acute alcoholism
Introduction
Introduction to acute alcoholism Acute alcoholic poisoning (acutealcoholicintoxication), commonly known as drunkenness, is a state of excitement or inhibition of the central nervous system caused by a large amount of alcohol or alcoholic beverages. It exhibits varying degrees of excitement and excitement, loss of binding force, abnormal behavior, multilingualism and unclear pronunciation. Exercise and gait disorders, agitation, drowsiness, and stupidity and coma in severe patients, the severity is often positively correlated with blood alcohol concentration, but there are individual differences, generally can return to normal in a short time, leaving no sequelae. According to the nature and severity of psychopathology, it is divided into simple, complex and pathological drunkenness. basic knowledge The proportion of sickness: 0.45% Susceptible people: no specific population Mode of infection: non-infectious Complications: alcoholic cerebellar degeneration
Cause
Acute alcoholism
(1) Causes of the disease
It is caused by a large amount of alcohol or alcoholic beverage, causing acute central nervous system excitability or inhibition.
(two) pathogenesis
Alcohol is mainly absorbed in the small intestine and can be distributed in any organs and tissues of the whole body. Most of it is cleared by the liver metabolism. A small part is excluded by the lungs and kidneys. The mechanism of alcohol-induced damage to the nervous system has not been fully elucidated and may be related to the following factors:
Has fat solubility (35%):
It is fat-soluble and rapidly passes through the blood-cerebrospinal fluid barrier and nerve cell membranes, and acts on certain enzymes and receptors on the membrane to rapidly affect the function of nerve cells.
Alcohol metabolism (27%):
Free radicals and other metabolites produced during alcohol metabolism can also cause acute damage to the nervous system.
Affects vitamin B1 metabolism (20%):
Influencing and inhibiting the absorption of vitamin B1 and storage in the liver, the level of vitamin B1 in patients is significantly lower than that in normal people. In general, the main energy of nerve tissue is derived from sugar metabolism. In the absence of vitamin B1, due to sulfur deficiency The reduction of amines can cause disorders of glucose metabolism, causing a decrease in the energy supply of nerve tissue, which in turn leads to abnormalities in nerve tissue function and structure. In addition, the deficiency of vitamin B1 can also cause metabolic pathways of pentose phosphate metabolism, affecting phospholipids. The synthesis causes demyelination and axonal degeneration-like changes in the surrounding and central nervous tissues.
The symptoms of alcoholism are the result of the inhibitory effects of alcohol on the brain and spinal cord. In this respect, alcohol acts on nerve cells in a similar way to systemic anesthesia. Alcohol is an inhibitor of CNS rather than a stimulant, some alcohol Early symptoms of poisoning suggest brain excitement, such as chatter, aggressiveness, excessive activity, and increased electrical excitation of the cerebral cortex, which is due to the underlying cortical structure that regulates cerebral cortex activity (possibly the reticular formation of the upper brain stem) The suppressed results, as well as the early early sputum reflexes, may reflect the transient loss of control of the motor neurons in the spinal cord by the advanced inhibitory center. However, as the amount of alcohol increases, the inhibitory effect extends to the brain, brainstem and spinal cord neurons.
Prevention
Acute alcoholism prevention
A small amount of reasonable drinking may have certain benefits for the human body. Avoiding long-term heavy drinking is the main measure to prevent alcoholic neurological diseases.
Complication
Acute alcoholism complications Complications, alcoholic cerebellar degeneration
Alcoholism (like other malnourished patients) can cause cerebellar degeneration. Its pathology and clinical features may be the same as Wernicke encephalopathy. Posture and gait ataxia can start slowly in a few weeks or months, or it can suddenly start. CT showed atrophy of the upper temporal and cerebellar lobes. The use of thiamine and other vitamins B can improve symptoms.
Symptom
Symptoms of acute alcoholism Common symptoms Hand and lip tremors, anger, nausea, complexity, drunkenness, delusion, gait, instability, dysfunction, diplopia, drunken wine cellar
1. Simple drunkenness Simple drunkenness, also known as ordinary drunkenness, is an acute poisoning state of excessive drinking. Most of the drunkenness status is this condition. It is a normal reaction and has common clinical features. It is alcohol. It is caused by the central nervous system. Symptoms are closely related to blood alcohol content and metabolic rate. Generally speaking, according to its performance, it can be divided into two phases, namely, the excitatory phase and the inhibitory phase. After acute poisoning, it can still have a long time. Discomfort is called a continuation effect.
(1) Excitement period: the patient is excited, his face is red, his feelings are comfortable, he is sociable, his speech is endless, his emotions are unstable, or he is happy or angry, or sad or worried, sometimes generating hostility or attacking emotions, or appearing Abnormal behavior, such as the original personality change, impaired judgment, so that the confidence ability is enhanced, the blood alcohol concentration in this period is generally 500 ~ 1000mg / L, if the patient appears awkward, can not maintain the body balance, gait, speech vague Incoherent, can be accompanied by nystagmus, diplopia, blurred vision and nausea, vomiting, etc., blood alcohol concentration is generally 1500 ~ 2000mg / L, if driving is extremely dangerous.
(2) Inhibition period: When the drinking amount increases, the blood alcohol concentration reaches 25004000mg/L, and the patient immediately enters the inhibition period. The clinical features are dizziness, pale, cold skin, slightly purple lips; dilated pupils or normal Slow breathing and snoring, rapid pulse, can be stupor and coma, if the medullary center is inhibited, it can cause respiratory paralysis and die.
The symptoms of alcoholism are the result of the inhibitory effects of alcohol on the brain and spinal cord. In this respect, the effect of alcohol on nerve cells is similar to that of systemic anesthesia, but unlike the latter, the amount of alcohol produced by anesthesia and The dangerous dose range of respiratory depression is relatively narrow, and it is prone to respiratory depression, which increases the acute component of alcoholism. It should be noted that barbiturates and other sedative hypnotics can enhance the inhibition of alcohol.
(3) Continuation effect: Ethanol has strong toxicity to brain and stomach, while aldehyde compound has stronger toxic effect. After a drunk, there is a long time headache, dizziness, insomnia, tremor, stomach discomfort and nausea, sometimes performance There are mental retardation and mild ataxia, which are usually short-lived and can persist in severe cases.
2. Complex drunkenness usually occurs on the basis of brain organic damage or severe brain dysfunction. Due to the acute alcoholism reaction caused by the decline of alcohol tolerance, the amount of alcohol consumption is generally small, but the disturbance of consciousness is obvious. Short-lived, often forgetting the onset, complexity drunk is the intermediate state between simple drunkenness and pathological drunkenness. Compared with simple drunkenness, it is quantity abnormality. The whole process of complex drunkenness is more intense than simple drunkenness. Patients have a history of drinking or a history of simple drunkenness. They generally have a history of brain organic diseases, or physical diseases that affect alcohol metabolism such as epilepsy, cerebrovascular disease, craniocerebral trauma, encephalitis and liver disease.
(1) The amount of drunkenness in the complex is higher than the amount of drunkenness in the past, and the amount of alcohol is gradually increasing. The disturbance of consciousness is rapidly deepening, and there is a strong mental and emotional excitement. The duration is longer, the paralysis period is prolonged, and the normal etiquette is disordered. Simple drunkenness can "maintain self". The difference between it and simple drunkenness is that the symptoms are strong, the time is long, the etiquette is lost, and the usual personality or behavior is judged by two people. The environment is kept roughly oriented and the general memory is maintained.
(2) Complexity Drunken excitement is different from simple drunken euphoric psychomotor excitement. It is a serious sports excitement, irritability and impulsiveness on the background of unpleasant emotions. It is more irritating and revengeful. The patient is deeper. The state of confusion and strong sports excitement can be irritating and hurting, attacking and sabotaging behaviors are common, occasionally no purpose repetitive or stereotyped movements, severe numbness, slurred gait, gait, environmental stimulation Excitement, there is a clear difference between the sudden disappearance of excitement and simple disappearance after entering the paralysis period. It can also be seen in extreme depression. Frequent crying or intense desperate anger episodes, self-blame and suicidal behavior, but with simple drunkenness The suicide is different before the drunk, and the seizure often lasts for several hours. After waking up, the patient is partially or completely forgotten.
3. Pathological drunkenness Pathological drunkenness occurs mainly in people with very low alcohol tolerance. Compared with ordinary drunkenness, it is a quality abnormality. Most patients never drink alcohol and drink a small amount of wine. Very uncomfortable, but no history of drunkenness.
Pathological drunkenness is an allergic reaction caused by alcohol. It often shows hyperactivity rather than sedation after a small amount of drinking. It often causes disturbance of consciousness, extreme excitement, attack and harmful behavior, etc. It usually lasts for a few hours or one day, and ends after a deep sleep. After waking up, it is completely unrecognizable after the attack. It is also called "acute alcoholic delusional state syndrome". It is also reported that it is called "atypical or specific." Sexually reactive alcoholism is more appropriate. In any case, the term pathological drunk is still widely used.
(1) Pathological drunkenness is a psychotic seizure caused by a small amount of drinking. Most people do not have a poisoning reaction when drinking this amount. The patient is extremely resistant to alcohol. Excessive fatigue or long-term severe insomnia can promote the occurrence of pathological drunkenness. .
(2) Unlike simple drunkenness, the patient has no speech, euphoria and obvious toxic neurological symptoms. The patient appears to have environmental awareness disorder and self-consciousness disorder after drinking, and is accompanied by horror illusion and victimization. Highly excited, extremely nervous and frightened, patients often suddenly appear aggressive violent behaviors under the illusion and delusion, such as destruction, self-injury or attacking others. The state of drunkenness usually lasts for a few minutes, hours to days, with patients After entering the dozing state, the patient will not be able to recall the attack.
(3) The common types of pathological drunkenness are sputum type and sputum type.
1 type: the scope of consciousness is significantly narrowed and narrowed, with reduced consciousness and self-consciousness almost completely disappeared, but there are some connections between inner spiritual activities, partial perception and reaction to external stimuli, and internal behavior coordination exists, such as simple Chilling, through obstacles, etc., more serious consciousness and disorientation, can be accompanied by delusions, hallucinations and other experiences, often with anxiety and depression, sports excitement with irritating tension, aimless attack and incomprehensible, more Complete amnesia or island memory, pupillary light reflection is slow or disappear, sputum reflexes are reduced or disappeared, and mild patients appear to drink a certain amount of alcohol and repeatedly express some vulgar social behavior.
2: The patient showed tremors, convulsions, internal mental activities completely collapsed, loss of relevance, strong and chaotic sports excitement, and complete forgetting afterwards.
4. Alcoholic transient memory loss refers to the patient's consciousness, behavioral performance, and logical thinking after a period of drunkenness. However, after waking up, there is no memory for this period of experience. Several observations show that only short-term (storage) Impaired memory, and immediate and long-term memory accessibility, these features are similar to transient memory loss.
The nature and significance of this lack of memory are unclear. Some psychiatrists deny the memory loss and believe that this transient memory loss is a form of cheat, while others believe that this is to prevent painful memory. A state of inhibition of conscious perception. The above observations are purely speculative. It is generally believed that the occurrence of transient memory loss is an early and important suggestion of alcohol dependence. A transient memory loss can occur in the process of alcoholism. Anytime, it can even occur during the first drinking, so it can happen to non-alcoholics.
Examine
Acute alcoholism check
1. The determination of blood and urine alcohol concentration has the significance of diagnosis and degree of poisoning.
2. Other blood tests include blood biochemistry, liver function, kidney function, and coagulation function.
Electrocardiogram, electroencephalogram, brain CT or MRI examination, differential diagnosis and significance of the degree of poisoning assessment.
Diagnosis
Diagnosis and identification of acute alcoholism
Diagnostic criteria
Simple drunkenness
(1) Diagnostic criteria (according to CCMD-II-R):
1 There is a history of drinking, which can be inferred from drinking.
2 acute after drinking, at least one of the following symptoms: decreased levels of consciousness or narrow range of consciousness, or drowsiness, lethargy, even coma, emotional excitement, increased speech movements, weakened self-awareness, irritability, irritability or behavior Disdain, nothing to do, regardless of the consequences, like a state of madness, depression, little language or weeping.
3 can have unclear words, ataxia, gait instability, nystagmus and facial flushing.
4 Except for physical illness or other mental disorders.
(2) Characteristics of legal involvement and legal ability assessment: The social harm caused by alcohol poisoning is serious. At present, all kinds of anecdotes caused by alcoholism in the world are strictly handled. Each type has special clinical characteristics, and the relevant legal methods and The characteristics are also very different, the legal ability assessment is not the same, simple drunkenness often appears many times in a person's life. Because drinking is a socially allowed public behavior, it is quite common to be forced to drink alcohol in social situations. Because of the clear consciousness before drinking, the pre-drinking parties have full anticipation of the consequences of drunkenness. The implementation of harmful behavior is mostly a realistic motive. The ability is often normal and the control ability is slightly weakened. Therefore, the criminal behavior of a simple drunken person should be assessed as full responsibility.
2. Complexity of drunkenness
(1) Diagnostic criteria according to (CCMD-II-R):
1 There is a history of drinking, the symptoms can be inferred to be caused by drinking.
2 craniocerebral injury, encephalitis, epilepsy and other medical history, or brain organic damage symptoms and signs, or physical diseases affecting alcohol metabolism, such as liver disease and other evidence.
3 disturbance of consciousness, and at least one of the following symptoms, such as pathological illusions, hallucinations or fragments of delusions; emotional excitement, excitement, or irritability, purposeless stereotypes, attacks or vandalism.
4 Loss of normal interpersonal skills and realistic testing capabilities.
5 The course of the disease is usually several hours, and the attack is completely or partially forgotten after the attack is relieved.
6 Exclude the general drunkenness caused by excessive drinking.
(2) Characteristics of legality and legal ability assessment: Complexity of drunkenness, in addition to the ability to control, the ability to identify is often incomplete, the current assessment of the responsibility of complex drunkenness, the vast majority of judicial psychiatric experts believe that: the first complex Sexual intoxication can be assessed as part of the responsibility, and re-emergence should be strictly assessed as a full responsibility.
3. Pathological drunkenness
(1) Diagnostic criteria according to (CCMD-II-R):
1 There is a history of drinking, the symptoms can be inferred to be caused by drinking.
2 Suddenly after a single drink, but the amount of drinking is not large.
3 conscious disorder, sputum or paralysis state, and at least two of the following symptoms, such as pathological illusion, illusion and other hallucinations, stunned delusions, nervous fear or panic reaction, aggressive behavior, convulsions.
4 Loss of normal interpersonal skills and realistic testing ability.
5 The course of illness is several hours or one day, and the episode cannot be recalled.
6 Exclude simple drunkenness caused by excessive drinking.
(2) Characteristics of legal involvement and legal ability assessment: Pathological drunkenness is seen in very few people, is an allergic reaction of individuals to alcohol, not caused by excessive drinking. Drinkers often do not know that they are allergic to alcohol before drinking, and cannot predict their own drinking. After the behavior, the degree of pathological drunkenness is deeper. In this case, the harmful behavior is due to lack of clear purpose, motivation, loss of ability to identify and control their own behavior; or in pathological drunkenness, behavior Subject to hallucinations, delusions, and other impulsive behaviors, it should be assessed as non-responsible. For patients who have had a history of pathological drunkenness, the same pathological drunkenness symptoms will occur again after voluntary drinking, and the harmful consequences should be strictly controlled. Responsibility.
Differential diagnosis
1. It should be noted that the excitement of identifying pathological drunkenness is different from the euphoric excitement of pure drunkenness. Most of them are in the unpleasant basic emotional background, and there are serious sports excitement, easy to be provoked, impulsive, often The expression of irritating retaliatory behavior is one of its characteristics. Complexity and pathological drunkenness are also often produced on the basis of encephalopathy.
2. The main disease that needs to be differentiated from pathological alcoholism is temporal lobe epilepsy. The latter has sudden anger, violent behavior, medical history and EEG have differential diagnosis significance.
3. Acute alcohol (ethanol) poisoning should also be differentiated from acute poisoning of other alcohols.
