chronic alcoholism
Introduction
Introduction to chronic alcoholism Chronic alcoholism (chronicalcoholism) is a long-term (several years to decades, usually more than 10 years) alcoholism, a variety of physical and mental disorders, and even irreversible pathological damage, such as alcoholic myocarditis, liver damage or cirrhosis, multiple Sexual peripheral neuritis, central nervous system degeneration or brain atrophy. The concept of biomedicine for chronic alcoholism is a special psychological state caused by long-term excessive drinking, which is chronic alcoholism. basic knowledge The proportion of the disease: the incidence rate of the alcoholic population is 0.3% - 0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: cirrhosis peripheral neuritis brain atrophy dementia arrhythmia congestive heart failure thrombosis cardiomyopathy myocardial infarction hypertension
Cause
Causes of chronic alcoholism
(1) Causes of the disease
The exact cause of alcohol dependence has not yet been fully elucidated, and is generally considered to be the result of synergistic effects of various factors such as biology, psychology, and social culture.
Genetic factor
Family surveys confirmed that the incidence of alcohol dependence among children of alcohol-dependent people was 4 to 5 times higher than that of non-drinkers. The incidence was early and serious. Among the relatives of 10 domestic cooperatives who investigated alcohol-dependent patients, the proportion of alcoholism was very high. The relatives were 44.7% and the second-degree relatives were 12.6%, indicating genetic predisposition. The twin study suggested that the prevalence of alcohol-dependent twins was higher than that of fraternal twins. .
2. Biochemical factors
Alcohol dehydrogenase and acetaldehyde dehydrogenase are the main catalysts for the metabolism of alcohol in the body. The activity of acetaldehyde dehydrogenase is an important biological factor affecting alcohol consumption. The activity of platelet monoamine oxidase is decreased in alcoholics. It is speculated that it is a factor of alcohol abuse quality. 1. The activity of dopamine -hydroxylase is decreased, and the risk of alcoholism is increased. Alcohol can reduce the activity of -aminobutyric acid and increase the tolerance of CNS to alcohol, which may be related to alcoholism and withdrawal symptoms.
3. Psychological factors
Psychological mechanism dominates drinking behavior, and the self-examination hypothesis of drinking behavior believes that the drinking behavior of drinkers is related to the self-evaluation of success or failure. When successful, they often make positive self-evaluation, are willing to introspect and drink less; when they fail, they try to avoid negative self-examination. Drinking can interrupt negative self-examination, increase in drinking, and personality characteristics have an important impact on alcohol dependence. Alcohol dependent people have ridiculous performance when they are young, such as too many activities, not gregarious, truant, aggressive, etc. For anti-social personality or immature personality, coping with difficulties and self-control is poor.
4. Social and cultural factors
Different nationalities, social, cultural backgrounds, family and marital status, and the level of social and economic development have an important impact on wine dependence.
(two) pathogenesis
Similar to general anesthetics, alcohol acts directly on the nerve cell membrane. These substances are fat-soluble like barbiturates. They act by lysing the cell membrane to interact with the lipoproteins of the cell membrane. Alcohol is an inhibitor of CNS rather than excitement. Agents, some early symptoms of alcoholism suggest brain excitement, such as chatter, aggressiveness, excessive activity, and increased electrical excitation in the cerebral cortex, which is due to certain structures under the cortex that normally regulate cerebral cortical activity (possibly upper brain stem As a result of inhibition of the reticular structure, the same 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 nerves. cell.
The mechanism by which alcohol causes secondary damage to the nervous system has not yet been fully elucidated and is thought to be related to the following factors:
1. Affect vitamin B1 metabolism
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.
2. Has fat solubility
It can rapidly pass through the blood-cerebrospinal fluid barrier and nerve cell membranes, and can act on certain enzymes and receptors on the membrane to affect cell function.
3. Other
Free radicals and other metabolites produced during alcohol metabolism can also cause damage to the nervous system.
The main pathological changes of alcohol-induced neurological diseases: chronic chronic alcoholism causes chronic damage to nerve cells, decreased synapses, and neuronal loss.
Prevention
Chronic alcoholism prevention
Promote the harm of alcohol to the human body, improve the cultural quality of the whole nation, strictly enforce the law on minors, strictly prohibit the drinking of minors, strengthen legal supervision, attach importance to and strengthen the mental health propaganda of wine, promote civilized drinking, do not persuade alcohol, do not drink alcohol, Do not drink on an empty stomach, treat physical or mental illnesses, avoid alcohol substitutes, promote the use of beverages to replace alcohol, reduce alcohol dependence caused by occupational reasons, promote the production of low-alcohol, control and ban the production of spirits, and crack down on illegal acts of illegal counterfeiting .
Complication
Chronic alcoholism complications Complications cirrhosis peripheral neuritis brain atrophy dementia arrhythmia congestive heart failure thrombosis cardiomyopathy myocardial infarction hypertension
Alcohol dependent patients are special psychological states caused by long-term excessive drinking, which is chronic alcoholism, and ultimately manifests as chronic alcoholism syndrome, which is a variety of body and spirit that occurs in long-term (several years to decades, usually more than 10 years). Obstacles, even irreversible pathological damage, such as liver damage or cirrhosis, multiple peripheral neuritis, central nervous system degeneration or brain atrophy.
Clinical may be accompanied by tremor, convulsions, hallucinations, delusions, Korsakov syndrome and dementia, etc., may have psychiatric symptoms, known as chronic alcoholic toxic disorders, psychotic symptoms can disappear quickly or slowly after stopping drinking. Physical symptoms are often difficult to heal, but chronic alcoholism can also be accompanied by alcohol dependence.
The concept of chronic alcoholism in China emphasizes that long-term excessive drinking leads to organic mental disorders, social function, occupational function and social adaptability.
In addition, the abuse of alcohol has a great detrimental effect on many organs of the human body. It has been confirmed that alcoholism can cause severe arrhythmia, congestive heart failure, cardiac wall thrombosis, cardiomyopathy, myocardial infarction, hypertension, and platelet count. Increased, increased agglutination function and prolonged spontaneous dissolution of fibrin.
Symptom
Symptoms of chronic alcoholism Common symptoms Alcoholic anxiety, mental retardation, tremor, shock, nausea, loss of appetite, depression, inability, drunkenness
1. Patients often have a long history of heavy drinking in about 10 years. The daily drinking amount (converted to ordinary white wine) is more than 250g. There is often a history of ordinary drunkenness. It is manifested by the inability to control the thirst for drinking, the constant drinking compulsion, and the fixed drinking mode. The patient must drink alcohol at a fixed time regardless of the occasion. He relies on drinking to support the mental life and good feelings of the body, relieve the symptoms of withdrawal, and the wine becomes a necessity in life. It is not a day or a deficiency. Drinking has become the center of all activities, obviously affecting Work, family life and social activities, those who are addicted soon or to a lesser degree, once they stop drinking, feel lost, empty, happy after drinking, emotionally excited, psychologically satisfied, and increased tolerance is an important sign of increased dependence. However, dependence on the formation of late tolerance decline, as long as a small amount of alcohol can also cause physical damage.
2. Stop or reduce alcohol consumption and prolong the drinking interval. Repeated withdrawal symptoms occur due to decreased alcohol concentration in the body. Common hands, feet, limbs and trunk tremors, ataxia, irritable emotions, irritability, often shocking reactions, or Feeling depressed, thinking stagnation, slow response and do not want to talk, may have general weakness, stomach discomfort, palpitation, excessive sweating, loss of appetite, insomnia and more dreams, nausea and vomiting, etc., if the timely withdrawal symptoms quickly disappear, and can appear briefly Illusion, hallucinations and visual distortion, unclear pronunciation, severe seizures may occur after relative or absolute withdrawal, confusion, tremors and convulsions. After a night of sleep, the blood alcohol concentration drops significantly, so the withdrawal symptoms appear in the early morning. Most patients need "morning drink" to relieve the discomfort caused by withdrawal symptoms. Morning drinking is important for the diagnosis of alcohol dependence.
3. Alcohol dependence often presents a pattern of recurrence and remission. Stop drinking shows psychological and physical withdrawal symptoms. Nearly half of alcohol abusers or dependents have mental disorders. The most common is anxiety (14.8% lifetime lifetime), hostile to society. Personality (14.3%) and affective disorder (13.4%), etc., those with less alcohol dependence can often be controlled by withdrawal and change of lifestyle habits. Patients with severe alcohol dependence can recover within a few days after a period of withdrawal. Alcohol abuse will cause alcohol dependence symptoms faster than before.
4. Some clinical problems of alcohol dependence
(1) psychological dependence (psychological dependence): early general desire for wine to apparent physical dependence, this period is mild mental dependence, when developing into serious physical dependence, patients fear withdrawal symptoms, strong drinking requirements, Unstoppable search for wine behavior, abstaining from drinking vows.
(2) Physical dependence: It is repeated physiological drinking that causes certain physiological and biochemical changes in the CNS, so that alcohol needs to persist in the body to avoid withdrawal syndrome.
(3) Tolerance: It is the expected amount of drinking the original amount of alcohol, and it is necessary to increase the dosage. The patient often states that the amount of drunkenness is not drunk now, and the tolerance of the dependent person to the wine is slow, but at most It is several times the initial amount of alcohol. Tolerance generally reaches an average high level in young and middle-aged adults. It is followed by aggravation of poisoning and decreased tolerance to age, and continues to decline in the middle-aged and old age. At this time, the alcohol-dependent person has no sense of intoxication. Pursue "drinking feelings" and drinking continuously.
(4) Common ways of drinking: people who rely on alcohol often spend a lot of time in a short period of time, satisfying the desire for alcohol and lifting the symptoms of withdrawal. When drinking, they often do not need any vegetables, drinking like white water. The amount of alcohol continues to reach more than 150ml of pure alcohol per day. Patients can drink for several days without eating, not drinking, not washing, and being isolated from the outside world until the body is dehydrated. Drinking water should also vomit, can no longer stop drinking, and stay in the next few days. Severe withdrawal state, and soon became drunk, this repeated drinking is called continuous drinking episode, in addition, alcohol dependent patients can be expressed as drinking drunk falling asleep awake drinking drunk sleep drinking cycle repeated, called Mountain drinking, continuous and mountain drinking are extreme conditions that alcohol-dependent patients drink.
(5) The symptoms of alcohol dependence depend on the amount of alcohol consumed, the type, the time and manner of drinking, the ethnicity and the individual's quality. The wine dependence should be combined with the cultural background, and some people who are not allowed to drink, time and occasions can drink alcohol. People are prone to wine dependence.
Examine
Chronic alcoholism check
1. The determination of blood and urine alcohol concentration has the significance of diagnosis and evaluation of the degree of alcoholism.
2. Other blood tests include blood biochemistry, liver function, kidney function, coagulation function and immunoglobulin.
3. ECG, EEG, brain CT or MRI examination, there is a differential diagnosis and the significance of the degree of poisoning assessment.
4. Electromyography and neurophysiological examination have differential diagnosis significance.
Diagnosis
Diagnosis and identification of chronic alcoholism
diagnosis
1. Diagnostic criteria for alcohol dependence (according to CCMD-II-R)
(1) There is a history of long-term or repeated drinking, and the symptoms can be inferred to be caused by drinking.
(2) There is a strong desire for wine.
(3) At least one of the following conditions, stop drinking alcohol can occur limb tremor, meditation can not, nausea, vomiting, sweating or irritability and other withdrawal symptoms; continue to drink to avoid withdrawal symptoms, often early morning drinking or Drinking with alcohol frequently; failing to stop drinking repeatedly; being resistant to alcohol, increasing alcohol consumption; giving up other recreational activities or hobbies for drinking, paying attention to excluding other physical diseases, especially psychoactive substances, affective Mental disorders such as depression and anxiety.
2. Characteristics of legality and legal ability When assessing the behavior of alcohol-dependent patients, the assessment of responsibility should be strictly controlled. Most judicial psychiatrists advocate that patients with alcohol dependence should be assessed for full responsibility, such as with significant intellectual disabilities. Part of the ability to be responsible can be assessed when the ability to identify and control is significantly weakened.
Differential diagnosis
The central nervous system depression symptoms of patients with alcohol dependence should be differentiated from the diseases that cause coma, such as sedative hypnotic poisoning, carbon monoxide poisoning, stroke, craniocerebral trauma, etc., intelligent disorders and personality changes of chronic alcoholism, and other reasons Caused by the identification of dementia.
