Delirium tremens symptoms, consequences and how to treat delirium tremens. What to do if a person has symptoms of delirium tremens

Probably everyone has heard about this disease. Despite the completely unfunny symptoms of delirium tremens, people suffering from it often become victims of comedy films, anecdotes, and jokes. Although there is nothing to joke about here. Since delirium has very sad consequences, even tragic ones - cerebral edema and death.

Delirium tremens is a disease that appears in alcoholics after a long period of heavy drinking. In medicine it is called delirium, from the Latin “delirium tremens”. Translated into Russian it sounds like “shaking darkness.” Already from this definition, the main symptoms of the disease become clear: tremors and clouding of reason. among the people delirium delirium called “squirrel”, “squirrel”, “Kondraty Ivanovich”, etc.

As numerous medical studies show, “squirrel” occurs in alcoholics with a long history of drinking, about 5-7 years. IN in rare cases diagnostics revealed this disease in patients who usually do not drink alcohol, but as a result of emotional shock, after severe stress started drinking and didn’t stop drinking for several weeks. In this case, the “squirrel” will visit them due to severe intoxication.

Delirium can also begin as a result of drinking low-quality alcohol. In women and men, this develops and proceeds in the same way. However, delirium is less common in women. Scientists explain this by the fact that in most cases, the “squirrel” is preceded by alcoholism in the form of binge drinking, which is more common in men.

Delirium tremens in alcoholics - withdrawal symptoms in drug addicts

In fact, delirium tremens is the body’s reaction to a lack of alcohol after a long binge. It is similar to the withdrawal that drug addicts feel without taking a new dose of a psychotropic substance.

An alcoholic can drink “without drying out” for several weeks. Then his body will become so saturated with alcohol that withdrawal symptoms will develop, accompanied by vomiting. Whether he wants it or not, it comes at a time. After 2-3 days you can wait for the “squirrels”.

The alcoholic's brain suffered toxic damage during his stay in a drunken stupor. When new doses of ethyl alcohol do not arrive, a kind of starvation begins, which can result in acute or delirium. Of course, delirium tremens does not always appear as a consequence of withdrawal. However, with weak mental and physical health drinking delirium is very likely.

What does “squirrel” lead to?

ConsequencesDelirium tremens can range from complete recovery to disability or even death. Often these are various types of acquired physical diseases and mental disorders. It all depends on how strong the alcoholic’s body is, how he recovers from binge drinking, and whether he has a genetic predisposition to alcohol addiction and mental disorders.

The most common consequences of delirium:

• chronic psychosis,
• disorders of the cardiovascular system,
• liver diseases,
• kidney diseases,
• anemia.

As with the treatment of any other illness, the sooner treatment for delirium is started, the better. more likely avoid complications. Timely diagnosis illness and following all the recommendations of specialists is the guarantee that the alcoholic will come out of this state, get rid of addiction, and will never want to repeat the sad experience.

How can you tell if an alcoholic has delirium tremens?

Do you have a drinker in your family? You don’t know what to do, how to determine that he has alcoholic delirium?

You can understand that an alcoholic urgently needs treatment by knowing the main symptoms of delirium tremens. First alarms– This is a sleep disorder and hallucinations.

A person in this state begins to be overcome by anxiety and sleep is disturbed. Either he cannot sleep at all, or he falls asleep, but begins to suffer from nightmares. It is accompanied by sleep disturbances such as migraines, vomiting, and speech disorders.

After some time, nightmares take the form of visions that occur during wakefulness. An alcoholic experiences deception of hearing and vision. He hears voices, sees shadows, people, non-existent phenomena. An obsessive state often manifests itself - as if they want to kill him, his life is in danger.

After several days of hallucinations, the alcoholic's health deteriorates. He is afraid to leave the house, believing that devils, elves and other creatures are waiting for him outside the door. It seems to him that insects are crawling over his body and biting him. Of course, an alcoholic can no longer sleep.

Delirium tremens may last several days. At the same time, you cannot expect the disease to go away on its own. If you do nothing, then the alcoholic can lose his mind forever, during the “arrival” he can jump out of the window, even kill someone close to him, mistaking him for a devil or another creature. Therefore, it is better to carry out treatment not at home, but in a specialized clinic.

So, an alcoholic needs treatment if he has the following signs of delirium tremens:

• auditory and visual hallucinations;
• loss of orientation in time;
• disorientation in space;
• insanity, state of madness;
• increased arterial pressure;
• increased body temperature, chills;
• panic fear, anxiety;
• insomnia or nightmares;
• increased sweating (cold sweat);
• tremor of the limbs;
• rapid heartbeat (heart pounding “like a hare’s”).

To prescribe the correct treatment, a specialist must examine the alcoholic. Alcohol delirium comes in several types. Diagnostics will show what kind of illness it is. Based on its results, the doctor will determine whether it is safe for the patient to stay at home or need to go to hospital, select the necessary medications, and prescribe procedures.

What types of “squirrel” are there?

There are several types of alcoholic delirium:

• Reduced – characterized by short attacks with mild symptoms. Treatment can be carried out at home.

• Atypical mixed - the main symptoms of “squirrel” are observed (hallucinations, disorientation in space). An alcoholic can come out of this state on his own, but delusional ideas will continue to haunt him for a long time. Therefore, it is better to entrust treatment to narcologists.
• Heavy – mumbling and professional. The name "mumbling" speaks for itself. The alcoholic will constantly begin to mutter something under his breath, while making strange body movements: wiping something, feeling something. With professional delirium, he will now and then imitate movements that he is usually used to doing at work. The alcoholic has lost contact with reality.

Treatment of severe forms of delirium should be carried out under the supervision of specialists not at home, but in a dispensary.

IN otherwise“squirrel” can develop into Korsakov psychosis – severe mental disorder, which begins after damage to the peripheral nervous system.

Extremely bad for the brain Negative consequences. Memory is impaired, up to complete amnesia. The patient cannot even reproduce the events of the current day; he does not remember who he is or the names of his loved ones. The ability to work is gradually lost, and the risk of paralysis and disability is high. Even if you completely stop drinking alcohol, go through long-term treatment, after 2-3 years it will be possible to restore memory, but the person will remain disabled for life.

What to do if the symptoms of “squirrel” are present?

If you see a manifestation in a “squirrel”, try to give him first aid:

1. Put him to bed and call an ambulance. Try to keep him in bed until the doctors arrive.
2. Apply a cold bandage to your forehead.
3. Bring water and try to convince him to drink as much as possible.
4. Give a sedative or sleeping pill.

If the alcoholic is violent, tie him to the bed. This must be done, because due to hallucinations, he is dangerous for everyone who is in this moment Houses.

How is delirium tremens treated?

The first thing that the relatives of an alcoholic must agree to is treatment in psychiatric hospital under round-the-clock supervision of doctors. Firstly, here he will be prescribed detoxification therapy: the effects of intoxication will be relieved. To do this, glucose is administered intravenously, droppers with hemodez and rheopolyglucin are placed, and hemosorption is performed.

Secondly, they will carry out sedative therapy, and it may be necessary to put the patient into medicated sleep. In this way, it will be possible to quickly restore his nervous system. Psychomotor agitation will be relieved with the help of such agents as sodium hydroxybutyrate, seduxen, diphenhydramine. After a few days, the doses of psychotropic and sleeping pills will be reduced until complete recovery.

Diagnostics will show the condition of the patient’s body. Based on its results, they will prescribe medications that normalize metabolism and heart function, leading to normal water-salt balance, restoring the respiratory function of the body.

The main thing is that in a hospital setting the patient will be provided with deep and restful sleep, which cannot be done at home. This is one of the prerequisites for complete recovery and speedy restoration of the body. There is no need to feel sorry for the alcoholic or blame yourself for putting him in a mental hospital. Time will pass, and he will thank you for this.

Which is caused by visual, auditory and/or tactile hallucinations, chills and fever. Hallucinations are usually threatening in nature, often presented in the form of small dangerous creatures (insects, devils). Most often it ends in recovery, very rarely in death. The main danger with delirium is the risk of self-harm.

Characteristic feature Alcoholic delirium is that it never develops against the background of intoxication, but occurs only in a sober patient when habitual alcohol intake is discontinued.

With alcoholism, some terrible conditions occur both for the patient himself and for his loved ones. One of them - delirium delirium or delirium tremens. Delirium translated from Latin means madness, insanity.

Delirium tremens- acute alcoholic psychosis, it is characterized by a disorder of consciousness, sudden onset of terrible visual and auditory hallucinations, disorientation in time and place, delirium, fear, strong excitement, unjustified aggression.

Alcoholic delirium, as a rule, occurs 2-4 days after the cessation of binge drinking, but it can also develop during the binge period. The first attack of delirium tremens follows after a long binge, the second and subsequent attacks are possible after shorter drinking bouts.

Signs of the onset of delirium tremens

You can determine that a patient with alcoholism will soon experience delirium tremens by the following: signs:

• Oddly enough, but on the eve of delirium tremens, alcoholics experience virtually no craving for alcohol, stop drinking alcohol, they say that it disgusts them and causes disgust.
• Happening towards evening sudden mood changes: carelessness and complacency are replaced by melancholy, anxiety, depression, unreasonable fear, apathy. Patients are excited, restless, cannot sit still, and constantly chatter.
• Increased trembling hands and feet.
• Dream restless, short-lived, with frequent nightmares. After some time it comes complete insomnia, which further increases the patient’s fear, anxiety, and restlessness.
• They begin to hear voices, intimidation, and terrifying visual images, which over time hallucinations are becoming more widespread.

This condition in a person suffering from alcoholism can last from several hours to several days.

Symptoms of delirium tremens

Alcohol delirium manifests itself in the form of various hallucinations : visual, auditory, tactile, reflected in movements and facial expressions sick. Let's take a closer look at these disorders.

Visual hallucinations

An attack of delirium tremens begins with the onset of darkness and is progressive. Visual images appear, deceptions of perception and illusions arise, for example, when the shadow of objects or clothes hanging on a hanger is mistaken for a person or a lurking monster.

Hallucinations come in a wide variety of forms, most often they reflect what once frightened the patient. But mostly there seem to be small insects and animals: mice, rats, spiders, worms, snakes, cockroaches, there are hallucinations in the form cobwebs, wires, ropes, threads, in which the alcoholic becomes entangled and cannot get out. Terrible ones arise images of unknown personalities: killers, dead people, devils, werewolves, monsters reminiscent of characters from horror films. The monsters make faces, tease, attack the alcoholic, cut with knives, beat with sticks, wound him with firearms. Destruction and chaos reign around the patient, rivers of blood flow. It happens that visual hallucinations do not have three-dimensionality and are perceived by the drunkard as movie or resemble a kaleidoscope, periodically replacing each other.

Auditory hallucinations

Simultaneously with visual images, auditory hallucinations, related thematically to visual visions. Patients begin to hear rustling animals, hissing snakes, screams, threats, swearing, calls for help. It seems to an alcoholic that something terrible is happening nearby, as if someone wants to harm loved ones, abuse their daughter, wife, kidnap children, rob a house. The patient wants to rush to help, but at the same time he is mortally afraid that this could overtake him too.

Movements, facial expressions and speech

Movements and facial expressions the patient is fully consistent with the visions in whose power he is. On his face you can see fear, confusion, grimaces of horror. Alcoholics shake off crawling insects, crush them, push away animals and monsters, try to get out of the web, wave their arms to protect themselves, hide, huddle in a corner, peer into objects, look for something. The patient feels like he is being bitten, crawled over, hurt, beaten, wounded, or feels foreign body in the mouth, tries to spit it out, get it out with your fingers - this is how they manifest themselves tactile hallucinations.

Alcoholic Speech abrupt and often consists of short phrases, shouts, the patient can talk with imaginary interlocutors from his visions.

A drunkard may suddenly start running, jump out of a window. Sometimes, under the influence of psychosis, an alcoholic grabs some thing and rushes to help or tries to protect himself from an imaginary attack, which can seriously harm the people around him.

Suicide in a state of delirium tremens - this is nothing more than getting rid of haunting hallucinations or obeying the voice that the patient allegedly hears inside himself. Often a sick person cannot find another way out, does not know how to cope with nightmares and kills himself.

Disorientation in place and time

Alcoholic delirium is characterized by incorrect orientation in place and time. An alcoholic often does not know where he is, cannot recognize home and relatives, determine what time it is and how much time has passed since the onset of delirium tremens. But meanwhile, he clearly states his name, surname and other information about himself, i.e. His orientation towards his own personality is preserved.

In the evening and at night, all these manifestations of alcoholic psychosis intensify, and gets weaker in the morning and afternoon, and the patient’s condition improves somewhat, but without appropriate treatment By the evening delirium symptoms are coming back again.

There are periods when hallucinations leave the patient, the symptoms of delirium weaken or completely disappear, such moments are called lucid intervals. At this time, the patient can talk about his hallucinations and imagined horrors.

Severe forms of alcoholic delirium

Occupational delirium

Alcoholics often exhibit behavior during delirium tremens. imitating it labor activity . The patient is fully confident that he is at work and performing his usual duties. At the same time, he moves his hands and makes sounds corresponding to his workplace.

Mumbling delirium

A complex case of acute alcoholic psychosis - murmuring delirium. When the patient lies in bed and incessantly mutters something, while making characteristic movements in the form of rubbing, palpating, smoothing. This behavior may be a sign of possible death.

Changes in physical condition during delirium tremens

Health status a patient with delirium tremens worsens over time from the onset of psychosis:

• there is an increase in body temperature, it can reach 40 degrees and above;
• blood pressure rises, rapid and irregular heartbeat is noted;
• comes severe dehydration body;
• acidosis;
• blood nitrogen levels increase;
• characterized by leukocytosis and increased ESR;
• the patient cannot move and is in bed all the time;
• tremor, trembling of muscles and limbs occurs (therefore, another name for delirium is shaking delirium);
• chills alternate with sweating, which has a specific smell like feet that have been unwashed for a long time;
• the liver becomes enlarged, the whites of the eyes become yellow;
• the patient's skin is pale (therefore delirium is also called delirium tremens), but sometimes, on the contrary, redness of the facial skin is possible.

Judging by the abundance of everyday synonyms for this rather specific psychotic disorder, one can already judge its popularity among the people. The most famous, most popular and most common of all alcoholic psychoses. One might say, the king (or queen?) of alcoholic psychosis.
Although in fact, the term “alcoholic psychosis” is not entirely correct, it is used due to established tradition. It would be more correct to say “metal-alcohol psychosis” and you will soon find out why.

There are a lot of misconceptions about alcoholic delirium. In my opinion, there are not so many even about schizophrenics. Therefore, if you want to survive delirium tremens, simply getting drunk will not help. Getting too drunk won't help either. A number of formalities must be followed for this.
You should know that delirium delirium occurs:
1.Only for alcoholics.
2. Only after a binge
3. Only from a sober person.

This psychosis develops exclusively against the background characteristic changes, occurring with a patient with alcoholism, and this alcoholism should be the second stage (out of 3 possible).
Actually, the very fact of the development of alcoholic delirium is an unambiguous reason to put the 2nd degree of alcoholism, i.e. stage physical dependence when it is no longer just a craving for alcohol and the inability to live without it, but when the body is already physically dependent on alcohol.
And as a simple and obvious consequence of this physical dependence, a hangover syndrome is formed (alcohol withdrawal syndrome, if correct).
It must be said that the hangover of an alcoholic and your hangover are two big differences(I proceed, of course, from the tacit assumption that now I am being read by people who do not suffer from this illness).

An alcoholic's hangover is abstinence; your hangover is post-intoxication. Those. When healthy person I feel bad in the morning and want to die, this is how the metabolism of the toxin occurs, which entered your body in the evening.
A lot of things happen there, in particular, ethyl alcohol is metabolized to acetaldehyde. In this state, you are unlikely to want to receive a new portion of the toxin, which you already know very well if you have ever seen vodka from a hangover.
This condition is unpleasant, but short-lived, and usually goes away by lunchtime, unless you drank something really dark.

An alcoholic does not have some kind of banal hangover. An alcoholic has alcohol withdrawal syndrome, and the products of alcohol metabolism in the blood are not the most big trouble. The biggest trouble is that the body suffers from the lack of ethyl alcohol in the blood and the only way to alleviate the condition is to drink more, while if you try to drink, you will vomit.
This condition is accompanied by a violation of everything possible and it lasts for several days, up to a week.
It looks like this.
pH blood shifts towards acidification (due to the formation of vinegar from alcohol). The blood loses ions and trace elements, primarily potassium, sodium, calcium and magnesium. The osmotic pressure of the blood drops, i.e. water leaves the bloodstream and enters the tissues.
This causes: a) the blood to thicken, b) the tissues to swell. Therefore, the mucous membranes dry out (“dry mouth,” you know, right?), while the tissues, on the contrary, are swollen (the face is swollen, for example).
Tissue numbness also causes pallor and hyperhidrosis (sweating, with full-blown withdrawal symptoms, pours out of a person like a stream, despite the fact that the tongue is like a dry emery grater). As a result of blood thickening, there is a sharp increase in the load on the heart, which is already having a hard time, because there is no potassium and the conduction system of the heart suffers from this - and, as a result, rhythm disturbances.
The heart beats unevenly and with strain. The pressure jumps, causing headaches. Due to direct toxic damage, massive death and disintegration of liver cells (hepatocytes) and pancreas occurs, their contents spill out into the blood again. Those. Added to this is toxic hepatitis & pancreatitis.
Of course, about nothing normal operation digestive system in such circumstances there is no talk, so the person is unable to drink or eat, he immediately vomits.
Well, plus, there is damage to the peripheral nervous system, so everything shakes and the legs go numb and paralyzed.
Additional intake of alcohol gives a new intoxication, which covers the consequences of the previous intoxication.

To avoid the range of experiences described above, it is enough for a person to be drunk all the time, because when he gets sober, then everything starts again immediately. Our body is an incredibly resilient thing, so it lasts for a long time.
This is how a binge turns out, when a person drinks day after day, not with the goal of getting pleasure from intoxication, but because he cannot stop.
As soon as you stop, you are immediately overtaken by the punishment for all the days of binge drinking. Moreover, the longer you drink, the heavier the retribution.
As a result, the longer you drink, the harder it is to stop.
As a result, after a week or two, it happens differently, even up to several months, since the compensatory abilities of the body, although colossal, are not unlimited, the reserve capabilities are completely depleted. This is called spontaneous cessation of binge drinking. A person can no longer drink, even if he wants to, even if he tries. He is physically unable to get a hangover. He pours a hundred grams into himself - he immediately vomits, he pours a hundred grams into himself - he immediately vomits. That's it, we've arrived.
And it begins withdrawal syndrome.

I have already spoken about tissue swelling and mentioned the swollen face. But this is more of an aesthetic defect. But what’s worse is that the brain also goes numb. And unlike the legs or face, the swollen brain has nowhere to go because it is surrounded on all sides by the cranial bones. The head looks like a pressure cooker. Mechanical compression of the brain tissue occurs.
In combination with direct toxic damage and disturbances in the neurochemistry of the brain, we get the consequence - acute alcoholic encephalopathy (brain damage).

So we got to the most delicious part, neurochemistry.
The fact is that an alcoholic has a perverted synthesis and metabolism of dopamine, a fairly important neurotransmitter in the functioning of the brain.

dopamine is the strongest excitatory and stimulating neurotransmitter, the precursor of all catecholamines (adrenaline, for example). During abstinence, its concentration in neurons (or rather, in interneuronal clefts) increases tenfold.
Its effect is like whipping a horse dying from exhaustion. The effect is like a short circuit in the head.
IN pathological mechanism This plays a vital role in the development of alcoholic delirium.

This is what ordinary, banal, uncomplicated abstinence looks like.
Now I'll tell you about the really unpleasant things.
After a binge, against the background of withdrawal, a person develops and gradually increases mental disorders.
He can't sleep, he can't eat, he can't drink. It sucks extraordinarily for him.
And usually on the 2nd or 3rd day of such a life, the brains fly out.
It all starts gradually. At first there is anxiety causeless fear, a person himself cannot explain its nature, he is afraid and that’s it, turns on all the lights in the house, TV, radio, etc.
In general, since the general condition of a person is grave and joyless, emotional instability and fearfulness accompany ordinary abstinence, but this is not yet a sign of psychosis.
Then, in the evening and at night, more often when falling asleep, some elementary hallucinations appear. Shadows move in the corners, the pattern on the wallpaper moves, threads, cobwebs in the air, the simplest sounds - rustling, sobbing, creaking floorboards, as if someone is walking around the room.
This is how delirium begins.
At first during the day, this whole thing recedes and disappears, this is called the lucid window. In moments of enlightenment, a person can still run to the hospital on his own.
With advanced delirium, these hallucinations already haunt the person constantly. The visions are bright, beautiful, spectacular, scene-like. Indistinguishable from reality, despite the fact that at the edge of consciousness the patient can even understand that this cannot be, but here it is! Here!!

In general, everything would be great, but they (these hallucinations) are almost always frightening in nature, for reasons that should already be obvious to you. What exactly an enraged mind produces is different for each person, but usually fits into a person’s worldview. In the classic case, small zoomorphic moving visions. As people say, “chases the devils.” Although now there are almost no good old devils left, people do not believe in them, they have disappeared from the public unconscious. On the contrary, there are plenty of small green humanoid monsters. Also giant spiders or rats.

I especially remember that I was pleased with one man, to whom a rat the size of a dog with the face of a mother-in-law came and abused him with terrible words as a drunkard and a parasite, whom it was not enough to kill.
I think it gurgled like a human. Here.
Further more. Hallucinations become widespread and bizarre. The dead are climbing through the window. Bandits in the house, corpses on the floor. It pours from everywhere and explodes.
The man, in fear, grabs an ax and runs out into the street. There are Chechens, riot police, soldiers, everyone is shooting, houses are falling on their sides, there are corpses and body parts everywhere.
A man screams, waves an ax, runs away, and is being pursued. There are shouts behind us, stop, we’ll shoot, we’ll catch up and kill you anyway.
Bloody rain pours from the sky, pools of blood, a man runs behind a trash can, and there is a trash heap full of shredded bodies. The man runs further, hands come out of the ground, grab him, want to throw him down...

This was a fairly typical case, I just cited the most recent one, whom I took recently, as an example.
Since a naked man, screaming and waving an ax in the air, creates an unhealthy stir around himself among ordinary passers-by and obsessive curiosity among police officers, he, as you understand, will not run far.

Or this.
One guy, besides being an alcoholic, worked as a petty swindler and was imprisoned many times. Accordingly, he had a difficult relationship with the police. And in delirium tremens, he saw the policemen at home, who told him that now they would rape him and then kill him.
The guy grabbed whatever he could, and a mop stick fell into his hands and began to fight off these “policemen.” But it doesn’t help much against hallucinations, haloperidol helps well against hallucinations, but the stick doesn’t do anything. The stick passed through them, and the cops laughed and told the guy that they had special suits with invisibility and transparency.
Then the guy ran outside to look for some cop without a special suit. Of course I found it, businesslike.
Imagine the picture: there is a reinforced outfit (then it seems that somewhere something was rushed again, so the cops walked around with machine guns and in bulletproof vests).
In short, they stand like that, smoke, don’t touch anyone, feel completely safe and, in general, masters of the situation.
Then some guy runs out from around the corner with a stick and let’s hit them! With a mop against four machine gunners.
They were so freaked out that they didn’t even resist for a few seconds, they just looked at him blankly, during which time he managed to hit one of them hard. They didn't shoot. Well done. They hit me on the head and took me to the hospital.

Summarizing.
To organize delirious stupefaction, it is not enough just to drink.
You must first develop alcoholism disease, i.e. so that the metabolism of neurotransmitters is distorted, so that changes occur in the synthesis of alcohol-splitting enzymes (primarily alcohol dehydrogenase).
To do this, you need to drink for a long time, at least 5 years.
Then there must be a long, heavy binge, ending in complete exhaustion of the body.
And finally, after binge drinking, you should not drink for several days (2-4 days in 80% of cases).
And only then will your head break. Only for alcoholics. Only for binge alcoholics. Only for sober binge alcoholics.

_________________________________________

I’ll add on my own behalf that I had many friends who were alcoholics. someone chased devils, someone communicated with aliens (they invited him to their planet). one acquaintance once saw an evil midget in a flower pot on his windowsill. He also remembers how he was suffocating in his apartment, as if all the air had been pumped out and a vacuum had formed around him. that's it))

Delirium tremens (delirium tremens), or acute metal-alcohol psychosis, is observed in patients with alcohol dependence in stages II-III of the disease and is characterized by a combination of delirium syndrome and severe somato-vegetative, neurological disorders.

What causes delirium tremens?

The main causes of delirium tremens:

• heavy and prolonged binges;
• use of alcohol substitutes;
• severe somatic pathology;
• organic brain damage.

The pathogenesis of alcoholic delirium is not fully known; disturbances in the metabolism of CNS neurotransmitters and severe, primarily endogenous, intoxication are presumably of great influence.

Symptoms of delirium tremens

According to epidemiological studies, most often the first delirium tremens develops no earlier than 7-10 years of the existence of the advanced stage of alcoholism. Alcoholic delirium usually develops at the height of alcohol withdrawal syndrome (most often on the 2-4th day) and, as a rule, manifests itself in the evening or at night. Early signs of approaching delirium tremens are restlessness and restlessness of the patient, severe anxiety and persistent insomnia. Signs of excitation of the sympathoadrenal system are increasing - pallor skin, often with a bluish tint, tachycardia and arterial hypertension, hyperhidrosis, moderate hyperthermia. Always present to one degree or another are expressed autonomic disorders(ataxia, muscle hypotonia, hyperreflexia, tremor). Characteristic water disturbances are observed electrolyte balance(dehydration, hyperazotemia, metabolic acidosis, etc.), changes in the blood picture (leukocytosis, shift of the leukocyte formula to the left, increased erythrocyte sedimentation rate, increased content bilirubin, etc.), low-grade fever.

Vegetative and neurological disorders occur before the onset of disorders of consciousness and long time are preserved after their reduction. Then the disorders described above are joined by pareidolic illusions (flat images of changeable, often fantastic content, usually their basis is a really existing drawing, ornament, etc.). The illusory perception of the environment is quickly replaced by the appearance of visual hallucinations. Psychotic disorders can be unstable: when the patient is activated, hallucinatory disorders can be temporarily reduced and even disappear completely.

Reduced forms of delirium tremens

Hypnagogic delirium is characterized by numerous vivid, scene-like dreams or visual hallucinations when falling asleep or closing the eyes. An increase in psychotic symptoms is noted both in the evening and at night, characterized by mild fear, an affect of surprise, and somato-vegetative symptoms typical of a delirious disorder. The content of hallucinations is varied: there may be frightening pictures (for example, a dangerous chase) and adventurous adventures. In some cases, the patient is transported to a hallucinatory environment, which indicates partial disorientation. When opening your eyes or waking up, a critical attitude towards what you see is not immediately restored and this can affect the behavior and statements of the patient. Hypnagogic delirium tremens lasts, as a rule, 1-2 nights and can be replaced by metal-alcohol psychoses of different structure and form.

Hypnagogic delirium tremens of fantastic content (hypnagogic onirism) differs from the variant described above in the fantastic content of abundant, sensually vivid visual hallucinations, the scene-like nature of hallucinatory disorders with a sequential change of situations. It is noteworthy: when the eyes are opened, the dreams are interrupted, and when they are closed, they are resumed again and, thus, the development of the hallucinatory episode is not interrupted. With this form of delirium, it is often not the affect of fear that predominates, but interest and surprise. Another one distinctive feature- disorientation in the environment (as a constant symptom). The duration and outcomes are similar to the hypnagogic delirium variant.

Hypnagogic delirium tremens and hypnagogic onirism are not identified in ICD-10 as separate nosological forms.

Delirium without delirium, delirium tremens without delirium tremens (delirium lucidum, trembling syndrome) - I. Salum. (1972) (F10.44*) - an atypical form, characterized by the absence of clinical picture hallucinations and delusions. Occurs acutely. The main disorders contain neurological symptoms, expressed to a significant degree: distinct, rough tremor, ataxia, sweating. Disorders of orientation in time and space are transient. The affect of anxiety and fear is constant. The behavior is dominated by confusion, fussiness, restlessness, and excitement. The course of this form of delirium is short-term - 1-3 days, recovery is often critical. Transition to other forms of delirium is possible.

With abortive delirium tremens (F0.46*), prodromal phenomena are usually absent. In the clinical picture, isolated visual illusions and microscopic hallucinations are observed; Among other hallucinatory disorders, acoasmas and phonemes are most often observed. The affect of anxiety and fear is similar to other forms of delirious stupefaction. Delusional disorders are rudimentary, behavioral disorders are unstable and transient. Neurological disorders are not pronounced.

With the abortive course of delirium and relatively shallow clouding of consciousness, patients may have critical doubts about the reality of what is happening, even during hallucinatory experiences. The patient’s degree of criticality towards the experiences he has suffered increases with recovery and the associated disappearance of delirious symptoms. The duration of abortive delirium is up to 1 day. The output is critical.

Typical or classic delirium tremens

In typical delirium tremens, the symptoms flicker from several hours to a day, after which the hallucinations become permanent. Alcoholic delirium undergoes several successive stages in its development.

Prodromal period

During this period, which usually lasts several days, sleep disorders predominate (nightmarish, frightening dreams, fears), changeable affect with predominance is characteristic, and asthenic complaints are constant. In 20% of cases, the development of delirium tremens is preceded by severe and, less commonly, abortive epileptic seizures, most often occurring on the first or second day of alcohol withdrawal syndrome. On the 3-4th day from the onset of alcohol withdrawal syndrome, epileptic seizures are rare. In other cases, delirium may develop after an episode of verbal hallucinations or an outbreak of acute sensory delirium. When diagnosing alcoholic delirium, one should not forget about possible absence prodromal period. I

First stage

Changes in mood that were present in the prodrome of the disease become more noticeable, and a rapid change of opposite affects is observed: depression, anxiety or fearfulness are easily replaced by euphoria, causeless fun. Patients are excessively talkative, restless, restless (akatasia). Speech is rapid, inconsistent, slightly incoherent, and attention is easily distracted. Facial expressions and movements are lively, fast, sharply changing. Disorientation or incomplete orientation in place and time is often observed. Orientation in one’s own personality, as a rule, is preserved even in the advanced stages of delirium tremens. Patients are characterized by mental hyperesthesia - a sharp increase in susceptibility when exposed to different stimuli, sometimes even indifferent. There are influxes of vivid memories, figurative ideas, visual illusions; Sometimes episodes of auditory hallucinations occur in the form of acoasms and phonemes, note different elements figurative delirium, in the evening all symptoms increase sharply. Night sleep is disturbed, frequent awakenings in a state of anxiety are observed.

Emotional and psychomotor agitation, rapid changes in affect are significant diagnostic signs for distinguishing delirium tremens from alcohol withdrawal syndrome with a predominance of the mental component. In differential diagnosis, it is necessary to distinguish between the initial stage of development of delirium tremens and a hangover state, characterized by a typical monotonous depressed-anxious affect.

Second stage

The clinical picture of stage 1 is accompanied by pareidolia - visual illusions of fantastic content. They can be black and white or color, static or dynamic. Characteristic hypnagogic hallucinations of different intensity. Sleep continues to be intermittent, with frightening dreams. During awakenings, the patient cannot immediately distinguish a dream from reality. Hyperesthesia increases, photophobia increases. Light intervals are possible, but they are short-lived. Dream-like experiences alternate with a state of relative wakefulness, with stupor.

Third stage

At stage III, complete insomnia is observed, and true visual hallucinations occur. Characteristic are visual zoological hallucinations (insects, small rodents, etc.), tactile hallucinations (most often in the form of a very realistic sensation of the presence of a foreign object - a thread or a hair in the mouth), verbal hallucinations are possible, mainly of a threatening nature. Orientation in place and time is lost, but remains in one’s own personality. Hallucinations in the form of large animals or fantastic monsters occur much less frequently. Affective disorders are labile, fear, anxiety, and confusion predominate.

At the height of delirious disorders, the patient is an interested spectator. Hallucinations are scene-like or reflect certain situations. may be single or multiple, often colorless. As delirium tremens deepens, auditory, olfactory, thermal, tactile, and hallucinations of the general senses also join. According to different data, hallucinatory phenomena are not just diverse, but complexly combined, combined. Visual hallucinations in the form of cobwebs, threads, wires, etc. are often encountered. Disorders of the body diagram come down to sensations of changes in the position of the body in space: surrounding objects begin to swing, fall, and rotate. The sense of time changes; for the patient it can be shortened or lengthened. Behavior, affect, delusional statements correspond to the content of hallucinations. Patients are fussy and have difficulty staying in place. Due to the prevailing affect of fear, patients try to run away somewhere, leave, hide, shake something off themselves, knock it down or rob it, and turn to imaginary interlocutors. Speech in this case is abrupt, consisting of short phrases or individual words. Attention becomes hyper-distracted, mood is extremely changeable, facial expressions are expressive. For a short time, bewilderment, complacency, surprise, despair alternate one another, but fear is most often and most constantly present. In delirium, delirium is fragmentary and reflects hallucinatory disorders; the content here is dominated by delusions of persecution, physical destruction, and, less often, jealousy and adultery. Delusional disorders in delirium are not generalized; they are affectively intense, specific, unstable, and completely dependent on hallucinatory experiences.

Patients are highly suggestible. For example, if a patient is given a sheet of clean white paper and asked to read what is written, he sees text on this sheet and tries to reproduce it (Reichardt's symptom); the patient starts a long conversation with the interlocutor if you give him a switched-off telephone receiver or some other object called a telephone receiver (Aschaffenburg symptom). When pressing on closed eyes and asking certain specific questions, the patient experiences corresponding visual hallucinations (Lillmann's symptom). It should be borne in mind that signs of increased suggestibility arise not only at the height of psychosis, but also at the very beginning of its development, and at its end, when acute symptoms reduced. For example, you can cause persistent visual hallucinations in a patient after the end of delirium, if you force him to peer at shiny objects (Bechterew's symptom).

Another interesting point: the symptoms of psychosis can be weakened by the influence of external factors- distractions (conversations with the doctor, medical personnel). A typical symptom of awakening.

In stage III of typical delirium tremens, light (lucid) intervals can be observed, while patients experience significant asthenic symptoms. In the evening and at night, there is a sharp increase in the severity of hallucinatory and delusional disorders, and psychomotor agitation increases. anxiety can reach raptus levels. By morning, the described state turns into soporous sleep.

This is where the development of delirium tremens ends in most cases. The recovery from psychosis is usually critical - after deep, long sleep, but sometimes it is lytic - gradual; symptoms can be reduced in waves, with alternating weakening and resumption of psychopathological symptoms, but at a less intense level.

The patient's memories of the mental disorder experienced are fragmentary. He can remember (often in great detail) the content of painful experiences. hallucinations, but does not remember and cannot reproduce what was happening around him in reality, his behavior. All this is subject to partial or complete amnesia.

The end of delirium tremens is accompanied by intensely expressed emotional-hyperesthetic weakness. The mood is changeable: alternation of tearfulness, depression, elements of faint-heartedness with causeless sentimental contentment and enthusiasm are observed; asthenic reactions are required.

After reduction of the clinical picture of delirium, transitional syndromes are observed in some cases. These include residual delusions, an uncritical attitude towards the experience or individual delusional ideas, mild hypomanic (more often in men), as well as depressive, subdepressive or asthenic-depressive states (more often in women).

The structural-dynamic characteristics of the thought process partially change, but no pronounced incoherence or disintegration of thinking is observed. After exiting the psychotic state, a slowdown, a small product of notes, is noted. thinking, but it is always quite consistent and coherent. Possible manifestations of a kind of alcoholic reasoning, alcoholic humor

The course of delirium tremens is usually continuous (in 90% of cases), but can be intermittent: 2-3 attacks are observed, separated by light intervals lasting up to a day.

The duration of alcoholic delirium averages from 2 to 8 days; in a small percentage of cases (up to 5), delirium can last up to days.

Mixed forms of delirium tremens

Alcoholic delirium can become structurally more complicated: it is possible to add delusional experiences, the emergence of ideas of self-blame, damage, attitudes, persecution. Hallucinations can become more complex, scene-like (everyday, professional, less often religious, battle or fantastic). IN similar cases It is possible to talk about mixed forms of delirium tremens, among them there are systematized delirium and delirium with pronounced verbal hallucinations. These forms are not highlighted in ICD-10.

Systematized delirium tremens

The development of stages I and II does not differ from the course of typical delirium tremens. At stage III, multiple scene-like visual hallucinations begin to dominate the clinical picture. The content is dominated by scenes of persecution, while the patient is always the object of assassination attempt and pursuit. The patient’s behavior is dictated by the experiences he experiences: he tries to run away, hide, find safe place shelter from pursuers. The affect of fear is pronounced, constant, persistent. Less common are visual hallucinations with a predominance of public spectacles or erotic scenes, witnessed by the patient. Some authors emphasize the constancy of drinking plots. In such cases, the affect of surprise and curiosity predominates. Visual hallucinations coexist with a variety of illusions, pareidolia, false recognitions, false, constantly changing orientation in the environment. In this case, we talk about the development of visual hallucinosis in the structure of alcoholic delirium.

Delusional statements are interconnected with the content of hallucinations, are of a stating nature and change depending on changes in hallucinations. The harm, thanks to the sequence of the story and the “crazy details,” resembles a systematized one.

The clouding of consciousness does not reach a deep level, since the patient, upon emerging from a painful state, is able to reproduce the content of painful experiences. Autonomic and neurological disorders are shallow. The duration of psychosis is several days to a week or more. If the course of psychosis has acquired a princely character, then the way out is always logical, with residual delirium.

Delirium tremens with severe verbal hallucinations

In this case, we talk about the development of verbal hallucinosis in the structure of delirium. Together with characteristic intense visual, thermal, tactile hallucinations, body diagram disorders, visual illusions there are constant verbal hallucinations. The contents of hallucinations are similar to other types of delirium tremens, usually of a frightening nature. That is why affect is determined primarily by anxiety, tension, and fear. Delusional statements resemble those in systematized delirium. However, in this case it should be noted: delusional statements are not supported by argumentation, so there is no need to talk about systematized delirium. In addition, signs of figurative delusion are identified - confusion, ideas of delusional staging, a symptom of a positive double, spreading to many people. Orientation in place and time is slightly impaired: the depth of confusion, despite the abundance of productive disorders, is insignificant. Neurological and autonomic disorders are also not pronounced. The duration of psychosis ranges from several days to several weeks. In the latter case, painful disorders disappear gradually, with residual delirium.

Severe delirium tremens

The identification of the group of severe delirium tremens is associated with severe somatovegetative and neurological disorders, features of psychopathological disorders, as well as the possibility of death. Severe delirium usually occurs in stage II-III or III alcoholism with high tolerance and constant use of alcohol. The development of severe delirium is often preceded by convulsive seizures. There are two forms of severe delirium - professional and excruciating.

Occupational delirium tremens (delirium with occupational delirium) F10.43*

Psychosis can begin with typical disorders; subsequently, a transformation of the clinical picture is observed, as a rule, its worsening. In this case, the intensity of hallucinatory phenomena decreases, the delusion of persecution weakens or disappears. Affective disorders become monotonous. Movement disorders and the patient's behavior also changes. Instead of well-coordinated actions that vary in content, requiring dexterity, strength, and significant space, monotonous movements of a limited scale and stereotypical nature begin to predominate. Patients perform their usual activities, including professional ones: dressing and undressing, counting money, signing papers, washing dishes, ironing, etc. Distraction by external stimuli in this state gradually decreases, and in the future may disappear completely. In the initial period of delirium with professional delirium, changeable false recognition of surrounding persons and constantly changing false orientation in the environment are observed. Self-awareness is always preserved. As the condition worsens, false recognitions disappear, movements become more and more automated. Symptoms of stunning appear already during the day, this also indicates a deterioration in the condition.

Professional delirium tremens is usually accompanied by complete amnesia. Less commonly, individual memories related to the onset of psychosis are retained in memory. As the condition worsens, occupational delirium may turn into delirium; transitional states may also occur in the form of transient dysmnestic, Korsakov's syndrome or pseudoparalysis.

Delirium tremens (delirium with muttering) F10.42*

Usually occurs after occupational delirium, less often - after other forms of delirium tremens with their autochthonous unfavorable course or the addition of intercurrent diseases. Delirium tremens can develop very quickly, within a few hours or days, with virtually no hallucinatory-delusional experiences. This condition is characterized by a combination of deep confusion of consciousness, specific motor disorders and severe somatoneurological disorders. Motor excitation is also observed within the local population; it is limited to the rudimentary movements of grasping, pulling, smoothing, and robbing (carphology). Myoclonic jerks are often noted different groups muscles, choreiform hyperkinesis. Speech stimulation - a set of simple, short words, syllables, interjections; the voice is quiet, devoid of modulation. Symptoms of stunning increase as the condition worsens; they occur at night and during the day. Recovery is possible, after which the entire period of psychosis is amnesic.

It should be noted that with persistent delirium tremens, the leading place in the clinical picture may be occupied by neurological and autonomic disorders. With it, tachycardia, sudden changes in blood pressure are noted, more often its decrease until the development of collaptoid states, muffled heart sounds, hyperhidrosis, the development of oliguria up to anuria (an unfavorable clinical symptom); often occur subcutaneous hematomas(capillary fragility, blood clotting disorders); hyperthermia (up to 40-41 °C), tachypnea, shallow, intermittent breathing are observed. Neurological symptoms presented by ataxia, tremor, hyperkinesis, symptoms of oral automatism, muscle tone disorders, neck muscle rigidity; possible urinary and fecal incontinence (unfavorable clinical sign).

As the clinical picture becomes more severe, amentia-like disorders, speech and motor incoherence appear.

Atypical delirium tremens

Atypical forms of delirium tremens include psychotic states with the presence in the clinical picture of disorders characteristic of the endogenous process (schizophrenia). In these cases, symptoms characteristic of delirium tremens coexist with symptoms of mental automatism or are accompanied by oneiric clouding of consciousness. Atypical delirium tremens often occurs after repeated psychoses. Such clinical forms are not identified in ICD-10 in the form of delineated syndromes; in this case, it is justified to classify such conditions as withdrawal syndrome with delirium other (F10.48*).

Delirium tremens with fantastic content (fantastic delirium, alcoholic oneiroid, oneiroid delirium)

The prodromal period is dominated by multiple photopsia, acoasmas, elementary visual hallucinations, and episodes of figurative delusions. The development of alcoholic oneiroid occurs according to the type of complication of the clinical picture. Psychosis may begin as fantastic hypnagogic or classic delirium. During the daytime, visual and verbal hallucinations, figurative delusions, and delusional disorientation may occur. Lucid intervals are characteristic. On the 2-3rd day, usually at night, the clinical picture becomes more complicated: scene-like visual and verbal hallucinations appear, delusional disorders fantastic content, multiple false recognitions, motor excitement from complex coordinated actions turns to disordered, chaotic.

The content of the experienced hallucinations is often of a fantastic nature; frightening visions are noted - wars, disasters, travel to exotic countries. In the minds of patients, events of everyday and adventure-fantastic content are intricately intertwined, without any particular sequence. Hallucinatory pictures are usually fragmentary and unfinished. Another interesting observation: with open eyes the patient is a spectator, with closed eyes he is a participant in the events taking place. At the same time, patients always have a feeling of rapid movement in space.

When scene-like visual hallucinations prevail in the clinical picture, general drowsiness and immobility increase; the condition resembles substupor or stupor. Tom, however, being in a state of inhibition, the patient answers questions, but only after repeated repetitions, in monosyllables. As with other types of delirium, autopsychic orientation is preserved, orientation in place and time is false. Double orientation is often observed - the coexistence of correct and false ideas. The patient's facial expressions resemble those of oneiroid - the frozen facial expression turns into a frightened, preoccupied, surprised one. In the initial stages of psychosis, the affect of fear predominates. With further complication of the clinical picture, fear disappears, replaced by curiosity, surprise, close to complacency. From time to time the patient tries to go somewhere, but with persuasion or slight coercion he calms down. There is no negativism.

Duration of psychosis - from several days to a week, recovery - critical, after deep long sleep. Painful memories persist for quite a long time; the patient talks about them in detail even after a long period of time. After psychosis, in some cases, residual delusions remain.

Delirium tremens with oneiric disorders (alcoholic onirism)

Delirium tremens with oneiric disorders is characterized by a small depth of stupefaction and a significantly lower severity of the illusory-delusional component compared to oneiric delirium. From the very beginning, the hallucinations are vivid. According to various authors, with onirism there are no pseudo-hallucinations of ordinary content, and mental automatisms are not expressed. Psychosis ends critically, after deep sleep, on the 6-7th day from its onset.

Delirium tremens with mental automatisms

Mental automatisms arise when typical or highly systematized delirium becomes more complex, when delirium is combined with pronounced verbal hallucinations or in oneiric states. Mental automatisms are transient, incomplete, and almost all of their variants are observed - ideational, sensory, motor. More often, automatisms occur in isolated form, sometimes there are combinations of them (ideational with sensory or motor with sensory); however, according to many authors, three types of automatisms are never encountered simultaneously. When delirium is reduced, automatisms disappear first. The duration of psychosis varies up to 1.5-2 weeks. The outcome is critical; with the lytic variant, the formation of residual delirium is possible.

Differential diagnosis of delirium tremens

It is necessary to carry out differential diagnosis alcoholic delirium and delirious disorders resulting from acute intoxication drugs with an anticholinergic effect (atropine, diphenhydramine, etc.), stimulants (cocaine, zphedrine, etc.), volatile organic substances, for infectious diseases, surgical pathology ( acute pancreatitis, peritonitis), febrile states of various origins.

Differential diagnosis of alcoholic and intoxicating delirium tremens

If problems arise with diagnosing a delirious state, the help of an infectious disease specialist or surgeon may be necessary.

Treatment of delirium tremens and alcoholic encephalopathies (F10.40*)

Modern treatment tactics for delirium tremens, regardless of its severity, are aimed at reducing intoxication of the body, maintaining vital functions or preventing their impairment. Already with the development of early signs of delirium, plasmapheresis is prescribed with the removal of 20-30% of the volume of circulating plasma. Then carry out infusion therapy. Such tactics can significantly alleviate the course of psychosis, and in some cases, prevent its further development. The method of choice for detoxification therapy for typical delirium tremens is forced diuresis: massive infusions of solutions in a volume of 40-50 mg/kg under the control of central venous pressure, electrolyte balance, acid-base state of the blood, plasma glucose and diuresis; If necessary, diuretics and insulin are prescribed. Enterosorbents are also used as part of detoxification therapy.

It is necessary to replenish electrolyte losses and correct the acid-base state. Loss of potassium is especially dangerous, as it can cause tachyarrhythmias and cardiac arrest. For potassium deficiency and metabolic alkalosis, a 1% solution of potassium chloride is prescribed intravenously slowly, not more than 150 ml/day. If renal function is impaired, potassium preparations are contraindicated in each clinical situation, doses are set depending on the indications of water-electrolyte balance and acid-base status. For elimination metabolic acidosis buffer solutions containing so-called metabolizable anions of organic acids (acetate, citrate, malate, gluconate), for example, sterofundin, acesol and other solutions are used intravenously slowly under the control of acid-base balance.

Large doses of vitamins are added to solutions for intravenous infusion (thiamine - up to 1 g / day, pyridoxine, ascorbic and nicotinic acids).

Drugs that enhance metabolism are prescribed (1.5% solution of meglumine sodium succinate 400-800 ml intravenous drip 4-4.5 ml/min for 2-3 days or cytoflavin 20 40 ml in 200-400 ml 5% glucose solution intravenous drip 4- 4.5 ml/min for 2-3 days).

Cytoflavin is the first complex neurometabolic drug developed on the basis of modern knowledge and discoveries in the field of molecular biology of cellular respiration and clinical medicine.

Cytoflavin is a harmonious neuroprotective composition that promotes safe and rapid recovery from withdrawal symptoms.

After the first day of treatment, headache, sweating, weakness, and irritability disappear. After a course of therapy, sleep normalizes and affective disorders are reduced. Cytoflavin is well tolerated and safe.

• Composition: in 1 ml of the drug: succinic acid- 100 mg, nicotinamide - 10 mg, riboxin - 20 mg, riboflavin - 2 mg.
• Indications: toxic (including alcoholic) encephalopathy, alcohol withdrawal syndrome.
• Contraindications: individual intolerance to the components of the drug.
• Method of administration and dosage: 10 ml of solution intravenously diluted with 200 ml of glucose 2 times a day for 5 days.
• Packaging: ampoules with injection solution No. 10, No. 5.

Also necessary are agents that improve the rheological properties of blood (dextran (reopolyglucin) 200-400 ml/day], cerebral circulation (instenon solution 2 ml 1-2 times a day or 2% solution of pentoxifylline 5 ml in 5% glucose solution 1-2 2 times a day). Use nootronic drugs that do not excite the central nervous system [Semax - 0.1% solution 2-4 drops and nose 2 times a day or hopantenic acid (pantogam) 0.5 g 3 times a day), and hepatoprotectors |ademetionine (heptral) 400 mg 1-2 times a day, thioctic acid (espa-lipon) 600 mg 1 time a day|. Medicines and measures aimed at preventing hypoxia and cerebral edema are also indicated: 10% solution of meldonium (mildronate) 10 ml once a day or 5% solution of Mexidol 2 ml 2 3 times a day. 25% solution of magnesium sulfate 10 ml 2 times a day, oxygen therapy, hyperbaric oxygen therapy, cranial hypothermia, etc. Careful monitoring of the patient’s vital functions (breathing, cardiac activity, diuresis) and timely symptomatic therapy, aimed at their maintenance (for example, the prescription of cardiac glycosides for heart failure, analeptics for respiratory dysfunction, etc.). Specific selection of drugs and solutions for infusion, medicinal and non-drug therapy must be built taking into account the existing violations in each specific case.

Treatment of delirium tremens and acute encephalopathies

It should be noted that in delirium tremens, the antipsychotic activity of existing psychotropic drugs not proven. They are prescribed for psychomotor agitation, severe anxiety and insomnia, as well as for the presence and history of convulsive seizures. Drugs of choice: benzodiazepine drugs 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip up to 0.06 g/day; 0.1% solution of phenazepam 1-4 ml intramuscularly or intravenously drip up to 0.01 g/day and barbiturates short acting sodium thiopental, hexobarbital (hexenal) up to 1 g/day intravenous drip under constant monitoring of breathing and circulation. In case of severe delirium tremens (occupational, excruciating) and acute alcoholic encephalopathies, the administration of psychotropic drugs is contraindicated.

1 year ago

Unfortunately, not everyone can resist the temptation of the green serpent. Alcoholism is dangerous illness, addiction requiring compulsory treatment. After several days of continuous drinking at high temperatures, a person may develop delirium tremens. We will discuss the symptoms and consequences of this pathology in today’s article.

"White and very hot"

Remember the movie "Prisoner of the Caucasus"? It was from there that the catchphrase “white and very hot” came from. Many people who watched this film remember that Shurik ended up in a psychiatric clinic due to excessive consumption of drinks containing alcohol.

Today we will discuss what kind of condition delirium tremens is, its symptoms and consequences, how long they live, features of treatment and much more interesting things. By the way, in medical practice there is no such concept; it is considered common. Official medicine diagnoses “alcoholic delirium.”

Psychosis caused by binge drinking occurs not only in heavy alcoholics. Even a person who has drunk more than the established limit on one occasion may experience delirium as a mental disorder progresses.

The reasons that provoke the appearance of delirium tremens include:

• excessive abuse of alcoholic beverages;
• use of substitute alcohol;
• a history of mental disorder;
• binge;
• infectious diseases;
• traumatic brain injuries varying degrees gravity, etc.

Today, there are three main forms of delirium of alcoholic type:

• neurotic;
• drug addict;
• encephalopathic.

At the first stage, as a rule, delirium tremens does not appear. People who suffer from stage 2 or 3 alcoholism are susceptible to this pathology. As shown medical practice, delirium tremens, or rather, its symptoms, appears after stopping the consumption of alcoholic beverages. There is a so-called withdrawal syndrome.

Clinical picture of the pathology

Symptoms of delirium tremens after binge drinking are considered specific. But each person may develop additional signs, it all depends on the physiological and psycho-emotional characteristics, duration of the binge, etc.

Important! With prolonged use of alcoholic beverages, addiction occurs. This is a disease that requires long-term and complex treatment, sometimes in conditions hospital inpatient. Alcoholism has a detrimental effect not only on the nervous system, but also on other internal organs.

Unfortunately, some people are no strangers to delirium tremens. Symptoms, what to do and a number of other questions are of primary interest to them. If we talk about the clinical picture in general, then against the background of refusing drinks containing alcohol, a person begins to panic, he is overcome by fears, and perhaps hallucinations appear.

Important! In most cases, the first and, perhaps, main feature delirium tremens – hallucinations. For example, an alcoholic feels as if he is surrounded by insects.

Delirium tremens is considered a type of psychosis. This condition is characterized by the following symptoms:

• hallucinations;
• aggressiveness;
• excessive sweating;
• tremor of the upper and lower extremities;
• talkativeness;
• sudden aversion to alcoholic drinks;
• rave;
• increased body temperature;
• chills;
• sleep disturbance;
• sudden mood swings;
• increased heart rate;
• loss of appetite;
• convulsive phenomena;
• dehydration;
• violation of orientation in space.

The first thing a person experiences is hallucinations. It seems to an alcoholic that he is being pursued by insects, devils, non-existent animals, corpses, zombies, etc. Against this background, fears appear and he tries to do something. This is where the danger lies. As the symptoms of delirium tremens progress, a person may cause harm to himself. Psychosis is characterized by suicidal thoughts.

On a note! An alcoholic poses a danger not only to himself, but also to those around him. With alcoholic delirium, mental confusion may occur. Most domestic crimes are committed precisely on this basis.

How can I help the patient?

Perhaps not a single alcoholic in the world has yet admitted his addiction. Alcoholism is dangerous disease which definitely needs to be treated. If you systematically drink high-intensity drinks in large quantities, this will primarily depress the functioning of the nervous system. Then the pathological process will affect the cardiovascular system, liver, digestive tract and musculoskeletal system.

Now you know what delirium tremens looks like. Its symptoms and treatment have their own specifics. If you find yourself next to a person who is suffering from alcoholic psychosis, immediately call an ambulance.

Trying to cure this pathology on your own without medical help is not recommended. This condition is best treated in a hospital. Specialized doctors prescribe medications various groups, including:

• multivitamin complexes;
• psychotropic substances;
• sedatives.

Important! As alcoholic delirium progresses, a person may develop complicated symptoms in the form of swelling of the brain. This condition is unpredictable, develops rapidly and in some cases can cause death.

As soon as the alcoholic has an attack of delirium tremens, at home before the arrival of the team psychiatric care the following steps must be taken:

• the patient must be put to bed;
• for safety reasons, his hands and feet are tied;
• all objects that could injure the alcoholic or harm the people around him are removed;
• the room should be cool;
• A cold compress is placed on the head.

Important! A person who is having an episode of alcoholic delirium should not be given any pharmacological drugs. If you do not know the specifics of a mental disorder, the patient can be harmed and the clinical picture can be aggravated.

A person who constantly uses alcoholic drinks, in other words, he goes on a drinking binge and is at risk. If delirium tremens manifested itself once, then in the future, if the abuse of alcoholic drinks continues, this mental disorder will overtake, and even with greater force.

Delirium tremens (delirium tremens, dromomania, delirium tremens) is the most common acute alcoholic psychosis (70–75% of all alcoholic psychoses). It usually develops in chronic alcoholics with more than 5 years of experience after long, heavy binges during the abstinence period, usually 2–4 days after drinking. Sometimes delirium tremens is preceded by malaise, insomnia, headaches, and somatic diseases. At this time, an aversion to alcohol often appears, and patients stop drinking. Psychosis develops rapidly, reaching a peak within just a few hours. This usually happens in the evening or at night.

Symptoms and course

The patient's orientation in space and time is disturbed. Characteristic sign delirium is an influx of abundant, vivid illusions and hallucinations.

Visual hallucinations predominate. Most often, patients see various moving small animals: snakes, rodents, insects, spiders, etc. Patients can see devils teasing and sticking out their tongues at them. Sometimes large animals also appear: bears, bulls, elephants, dogs. Patients can fight with them, scold them, escape from their attack; collect insects from your body, clothes, walls, throw them off, crush them with your feet, etc.

Auditory hallucinations. The patient hears voices coming from everywhere, remarks addressed to the patient, condemning, scolding him and threatening him. The patient talks to these voices, argues with them, makes excuses, threatens in response. Sometimes auditory hallucinations are in the nature of orders that the patient carries out.

Tactile hallucinations are manifested by a realistic sensation of a foreign object in the mouth (thread or hair), the sensation of insects crawling over the body, or their bites.

The listed hallucinations can appear in combinations with each other. In this case, the images are in the nature of plots and scenes on a specific topic, in which the patient acts as a central figure. Hallucinations associated with the profession are not uncommon: a shoemaker wields an imaginary hammer, hammering imaginary nails into the sole, holding the nails in his mouth, etc.

In addition to hallucinations, illusions often occur. Patients perceive their surroundings pervertedly: they see changing fantastic images based on real objects (ornaments, wallpaper designs, etc.).

With delirium tremens, as a rule, there are fragmentary delusional ideas that reflect hallucinatory experiences. The patient's mood is anxious and depressed. During hallucinations, patients often experience fear and are prone to outbursts of aggression, which makes them dangerous at these moments. But severe melancholy, a state of hopelessness, can also develop, under the influence of which, as well as under the influence of fear, the patient can commit suicide. Occasionally during delirium tremens, euphoria occurs with the flat humor characteristic of chronic alcoholics.

As a rule, during delirium tremens, motor excitation occurs, reflecting the visionary scenes experienced by the patient. The patient attacks imaginary opponents and runs away from them; at the same time, he can jump out of the window of a house or throw himself under a car.

Somatic symptoms:

• pronounced trembling as with chills;
• dilated pupils while maintaining their reaction to light;
• strengthening of tendon reflexes;
• increase in body temperature to 37-38.5°;
• increased heart rate, increased blood pressure;
• redness of the skin, especially the face;
• expressed inflammatory phenomena from the gastrointestinal tract, the tongue is coated;
• enlarged liver, painful when palpated;
• increased levels of leukocytes and bilirubin in the blood, accelerated ESR.

According to the severity of the course, alcoholic delirium is divided into:

• abortive (last several hours, there are no pronounced disturbances of consciousness and agitation, they go away without treatment, criticism of one’s condition remains);
• delirium with a predominance of auditory hallucinations;
• classic delirium tremens;
• fantastic delirium (detachment, darkened consciousness, disorder of self-awareness with depressive or manic affect);
• severe forms (professional, murmuring (“mumbling”) delirium; with signs of acute disorders of the functions of the brain, consciousness, neurological and somatic disorders).

Delirium tremens lasts 3–5 days, less often – a week. The intensity of these clinical symptoms fluctuates at different times of the day. Psychosis is especially pronounced at dusk and at night. Throughout the course of the disease, patients sleep very little, their sleep is severely disturbed.
Usually the disease ends as unexpectedly as it began. Within a few hours the symptoms subside. Patients fall into a long, deep sleep and wake up without signs of illness. Only over the next few days is asthenia observed - a consequence of psychosis.

Treatment

Delirium tremens is an emergency condition and requires emergency therapeutic measures. Treatment is carried out within the framework of specialized medical care in a psychiatric hospital.

The main tactical objectives of treatment are to relieve agitation and insomnia, prevent seizures, relieve intoxication, and combat concomitant pathology and complications.

Neuroleptics and benzodiazepines are used to treat delirium tremens. They are treated in an intensive care ward (department). Excitement is relieved with neuroleptics, devoid of pronounced sedative effect, the risk of excessive reduction in blood pressure. The drug of choice among antipsychotics is haloperidol in a dosage of 2–10 mg IM; if the excitement is not relieved, the indicated dose is re-administered every hour. Once a sedative effect is achieved, they switch to enteral administration of haloperidol (10–60 mg per day).

Phenothiazines (Chlorpromazine and others) are also used in the treatment of delirium, but they more often cause a decrease in blood pressure and sedative effect. Zuclopenthixol and quetiapine are also used. Benzodiazepines (for example, diazepam, triazolam, nitrazepam) help treat insomnia. Benzodiazepines reduce the likelihood of developing seizures. However, some patients require additional anticonvulsant therapy with hydantoin or barbiturates.

Carbamazepine is effective in relieving agitation and seizures in abortive form delirium tremens. Compared to benzodiazepines, the drug is more successful in suppressing psychosis. But in case of severe delirium it is not used.

For delirium, detoxification and hydration therapy are additionally carried out; appoint loading doses vitamins of group B (especially B1) and C. Intoxication is relieved by hemosorption, intravenous drip infusions of hemodez, glucose, rheopolyglucin. Infusions are often used isotonic solution, unithiol, magnesium sulfate, sodium thiosulfate. Heart activity is supported by corglycone and cordiamine. To prevent cerebral edema, Lasix (1% solution) is administered.

Help at home

We should immediately make a reservation: treating delirium tremens at home is impossible. The consequences of such attempts can be lethal. We can only give a few tips on how to carry out urgent measures before qualified assistance is provided:

• put the patient with delirium tremens on the bed and keep him in this position until the doctors arrive;
• if necessary, tie him to the bed;
• give plenty of fluids to relieve intoxication;
• A cold shower wouldn't hurt.

Conclusion

“Are you still drinking? Then I’m coming to you!” – the frightening-looking squirrel decisively declared, pointing at you with its furry, clawed paw.
Delirium tremens, which is popularly associated with this harmless rodent, has long become a reason for jokes and funny stories. However, we must not forget how many dangerous consequences this disease is fraught with, the mortality rate of which is 10–25%. That's why preventive measures against this alcoholic psychosis are of no small importance. Prevention of delirium tremens comes down to prevention and treatment chronic alcoholism, to restriction, or better yet, to complete refusal from drinking strong drinks.