskov A. P., Filimonov B. A. Severe alcoholic delirium. Research Article. Regular issues of "RMZh" No. 2 dated January 16, 1998. — 4 s.