Alcoholic paranoia

Alcoholic paranoid is an acute delusional psychosis accompanied by a vivid effect of fear.

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Causes of Alcoholic Paranoia

Chronic alcohol abuse.

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How does alcoholic paranoia manifest itself?

Acute alcoholic paranoid manifests itself in sensory (unsystematized, fragmentary) delusions of persecution, anxious-depressive affect, ideas of special significance, physical impact. Acute alcoholic paranoid, along with delusional interpretation of the environment, is characterized by illusory perception. For example, patients hear threats in conversations, an emphasized negative attitude, etc. The affect of dust prevails, aggressive actions are possible in relation to imaginary persecutors.

Abortive, acute and protracted alcoholic paranoids with schizophrenia-like inclusions are distinguished.

Abortive alcoholic paranoid most often develops against the background of binge drinking, in a state of intoxication. The clinical picture is similar to acute alcoholic paranoid, but the duration of such psychosis is determined by several hours.

In acute alcoholic paranoid, prodromal phenomena last 3-5 days and develop in patients during the period of withdrawal disorders; characterized by depressed mood, malaise, anxious-fearful affect, sleep and appetite disturbances; autonomic disorders (tremor, sweating, palpitations, etc.), which intensify in the evening and at night. Psychosis itself develops against the background of withdrawal syndrome, as a rule, after complete insomnia, in the evening or at night. The state of confusion in patients changes to acute fear and motor restlessness. At the same time, delirium of special significance, elementary auditory deceptions in the form of knocks, rustling, coughing, footsteps, etc., quickly join fragmentary verbal hallucinations with delusions of persecution. Delusions of special significance are transformed into diffuse-sensory delusions of persecution - simple in content, often addressed to everyday topics or specific situations. The complication of the plot of delirium depends on illusory-hallucinatory disorders: on their basis, delirium of poisoning, physical impact, jealousy develops. In the structure of the paranoid syndrome, along with delirium of physical impact, individual phenomena of mental automatism arise, monofabularity, fragmentation, extreme instability are characteristic. Auditory pseudohallucinations are often observed, simple and specific in content.

In all cases of acute alcoholic paranoid, short-term impulsive actions are observed; patients suddenly start running, leave vehicles on the move, ask for help, etc. However, it should be emphasized that they rarely commit aggressive actions towards imaginary persecutors.

In the evening and at night, patients experience elementary visual illusions and hallucinations. The clinical picture of psychosis remains developed and saturated with psychopathological symptoms for an average of 10-24 days. The reverse development of psychosis occurs much more slowly, the regression of psychopathological symptoms sometimes lasts up to 1-1.5 months. At first, the affect of fear weakens, mental automatisms, auditory deceptions, and then delusional ideas disappear. In terms of clinical features, acute alcoholic paranoid is similar to paranoid of the "external environment". These clinical variants of psychotic states are similar to the development of alcoholic paranoid in a "road situation". The restoration of a critical attitude to the suffered psychosis does not occur immediately, it is accompanied by long-term residual phenomena, post-intoxication asthenia and symptoms of a psychoorganic personality defect.

Prolonged alcoholic paranoid is indicated by the transformation of affect and delirium. The affect of fear becomes less intense, and an anxious and depressed mood begins to prevail. The sensory-illusory component of delirium is also reduced, and a certain systematization is noted: for example, the patient begins to suspect not everyone in a row of an attempt, but only certain, specific people. The motives for persecution also become more specific and definite. Outwardly, the behavior seems orderly, but the patient's suspicion, distrust, and low accessibility remain. Sometimes it is difficult to distinguish residual delirium from protracted paranoid, and the presence of a changed affect speaks in favor of the latter. Repeated alcoholic excesses aggravate the course of paranoid, and psychosis in this case can become recurrent. The duration of psychosis is several months.

Differential diagnosis of alcoholic paranoid

It is very difficult to differentiate between alcoholic delirium and paranoid syndromes of schizophrenia, especially when complicated by alcohol dependence.

Differential diagnostics of alcoholic paranoids and paranoid schizophrenia complicated by alcohol dependence

Alcoholic paraioids	Paranoid schizophrenia complicated by alcohol dependence
Preceded by a full clinical picture of alcoholism. The formation of delirium is always preceded by an exacerbation of alcoholism	There is no clinical picture of alcoholism. Alcoholic AS is expressed fragmentarily or is absent. Systematic alcohol intake is rare.
There is no dissociation in behavior, but long-term antisocial behavior, quarrels and conflicts in the family are characteristic	Dissociation in behavior is present: emotional manifestations do not correspond to actions. Quarrels and conflicts are rare.
There is no isolation, alienation, emotional coldness. As a rule, rudeness and egocentrism prevail, sexual harassment and cruel acts towards the object of jealousy are possible.	Constant emotional tension, distrust, suspicion, combined with inadequacy, emotional coldness towards his wife and children
Delusions are limited, specific in nature (mainly persecution and/or jealousy), always follow from understandable connections and depend on the surrounding situation.	Delirium is polymorphic and diffuse in nature, often transforming, and is characterized by absurdity and intricacy.
Personality changes of the organic type (emotional responsiveness, liveliness, alcoholic humor, accessibility, etc.)	Specific thinking disorders Further increase of productive and negative disorders. The outcome is a specific schizophrenic defect

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