Nijindou "Jin", man suffers from "mental disorder caused by alcohol"

In the past six months, Mr. Wu's family has been miserable, and Mr. Wu, who is nearly fifty years old, often quarrels with his former beloved wife for no reason, and even suspects that his wife is having an affair and scolds and stalks his wife. Sometimes even nervous, frightened expression, said that there are police cars outside to catch themselves, someone to monitor themselves, do not dare to open the curtains and so on. Recently, his family sent him to the Hunan Provincial Brain Hospital (Hunan Second People's Hospital) for treatment of physical diseases and psychiatry.

Dr. Liu Yadi of the Department of Physical Disease Psychiatry learned after receiving the consultation that Mr. Wu began to drink alcohol 20 years ago, boasting that the amount of alcohol was good, and in the early days, he generally drank liquor 3-4 two a day, and then gradually increased to 1-2 pounds of liquor per day, and drank on an empty stomach early in the morning, if he stopped drinking, his hands were shaky, upset, nausea and so on. Usually eat less and sleep poorly. And after recently trying to quit drinking and stopping drinking, there have been many general convulsions, loss of consciousness, and incontinence, and it has improved in a few minutes or so. After further improvement of the relevant examinations, the final diagnosis was "mental disorder caused by alcohol".

Due to the influence of China's wine culture, many people have the habit of drinking. Dr. Liu Yadi introduced that in the process of diagnosis and treatment, it is necessary to distinguish between alcohol dependence and social drinking. On the basis of the assessment of harmful drinking, the presence of concomitant organic injury and mental disorder is further judged.

Dr. Liu Yadi reminded that the occurrence of alcohol-induced mental disorders is closely related to genetic inheritance, individual personality, family environment, social culture and individual susceptibility. Specifically, there are five types:

1. Mental disorders in a drunken state

1. Simple drunkenness, also known as ordinary drunkenness, is an acute poisoning caused by heavy drinking, and the severity of clinical symptoms is related to the patient's blood alcohol content and alcohol metabolism rate.

In the early stage of drunkenness, the drunkard's self-control ability is reduced, the speech increases, the content is exaggerated; the emotional excitement, emotional instability, with the characteristics of irritability and venting; the action also increases when drunk, the behavior becomes frivolous, often provocative, and sometimes reckless. Clinically, some drunken people are also seen to be depressed, silent, venturing, or sleepy. At the same time, the vast majority of drunks experience slurred articulation, ataxia, and unstable gait, accompanied by increased heart rate, decreased blood pressure, flushing of the face and skin throughout the body, and sometimes nausea or vomiting. If drunkenness progresses further, there are impaired consciousness, such as decreased clarity of consciousness and/or narrowing of the range of consciousness, to drowsiness or even coma. Except for severe patients, it can generally recover naturally and has no sequelae.

2. Pathological drunkenness is a psychotic episode caused by small amounts of alcohol consumption. Patients develop acute disorders of environmental awareness and self-awareness after drinking alcohol, often accompanied by fragmentary horror hallucinations and delusions of victimization, and are clinically characterized by high excitement and extreme nervous panic.

Under the domination of hallucinatory delusions, patients often develop sudden aggression, mostly violent acts, such as destroying objects, self-harming, or attacking others. This drunken state typically lasts for minutes, hours, or even a full day, ending with the patient entering a state of deep sleep. After waking up, the patient cannot recall the course of the seizure.

Unlike simple drunkenness, patients with pathological drunkenness do not have increased speech, euphoria, and significant toxic neurologic symptoms. These patients are extremely intolerant to alcohol and drink alcohol in large quantities that do not cause intoxication in most people. In addition, excessive fatigue or prolonged severe insomnia may sometimes contribute to the development of pathological drunkenness.

3. Patients with complex drunkenness generally have a history of cerebral organic diseases, or suffer from physical diseases that affect alcohol metabolism, such as epilepsy, cerebrovascular disease, head trauma, encephalitis and liver disease. On this basis, the patient's sensitivity to alcohol increases, and after a small amount of alcohol, an acute poisoning reaction occurs, a significant disorder of consciousness occurs, often accompanied by delusions, hallucinations, fragmentary delusions, significant emotional excitement, irritability, aggression and sabotage behavior are common, and occasional aimless repetitive actions are seen. Such seizures usually last for several hours, and the patient forgets part or all of the passage after remission.

2. Mental disorders caused by chronic alcoholism

1. Dependence syndrome is a special psychological state caused by repeated drinking, the patient has a desire for alcohol and a compulsive sense of constant need to drink, can occur continuously or intermittently, if you stop drinking, there are psychological and physical withdrawal symptoms.

2. Patients with delirium tremor can quickly produce a temporary impairment of consciousness after a long period of alcohol consumption, suddenly reducing the amount of alcohol consumption or stopping drinking. Delirium tremor can also be induced by physical illness and psychiatric stimuli, but is less common; some patients have prodromal symptoms such as depression, anxiety, and insomnia several days before the onset. At the time of the attack, the patient is unconscious, has disorientation such as time and place, and has vivid and distinct hallucinations and delusions of victimization; thus manifests as extreme fear and restlessness or impulsive behavior. At the same time, patients can see limb tremor and ataxia, often accompanied by fever, sweating, increased heart rate, increased blood pressure, and mydriasis. In severe cases, it can be life-threatening. Delirium tremors vary in duration and are generally 3 to 5 days. After recovery, the patient has partially or completely forgotten the disease.

3. Alcohol toxic hallucinations are a state of hallucinations caused by long-term alcohol consumption. Patients have a large number of rich and vivid hallucinations within 1 to 2 days after suddenly reducing or stopping drinking, and hallucinations and hallucinations are the main ones. Primitive hallucinations as well as critical and command auditory hallucinations are common.

On the basis of hallucinations, fragmentary delusions and corresponding nervous fears or depressions may also occur. During the onset of the disease, the patient's state of consciousness is clear, and there are no obvious symptoms of psychomotor excitement and autonomic hyperfunction. Alcohol-toxic hallucinations vary in duration, ranging from a few hours to 6 months.

4. Patients with alcohol toxicity delusions have jealous delusions and victim delusions in the case of clear consciousness, which are more common in clinical practice. Patients suspect that their spouse is unfaithful, which often reacts violently, which can also lead to attacks on the suspected partner or spouse, sometimes resulting in homicide. In the past, it was also called alcohol toxicity jealousy. The occurrence of jealous delusions is usually associated with a decrease in sexual function caused by long-term alcohol consumption in patients. Alcohol toxicity delusions begin slowly and the course of the disease is prolonged, such as long-term adherence to alcohol abstinence can gradually return to normal.

5. Alcohol-toxic encephalopathy, also known as Wernicke encephalopathy, is the most serious psychotic state in chronic alcoholism, which is the result of long-term mass drinking caused by brain organic damage. Onset is acute or subacute, and some patients may develop a triad of signs immediately following delirium tremor: drowsiness, ophthalmoplegia, and ataxia. Sometimes pupillary reflex disorders and spastic episodes may occur. Clinically, psychiatric symptoms are characterized by delirium, memory deficit, dementia, and personality changes, and the prognosis is poor, most patients cannot return to normal, and survivors generally remain With Kosakov psychosis.

Third, alcohol toxicity dementia

Due to prolonged alcohol consumption and multiple episodes of delirium tremor, it can gradually progress to a state of dementia, presenting a variety of advanced cortical dysfunctions, such as impairments in memory, thinking, comprehension, computing, orientation, and language function. Severe cases often affect daily life and cannot take care of themselves. Personality changes are also significant, with patients becoming selfish, incapacitated, and behaving violently and cruelly.

4. Mood disorders caused by alcohol

Alcohol-induced mood disorders mostly occur after severe alcohol dependence, and significant mood loss is closely related to alcohol consumption. It is estimated that 1/3 of people with mood disorders in alcohol-dependent patients are depressed before heavy drinking, while 2/3 are after drinking alcohol. Repeated heavy drinking can often cause severe depressive symptoms, with 80% of alcohol-dependent patients reported having had a strong experience of depression, and about 35% meeting the diagnostic criteria for depression.

5. Personality changes caused by alcohol

Long-term alcohol dependence can lead to personality decline, the need to drink more than all other activities, increasing self-centeredness, selfishness, declining standards of behavior, dishonesty or even theft and fraud in order to get alcohol, and loss of responsibility to the family and society. The negative impact of the above manifestations on individuals, families and society is large and extensive, and it needs to be highly concerned by the state, society, families and doctors.

Contributed by: Department of Physical Disease psychiatry (male ward) of the Second People's Hospital of Hunan Province, Liu Yadi

Editor: Cheng Jie

Image: From the Internet, intrusion and deletion