Alcohol-Associated Mental Disorders
Introduction
Introduction to mental disorders associated with alcohol Drinking is a long-standing and common habit and social customs, but now it has become an important public health issue in all countries of the world. Alcohol-associated mental disorders (mentaldisorderscausedbyalcobol) are caused by alcohol consumption, which can occur after a single drink, or can occur gradually after a long-term alcohol addiction, or suddenly stop drinking. In addition to mental disorders, often accompanied by physical symptoms and signs. Alcohol is an anesthetic, which is a neurotropic substance. It can produce alcohol dependence, alcoholic toxic mental disorder and even irreversible neurological damage in long-term drinking. However, acute neuropsychiatric symptoms can also occur after heavy drinking. basic knowledge The proportion of illness: 0.0013% Susceptible people: a large number of long-term drinkers Mode of infection: non-infectious Complications: Alcoholism Fatty liver Alcoholic cirrhosis
Cause
Causes of mental disorders associated with alcohol
(1) Causes of the disease
1. Effects of alcohol metabolism genes on alcohol abuse and alcohol dependence Ethanol is primarily metabolized in the liver by two active enzymes. Alcohol dehydrogenase (ADH) converts ethanol to acetaldehyde, and acetaldehyde dehydrogenase (ALDH) converts acetaldehyde to acetic acid. Some Asians may experience blushing, headache, palpitations, dizziness and nausea after drinking alcohol. They are uncomfortable after drinking and are called blushing reactions. This reaction is associated with inactivation of ALDH, accumulation of acetaldehyde in blood and tissues. Compared with other races, Asians have lower alcohol dependence and higher abstinence rates. Some scholars believe that blushing reaction can protect these people from excessive alcohol and alcohol related problems.
Since the enzyme is directly guided by the gene, studying the variation of the alcohol metabolism enzyme between the alcohol-dependent patient and the normal control at the genetic level can help to understand the role of these enzyme genes in the pathogenesis of alcohol dependence and contribute to alcohol dependence. In-depth discussion of the pathogenesis. About 50% of Chinese and Japanese belong to the inactive ALDH2 genotype, but only 2% of Chinese and Japanese have alcohol dependence. The "mutant" and "wild-type" of the ALDH2 allele are designated ALDH2*2 and ALDH2*1, respectively. Although the reduction in ALDH2 activity may help to explain the difference in alcohol dependence among Asian and Asian and non-Asian populations, the fact that there is virtually no genetic ALDH2 activity in European and African-American individuals does not help. Explain the differences between or among these groups.
The genetic variation of ADH also plays a regulatory role in the relationship between the lack of ALDH2 activity and alcohol consumption. The high activity of ADH is the same as the low activity of ALDH, which can increase the concentration of acetaldehyde in the blood after drinking and can aggravate the symptoms of "blushing reaction". Humans have six ADH genes (ADH1-ADH6), and studies have confirmed that only ADH2 and ADH3 have genetic polymorphism; the ADH2*2 and ADH3*1 alleles encode high-activity ADH. Thomasson et al. (1991) found that the ADH2*2 and ADH3*1 allele frequencies in the non-drinking group were significantly higher than those in the alcohol-supplement group. Shen Yu? et al (1997) studied the dependence of wines on four different ethnic groups in China, Mongolia, North Korea and Oroqen, and found that the protective factors affecting alcohol dependence in different ethnic groups are different: Korean and Han are basically the same, mainly The ALDH2 gene plays a protective role; in the Mongolian population, the ADH2 gene plays a major role; while in the Oroqen, the ALDH2 and ADH3 genes play a role. These studies confirm that although the effects of ADH polymorphism on alcohol dependence are weaker than ALDH, the genetic variation of the two major metabolic enzymes of ethanol is indeed associated with the risk of alcohol dependence.
Despite the genetic factors, the cultural background also has an effect on the interrelationship between drinking and ALDH2 activity. Goedde et al. (1992) reported that the ALDH2 activity deficiency ratio was the same in the Korean, Japanese, and Chinese populations.
2. Genetic factors affect the evidence of the formation of alcohol dependence
(1) Family research: Since ancient Greece, people have repeatedly noticed that family members of alcohol dependence have family aggregation. Recent studies have confirmed that the prevalence of alcohol dependence among family members who are related to alcohol-dependent patients is higher than that of the general population. The risk of alcohol dependence of first-degree relatives of alcohol dependent patients is 4 to 7 times higher than that of the control group. The family-aggregation characteristics of alcohol dependence are consistent with diseases with genetic components, but family studies do not prove that wine dependence has a genetic basis, because the common family environment also has a great impact on drinking behavior. In contrast, twin studies and foster child studies can distinguish the role of genetic factors and family environmental factors in the occurrence of alcohol dependence by controlling the influence of family environmental factors.
(2) Foster child research: Separating young children from birth parents and fostering them in unrelated parent families. If foster children carry genes that are susceptible to drinking disorders, they tend to have alcohol abuse or alcohol dependence after adulthood. Large, thus enabling researchers to distinguish between genetic-environmental factors and analyze the role of each of the two factors.
(3) Twin studies: This method compares the consistency (consistent rate) of alcohol dependence in monozygotic twins with double-oval twins. Since the genetic qualities of single-oval twins are identical, it can be considered that the difference between twins is caused by environmental factors. The difference between twins can be affected by genetics, the environment, or both. If the wine dependence has a genetic basis, the monozygotic twins will be more consistent than the double egg twins if the environmental impact is the same.
3. The neurophysiological changes of alcohol dependence According to domestic research data, the ratio of EEG abnormalities in alcohol dependent patients is 35.0%-85.1%, mainly manifested as diffuse , waves, scattered or paroxysmal spikes, spikes The amplitude is reduced, the adjustment, the amplitude difference is small, and the induced test is not sensitive; the longer the drinking history and the higher the alcohol, the higher the abnormal rate, but after treatment and reducing the amount of alcohol, the brain wave abnormality can be improved. The brainstem auditory evoked potential (BAEP) was examined in alcohol dependent patients, and abnormalities were found. The expression of III, IV, V wave latency was prolonged, and the III-V peak interval was prolonged. Part of the CT examination showed brain atrophy. The visual evoked potentials were examined in alcohol dependent patients, and the latency of visual evoked potentials was prolonged, the amplitude was decreased, the main wave group was abnormal, the late component rate was low, the periodicity was not obvious, and the lateral advantage disappeared.
These results indicate that long-term heavy drinking can cause damage to the structure and function of the central nervous system.
Although common EEG, quantitative EEG, and brain evoked potentials contribute to the detection of brain dysfunction, there is currently little benefit in the diagnosis and treatment of alcohol dependence, because its sensitivity and specificity are not high.
In recent years, with the emphasis on the genetic factors of wine dependence, neuroelectrophysiological research has also shifted from early studies of alcohol-dependent patients to high-risk individuals who have not yet experienced alcohol dependence, such as the son of a father who is dependent on alcohol. What is more meaningful in the results of these studies is the study of the event-related potential P3 component, while the results of N1, N2, P2, MMN, and CNV are different and the significance is to be determined.
Begleite H, Porjesz B et al (1984) used 25 to 13 boys whose fathers met the DSM-III wine-dependent diagnostic criteria as subjects to examine visual P3 and compared them with the father's non-alcoholic control boys and found alcohol dependence. The P3 amplitude of high-risk boys is significantly reduced, so the proposed P3 amplitude reduction may be a susceptibility factor for alcohol-dependent abuse in high-risk boys. Since then, for the relationship between the decrease of P3 amplitude and the risk of alcohol dependence, many studies have been carried out on high-risk children or adolescents who have not yet drunk alcohol. Most of the results support the reduction of P3 amplitude, which is a biological marker of susceptibility to alcohol dependence. . These results support at least one type of alcohol dependence from a neurophysiological perspective that is influenced by genetic factors.
Regarding the view that P3 is a sign of susceptibility to alcohol dependence, Van Der Steh (1998) reviewed the literature. These literatures indicate that P3 meets four criteria for biometric susceptibility to alcohol dependence: 1 with alcohol-dependent or alcohol-dependent subtypes; 2 heritability; 3 pre-existing before alcohol dependence occurs; 4 with family wine Dependency is accompanied. The authors believe that although P3 appears to be the most promising and most likely marker of susceptibility to alcohol dependence, it can also be linked to other behavioral disorders other than alcohol dependence and may therefore lack specificity.
4. The influence of social and cultural psychological factors in the occurrence of alcohol dependence
(1) Social customs: In 1979, in the Dawenkou cultural tombs of Yinhe County, Shandong Province, pottery for wine making, wine storage and drinking was discovered. It is inferred that the Chinese people in the Xia Dynasty since 5,000 years ago have Start making wine and drinking alcohol. In the long history of drinking, drinking is not only an important part of the ceremonial celebrations in the temple, the sacrificial activities in the ancestral temples, the shallow chanting of the literati, but also the daily life of the people. Weddings and funerals, reunion during the New Year, will all contribute to drinking. Drinking has become a generally accepted behavior in Chinese society and has become essential in some specific situations. A few cultures are repulsive to drinking. For example, Islam believes that drinking is a sin. Therefore, in Islamic society, there are very few people who rely on alcohol.
Most cultures accept certain drinking behaviors while making certain restrictions on drinking behavior. These norms generally play a role in preventing excessive drinking. For example, the Han society is opposed to women's drinking, so the proportion of women drinking is relatively low. Another example is that China has had a "drink" since ancient times. In "Shangshu·Women's Liquor", it is mentioned that "drinking only " (only when you are offering sacrifices); "no alcohol" (do not drink regularly); "executing group drinking" (forbidding people to drink alcohol) and "forbidden" Wine" (prohibition of excessive drinking).
Some ethnic minorities in China, such as Yunnan Yi and Hainan Li, advocate booze, and respect the old and treat guests with wine. The alcoholic beverages that these ethnic minorities used to drink in the past were mostly home-brewed rice wines. The alcohol content was not high, so they could not drink more than a few drinks. After getting in contact with the outside world, distilled spirits with high alcohol content have become popular, and the way of booze is unchanged, so various damages associated with alcohol are more likely to occur.
Another unique phenomenon in Chinese society is the use of alcohol as a medicine to impart alcoholic beverages with various medical functions. In the Chinese medical classics "The Yellow Emperor's Internal Classic", it was mentioned that "the sage of the ancient saints was thought to be prepared." It means that the ancients brewed alcohol, which was reserved for medicine. In Li Shizhen's "Compendium of Materia Medica", 69 kinds of medicinal liquors were collected. Until now, it is easy to see a lot of "medicine wine" indicating various medical effects. This concept of drinking and rickety and strengthening the body should not underestimate the role of drinking in the elderly.
(2) Economic factors: Most of the wine is brewed from cereals. Therefore, in the era of economic poverty, wine and beverages have become luxury goods, and the supply is short. The problems caused by drinking are correspondingly less. For example, in 1952, the national sales of alcoholic products in the country was 666,000 tons, and the per capita consumption of alcoholic beverages was less than 1kg. By 1996, there were more than 50,000 brewing factories nationwide, with 20 million employees, an annual output of 7.9 million tons of liquor, and a per capita consumption of alcoholic beverages of about 10 kg. The increase in supply and the variety of supply varieties have objectively promoted the growth of drinking behavior.
(3) Psychological factors: McClelland and Kalin studied drinking methods and came to the conclusion that men drink alcohol in order to obtain a subjective sense of power: physiologically feel the warmth caused by alcohol, and experience the feelings of alcohol after psychologically. Strong and superior, socially experience the respect of others.
Horton used the method of cross-cultural research in the 1940s to study the behavior of drinking. His research methods and research conclusions still make sense today. He pointed out that "the main function of alcoholic beverages is to reduce anxiety." It has been suggested that drug dependent individuals have certain special personality traits such as maladaptation, oversensitivity, impulsivity, poor tolerance to the outside world, disregard of social relationships and social obligations. But so far, it is not certain that there is a special personality with addiction tendency.
(two) pathogenesis
1. Alcohol Metabolism Alcohol, except for a small amount absorbed through the stomach wall, mostly reaches the blood through the small intestine. In general, the faster the absorption, the longer the time remaining in the blood, the greater the effect of alcohol. 90% of alcohol is metabolized by the liver, oxidized to acetaldehyde by the alcohol dehydrogenase (ADH) in the liver, oxidized to acetic acid by ALDH, and finally oxidized to carbon dioxide and water. Only 10% are excreted through the lungs and kidneys. A person weighing 60 kg can metabolize an average of 10 g to 12.5 ml of alcohol per hour.
2. The effect of alcohol on the central nervous system is firstly the expression of subcortical release. The patient's excitement, words, self-control ability, irritability, abnormal behavior; subsequent movement accuracy is poor, gait instability; finally, central inhibition, from Drowsiness to coma, severe cases can die due to central inhibition.
3. Individual quality
(1) Genetic factors: Family studies have found that the alcohol-dependent relatives of alcohol-dependent patients are higher than the general population, while the first-degree relatives of alcohol-dependent patients are 4 to 7 times more likely to suffer alcohol dependence than the general population. The twin study found that the same rate of alcohol dependence, single egg twins were significantly higher than the two eggs twins. The foster child study found that the alcoholism of the offspring is closely related to the blood alcoholism of the parents, but not related to the alcoholism of the foster parents. Another study found that male alcohol-dependent patients with an earlier onset age were significantly affected by genetic factors, with a younger onset age and female patients with lesser genetic factors.
(2) Biochemical factors: Orientals such as Chinese, Japanese, Vietnamese, and Indonesian have lower acetaldehyde dehydrogenase than Westerners. Drinking alcohol easily causes acetaldehyde to accumulate in the body, releasing amines and causing blushing. Adverse reactions such as headache, dizziness, lethargy, vomiting and tachycardia, the incidence of alcohol dependence is lower than in Westerners.
4. Psychological factors It has been pointed out that the pre-disease personality characteristics of alcoholics are often passive, dependent, self-centered, prone to suffocation, lack of self-esteem. According to the theory of behavior, drinking can significantly alleviate negative emotions such as anxiety and sorrow; in addition, drinking can give the drinker a subjective sense of strength, physical warmth, psychological strength and satisfaction, so drinking is easy. Being fixed, it will become addictive for a long time.
5. Social and Cultural Factors China has been drinking and drinking for more than 5,000 years. It has become a custom to drink alcohol on holidays and celebrations and gatherings. In China, there is also the habit of drinking alcohol, which gives the wine various medical functions. And with the improvement of people's living standards, the demand for wine is increasing. These have all contributed to the increase in drinking behavior.
6. Alcohol-induced physical damage Excessive drinking can lead to serious damage in many aspects of the body, mind and society. The damage of the visceral system and nervous system is obvious. Alcohol is an inhibitor of the central nervous system. When alcohol is poisoned, the permeability of the blood-brain barrier is increased. Therefore, the central nervous system damage caused by alcoholism is extensive and serious. Alcohol excretion into the tissue is very slow, so many people with alcoholism can often be poisoned. Nervous system damage such as peripheral nerve damage, epilepsy and cerebellar lesions, rare associated with such as optic atrophy, basal ganglia central gray matter bleeding, ataxia, more persistent ways can have dementia. In addition, head trauma is more common in alcohol-dependent patients and may result in disability due to dangerous accidents. Excessive drinking of the body associated with malnutrition, cirrhosis, gastritis, gastric ulcer, kidney cirrhosis, myocarditis, and acute and chronic cholecystitis, especially the rate of liver damage caused by alcohol is increasing. In the United Kingdom, the annual prevalence of cirrhosis due to alcoholism between 1959 and 1975 increased by 1/2 to 2/3 in all cirrhosis (Saunders, 1981). The risk of dying from cirrhosis is about 10 times higher than the mean (Williams and Davis, 1977). In 1995, there were 100,000 alcohol-related deaths in the United States, accounting for the fourth leading cause of death. In addition to the effects of direct poisoning on certain tissues, they are accompanied by poor diets such as protein and vitamin B deficiency. Patients generally also ignore health and may cause susceptibility to infection. Such as acute and chronic infections, there may be physical complications such as anemia, myopathy, myocardial disease, tuberculosis and so on. The next generation of excessive alcoholics, such as the fetus, can produce fetal alcohol syn-drome, which is characterized by severe damage to newborns with low body weight, low intelligence, growth and development.
7. Alcohol-induced psychological changes Alcohol dependence can also lead to personality changes, such as increased self-centered tendencies, a sense of obligation, responsibility, and a sense of morality, such as lack of care for the family, work, and little regard for relatives and families. Responsible and negligent. Not many good moral standards have been lowered. It can also be caused by sexual dysfunction (mostly impotence, premature ejaculation, etc.), causing tension or rupture in couples, and it can also be seen as a concept or paranoia of sexual objects. Excessive drinkers are still not seen in anxiety or depression. Some countries report that about 6% to 20% of people with chronic alcoholism have suicidal behavior (Rit-son, 1977), and about 8% of discharged patients commit suicide within one year (Kessel and Grossman, 1965). A 1993 study showed that 24% to 35% of suicides had positive blood alcohol levels.
8. Social damage caused by alcohol In the United States, in 1996, 320,000 people were injured in traffic accidents related to alcohol and 17,000 people died. Other accidental injuries such as falls (including death from falling), convulsions, burns, etc., are also associated with a high percentage of alcohol consumption. Alcohol and violent crimes, including physical attacks, rape, child abuse, and murder, are more relevant. A study done in early 1990 showed that 60% of homicide criminals had alcohol during the attack. A survey in 1992 suggested that 25% of rapists had drunk before the incident. Chronic alcoholism is also closely related to high divorce rates and separation rates. Alcohol-related problems can also cause economic losses. In 1995, the United States spent $16.5 billion on alcohol abuse, alcohol dependence and other related obstacles, including $22.5 billion in medical care and $119.3 billion in productivity losses associated with drinking. Other losses associated with drinking, such as traffic accidents, fires and crime disposal, 24.7 billion.
Prevention
Alcohol-related mental disorder prevention
1. Early intervention in foreign experience For areas with heavy alcohol dependence, screen out people with alcohol problems as early as possible to explain the health knowledge about wine, such as indicating how much alcohol and men should not exceed the amount of alcohol and physical damage and society. The relationship between family problems, the patient is given a simple booklet on relevant knowledge, about 5 minutes of simple intervention, after half a year of follow-up, each intervention person reduces about 1/3 of the amount of alcohol consumed, if the hospital's medical staff and grassroots Health workers can actively engage in such interventions and will have a satisfactory effect on prevention.
2. Strictly implement the Law on the Protection of Minors, control and prohibit the drinking of juvenile juveniles, and at the same time strengthen and strengthen the promotion and inspection of relevant laws in this regard.
3. Promote the state to produce low-alcohol, reduce or stop the production of spirits, crack down on illegal production of alcohol, counterfeit and inferior wines and other illegal acts.
4. Timely treatment of certain physical or mental illnesses, avoiding alcohol dependence caused by alcohol substitutes.
Complication
Alcohol-related complications of mental disorders Complications alcoholism fatty liver alcoholic cirrhosis
Chronic alcoholism is prone to infection and brain trauma, alcohol dependence, alcoholism often associated with digestive system gastrointestinal, liver and kidney dysfunction, fatty liver, alcoholic cirrhosis and other digestive diseases.
Symptom
Symptoms of mental disorders associated with alcohol Common symptoms Drowsiness, shortness of breath, nausea and vomiting, leukocytosis, bed rest, urinary incontinence, constipation, fever, eye tremor, convulsions
Alcohol is an anesthetic, which is a neurotropic substance. It can produce alcohol dependence, alcoholic toxic mental disorder and even irreversible neurological damage in long-term drinking. However, acute neuropsychiatric symptoms can also occur after heavy drinking.
1. Alcohol dependence, also known as alcohol addiction, refers to a special psychological and physiological state of wine craving due to repeated drinking, manifested as a strong desire for alcohol and compulsiveness that often requires drinking. Experience can occur continuously or periodically. Stop drinking and often have withdrawal symptoms. When you resume drinking, these symptoms disappear quickly. Therefore, alcohol dependent people have mental or physical dependence on alcohol, and the alcohol dependent people may seek spiritual effects after drinking or Avoid withdrawal syndrome caused by alcohol withdrawal and continue to drink alcohol. Some drinkers often drink alcohol in the morning (during the morning) or drink with them frequently. They are often tolerant to alcohol and drink a lot. Affecting social function, most alcohol addicts have tried to stop drinking many times but ended in failure.
Alcoholic dependence syndrome, first described by Victor and Adams (1953), refers to a group of people who have a strong and urgent desire to drink alcohol, a set of symptoms that appear after completely or partially stopping drinking, such as feeling restless Or symptoms such as limb tremor, nausea, vomiting, sweating, etc., and the symptoms of restoring drinking disappeared.
Edwards et al. (1977) pointed out that alcohol dependence syndrome has the following characteristics: 1 The compulsive feeling of drinking can not be stopped once drinking, 2 fixed drinking mode, the drinking of normal drinkers can vary from place to place, and alcohol dependence People must drink regularly to relieve or avoid the appearance of withdrawal symptoms. 3 Drinking alcohol is the center of all activities. For example, drinking has affected career, family, society and entertainment. 4 Tolerance increases, blood alcohol affects normal people. Concentration, alcohol dependent can be unaffected, so continue to drink, increased tolerance is an important sign of dependence, in the late stage of dependence, tolerance will decline, as long as a small amount of alcohol can cause mental and physical damage, 5 Repeated symptoms of withdrawal, repeated drinking over the years and heavy drinking several times a week, whenever the blood concentration drops, withdrawal symptoms appear, the most common early symptoms are acute tremor, involving the hands, legs, and trunk, so that can not Toast, buckle, emotional, easy to jump; often have nausea, vomiting and sweating, once the symptoms of drinking disappear immediately, otherwise it lasts for several days, such as one Development, there may be a short-term illusion, illusion and visual distortion, the pronunciation is unclear, and finally there may be seizures or tremors, 6 to relieve symptoms by drinking: as long as you continue to drink, you can relieve the symptoms of withdrawal, so many patients early in the morning Wake up and drink alcohol. This is due to the decrease in alcohol concentration in the long-term sleep time. "Dawn drink" is of great significance for diagnosing alcohol dependence. In order to continue to relieve withdrawal symptoms during the day, patients often carry alcohol bottles at any time, 7 after withdrawal. Heavy drinking, heavily dependent on the withdrawal of a period of time, can be restored within a few days.
(1) Experience of alcohol dependence on alcohol: Most patients with alcohol dependence experience a good mood at the beginning of drinking, prefer to communicate after drinking, and ease tension. People with such sensitive qualities promote the use of alcohol to socialize and ease tension or fatigue. Gradually, the wine is gradually formed every day, but it is still possible to drink a certain amount of wine at a certain time in a certain period of time, to maintain a certain physical strength, to meet the needs of normal social activities, and to satisfy the desire of individual drinking, which can keep drinkers drinking. The long-term balanced drinking, called habituation or stabilized alcoholism, is often not used by social or medical workers as a wine dependent, but when this equilibrium is chronic alcohol When the factors such as poisoning are broken, the patient's alcohol-seeking behavior accompanied by strong or compulsive craving for drinking is obviously advanced, which becomes a typical alcohol-dependent patient.
(2) Psychological dependence refers to the thirst for wine. The early is the general desire for wine. From the early general desire to the obvious physical dependence, the spiritual dependence of this period is mild, when developed into In the case of severe physical dependence, the patient fears withdrawal symptoms, and there is a strong and compelling desire for drinking, leading to an unstoppable search for alcohol. At this time, the determination and oath of abstinence are gone.
(3) physical dependence: physical dependence refers to repeated drinking to cause some physiological and biochemical changes in the central nervous system, so that alcohol needs to be continuously present in the body to avoid special occurrence, called withdrawal. Symptoms of the syndrome, withdrawal syndrome refers to the physical dependence on the wine, once the drinking is interrupted, certain physical and mental symptoms can occur.
Alcohol dependence symptoms are light and heavy, depending on many factors, such as the amount of alcohol consumed, the type of alcohol, the time and manner of drinking, the ethnicity and individual quality, etc., the judgment of patients with alcohol dependence should be based on cultural background, in some Countries and regions that can drink alcohol, time and occasions are prone to alcohol dependence. If alcohol consumption, time and occasions are free to pursue drinking without regard to the cultural background, it is often a patient who has fallen into alcohol dependence. Drinking behavior is monotonous from diversity, drinking in the same way every day or several days, determined to control, but always unable to control, this desire to further develop makes drinking the center of all activities, strong drinking desire to make it Continuous drinking status.
Due to changes in mental and biological status, the patient is extremely sensitive to the mild symptoms of withdrawal. Even after the nighttime drink, the withdrawal of alcohol in the morning on the second day can cause withdrawal symptoms. The patient usually consumes 50 ml of pure alcohol. The wine can reduce or disappear from withdrawal symptoms within about 30 to 60 minutes.
(4) Withdrawal syndrome: Victor (1973) classified withdrawal syndrome into early withdrawal symptoms and late withdrawal symptoms. Early symptoms felt an uncontrollable desire to drink when the patient stopped drinking. There will be a series of physical symptoms, such as anxiety, unpleasantness, depression, accompanied by nausea, vomiting, loss of appetite, aversion to cold, sweating, palpitations, frequent pulse and irregularities, hypertension and other autonomic symptoms. Sleep disorders, such as nightmares, shallow sleep, difficulty falling asleep, etc. These symptoms are often mild symptoms of withdrawal or early withdrawal. After 7-8 hours of drinking, acute tremors of the extremities of the extremities appear. Quiver is withdrawal from alcohol dependent patients. One of the typical symptoms, meditation, excitement and startle, often nausea, vomiting and sweating, can last for several days, if drinking alcohol quickly disappears, after a 24-hour stop, there may be a short illusion, hallucinations, sights Deformation, even seizures, tremors can occur after 3 to 5 days, so patients with chronic alcoholism often have tremors in their fingers and eyelids in the morning. In severe cases, they can not chew and stand unstable. Tremor can be aggravated or aggravated by activity or emotion, and can be alleviated or disappeared within minutes by drinking a certain amount of alcohol. This is also the point of identification with other tremors. Hallucinations and delirium are chronic alcohol-dependent mental disorders. According to Victor's clinical experience, most of it occurs within 48 hours after alcohol withdrawal, so it can be considered as one of the early withdrawal symptoms.
(5) delirium tremble: a transient state of toxic disturbance, often occurs after a long-term drinking and 72-96h of sudden drinking, Vietor used it as one of the late withdrawal symptoms of alcohol-dependent patients, often accompanied by Limb tremor or convulsion, illusion, hallucinations, fragmentation of delusions or panic, impulsive behavior, fever, increased heart rate and other symptoms of autonomic hyperactivity, the episode usually lasts 3 to 4 days, ending with asleep, on the onset The process cannot be remembered.
If alcohol-dependent patients can persist in abstinence, the above-mentioned physical dependence or withdrawal symptoms generally disappear within 1 week, and physical strength begins to recover, but a few people may have persistent withdrawal symptoms.
(6) Tolerance: It means that the amount of alcohol consumed does not reach the expected drinking effect. In order to obtain the expected effect, the dosage must be increased. This tolerance is often expressed in patients during clinical examination: Drinking the previous amount has not been effective." or "The amount of drunkenness is not drunk now." The dependence of the dependent person on the tolerance of alcohol is slow and moderate. Therefore, the tolerance does not rise as sharply as morphine, but at most it is the initial stage. Several times the amount of alcohol, the tolerance is generally reached in the average high level in young and middle-aged, and then the tolerance with increasing aggravation and age is reduced, and it continues to decline in the middle-aged and old age. At this time, the wine dependents feel deprived of intoxication. In order to pursue "real drunk", continuous drinking episodes can occur, which is a common clinical image of patients with long-term alcohol dependence.
(7) Certain behavioral characteristics of long-term alcohol dependent persons: regardless of time, the place can drink a lot of alcohol in a short time, and the amount of alcohol can exceed 150ml of pure alcohol per day. Although it has repeatedly claimed that it is broken, it cannot be interrupted. "Intoxication" further enhances the affinity for drunkenness. The patient drinks alcohol for a few days, does not eat, does not drink, does not wash, and even the size is convenient for the body, isolated from the outside world, has been drinking until the body is dehydrated, that is, drinking water Vomiting, can not stop drinking again, this is a serious withdrawal in the next few days, and soon caught in drinking state, this repeated drinking called continuous drinking episodes, there are long-term alcohol dependence patients drink alcohol drunk sleep awake drinking drunk Falling asleep, repeating such a drinking cycle, this form of drinking is called mountain-type drinking, and continuous and mountain-type drinking are monotonous in the way of drinking alcohol-dependent patients.
(8) Combination of other drugs: In Western countries, alcohol-dependent people use other active substances, such as heroin, sedative and hypnotic drugs, etc., which are mainly found in domestic use with sedative hypnotics.
(9) Physical complications: Among patients with alcohol dependence, malnutrition and various physical complications are common. The frequency of various physical complications is extremely different due to the diagnosis and treatment or national conditions. In the statistics of deaths in European and American countries, patients with heart disease are suddenly killed. The risk factor is important for alcohol dependence. Among the diseases caused by alcohol in Japan, the liver disease is the first, such as alcoholic hepatitis, fatty liver, cirrhosis, etc. It is mainly caused by liver diseases and digestive diseases.
(10) Fetal Alcohol Syndrome: French (Lemoine, 1968) and American (Jones & Smith, 1973), the first publicly published report describes that children born to alcoholic mothers have common birth defects, defects The special symptom group is called fetal alcoholic syndrome (FAS) (Xu Jinhe, 1995).
Fetal alcohol syndrome is caused by a large amount of alcohol in the early pregnancy of the mother. Alcoholism causes these fetal and neonatal growth and development disorders, mild to moderate mental retardation, the baby is 2 standard deviations below normal, and the head circumference is often smaller than normal children. The average level becomes a microcephaly, special face: short cleft palate, ptosis, mandibular retraction in infancy, maxillary dysplasia, flat nasolabial fold, thin upper lip, short nasal upturn, and some children may have different Degree of cardiac malformation, genitourinary system, ear and limb deformities, neonatal can have alcohol withdrawal symptoms, infants can have irritability.
Studies have shown that alcohol-dependent women drink more alcohol during the early pregnancy, the greater the incidence of fetal alcohol syndrome, even if not alcohol-dependent women, if early pregnancy, repeated, heavy drinking can also cause this disease.
This disease has become one of the three major causes of mental retardation. It is estimated that the incidence of neonatal diseases in the world is 0.33~1.04, which has been reported in recent years in China (Xu Jinhe, 1995). Children of FAS are exposed before birth. Alcohol causes birth defects. In order to ensure the healthy growth of our offspring, publicity should be widely carried out. If the mother bans drinking before and after pregnancy, the appearance of FAS children can be completely avoided.
2. Alcohol toxic mental disorder Alcoholism, also known as alcoholism, can be divided into acute poisoning and chronic poisoning.
(1) Acute alcohol intoxication: Acute alcohol intoxication is divided into ordinary drunkenness and abnormal drunkenness, the latter including complex drunkenness and pathological drunkenness.
1 Drunkenness (drunkenness) is also called simple drunkenness. It is a poisoned state after 1 excessive drinking. Most of the drunkenness is the case. It is caused by alcohol directly acting on the central nervous system. The severity of symptoms and blood. Alcohol content is closely related to the rate of metabolism, and is usually divided into an excitatory phase and a paralytic phase.
The excitement period begins to gradually occur from drinking. Because of the weakening of the suppression control function, there is more emotional excitement. No matter whether subjective or objective, there is almost no fatigue. The patient is euphoric and has many words. He is more acquainted with acquaintances, and is unfettered and unsatisfied with strangers. Energetic and happy, accompanied by increased heart rate, flushing, shortness of breath and various reflexes. At this time, consciousness has not changed. Some social drinkers almost end up with this drunk, which does not affect social function. Some scholars believe that only the state of drunkenness is not ordinary drunkenness.
The typical general drunkenness begins with the paralysis period. After the paralysis period begins, the patient's consciousness gradually enters the turbid state. The thinking is further de-suppressed, the excitement is obvious, the euphoria and association are accelerated, and the perception can be realized. The emotions of the combination of appearance and emotion are high, the patient Carefree, easy to provoke and emotionally unstable, self-centered, mysterious exaggerated experience, loud voice, arrogant attitude, excitement and excitement, shouting, commotion, knocking on the table, etc., sometimes even around people Aggressive behavior, these behaviors are within a certain range, that is, there is a certain etiquette for indulgence and excitement in sports. There are also a few ordinary drunks whose basic emotions are not euphoria and satisfaction, but a mixture of passion and depression. When the emotions and dissatisfaction that are usually suppressed are vented, sorrow, sadness, and disgusting can occur at the same time as anger, and the verbal association is often related to oneself, but not to the extent of delusions or delusions. There are no illusions and hallucinations.
After the obvious symptoms of paralysis of the ordinary drunken people, such as movement disorders, unclear articulation, tremors, etc., the symptoms of mental excitement disappeared. At this time, the patient's mood became mild, no longer concerned about the surroundings, and the desire for activities decreased. The directional force can be kept until falling asleep, and the memory is mostly in the normal range. Some patients have general memory of the situation at that time. Very few people may have obvious memory defects or complete forgetting due to turbidity and stimulating state, so they cannot be based solely on memory impairment. Judgment should be made based on the characteristics and evolution of clinical symptoms after drinking.
2 abnormal alcoholic intoxication (also known as pathological drunkenness), is an alcohol-induced idiosyncratic reaction, more common in people with low tolerance to alcohol, often drunk after a small amount of drinking, and Serious disturbances of consciousness (such as sputum and sputum), as well as nervous fear, or panic, extreme excitement or aggressive behavior; and illusions, hallucinations and fragmentary delusions (commonly seen in victimization), and suspicion of delusions and convulsions, Because patients can't correctly judge things in the real environment, they often have violent behaviors, no ambiguity, ataxia and other paralytic symptoms. The general episode lasts for tens of minutes to several hours. It is a very strong and long-lasting mental excitement and advanced.
(complex drunkenness)()()()
120()
(2)
A.(alcoholic hallucinosis)1847Marcel2448h,6
3CT1
B.(convulsionrumfits)
pH19h40h24h(48h)40h
C.(delirium tremble)10.1%
101530407296hVicto;
D.(alcoholic delusion of jealousy)
76%
E.(Korsakov's psychosis)1887KopcakoBB
-
F.Wernickewernicke()1korsakovWernicke()(1997)
WernickekorsakovkorsakovBwernicke
G.(alcoholic dementia)(1985)2%
BWernicke
3CT
H.80%30%40%2(1999)10.58%1/32/3(2000)
55()555
(1999)1878%2315%
I.(personality deterioration)(Personality deterioration)
916l67.0%
Examine
B35.0%85.1%;(BAEP)-CT
Diagnosis
Diagnostic criteria
1.2312
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
2.
(1)
(2)1
(3)
(4)
3.
(1)
A.1
a.
b.
c.
d.
e.
A.1
B.
C.
a.
b.
c.
d.
e.
f.
g.
A.
B.
a. Pathological illusions, hallucinations or other hallucinations.
b. Victims of suspicion.
c. nervous fear, or panic reaction.
d. Aggressive behavior.
e. attack.
C. Loss of normal interpersonal skills and realistic testing capabilities.
D. The course of the disease is several hours or days, and the episode cannot be recalled.
E. Exclude the general drunkenness associated with excessive drinking.
(2) Chronic alcoholic psychosis:
1 There is a long history of alcohol abuse, and there is reason to infer that mental disorders are caused by drinking.
2 often eager to drink alcohol, stop drinking and there are withdrawal symptoms.
3 The clinical manifestations of the above alcoholism occurred.
4 physical or psychological symptoms such as poisoning, dependence syndrome, withdrawal syndrome, psychotic symptoms, affective disorder, neurological symptoms, mental retardation, amnesia syndrome, and personality changes.
5 social function is impaired.
6 Mental disorders occur within a reasonable period of time that can be achieved by the direct effects of alcohol.
Differential diagnosis
1. The physical symptoms caused by alcohol dependence and withdrawal syndrome are differentiated from the symptoms caused by other physical diseases.
2. Acute alcoholism should be differentiated from acute madness associated with mania or other causes of poisoning. It should also be differentiated from intentional disorders caused by craniocerebral trauma, hypoglycemia, and primary epilepsy. A special medical history and corresponding symptoms and signs can be identified.
3. Mental disorders caused by chronic alcoholism
(1) The tremor should be differentiated from various types of symptomatic sputum (such as infection and poisoning).
(2) Hallucinations caused by alcoholism, paranoia should be differentiated from paranoid schizophrenia, paranoid psychosis, menopausal psychosis, the former has a history of alcohol dependence, and often occurs in alcohol-dependent patients shortly after drinking, short course, good prognosis For the rare chronic illusion, it should be followed up and diagnosed according to the further changes of the disease course.
(3) Alcoholic seizures should be differentiated from primary epilepsy and traumatic epilepsy.
(4) Coxakov syndrome should be differentiated from similar syndromes of brain organic diseases caused by severe infection, metabolic disorders, craniocerebral trauma, and cerebrovascular diseases.
(5) Alcoholic dementia and personality changes are distinguished from dementia and personality changes caused by other causes. The former has a history of alcohol dependence or withdrawal syndrome, and the above can be identified based on medical history, clinical features and laboratory tests.
