Alcoholic hallucinosis

Alcoholic hallucinosis - verbal hallucinosis in persons with alcohol dependence, combined with delusions of persecution.

[1],

What causes alcoholic hallucinosis?

• Prolonged course of the disease - alcoholic hallucinosis develops, nik rule, not earlier than 10-14 years of the existence of unfolding alcoholism, more often observed in women.
• Prolonged systematic alcohol intoxication.

Symptoms of alcoholic hallucinosis

Acute alcoholic hallucinosis manifests with affective disorders in the form of anxiety, anxiety, fear, often observe sleep disorders. Against this background, hallucinations arise in the form of separate sounds, noises, words and phrases. Usually patients can clearly localize the source of sound (from the corridor, window, adjacent room, etc.). Hallucinations are accompanied by motor anxiety, an affect of perplexity. Psychotic disorders often disappear after deep sleep, and affective disorders are simultaneously reduced.

With the further development of psychosis, multiple verbal hallucinations appear, secondary raving (relationships, effects, accusations, persecution or physical destruction) are added to them. Patients are extremely prone to start fears and panics, extremely suspicious. Gradually, delirium begins to line up with the sick in a certain system - hallucinatory experiences are woven into real events (sometimes quite plausible). After the appointment of therapy, psychotic disorders tend to be quickly reduced, a criticism to the experience occurs, but depressive and asthenic disorders may persist. In this case, patients, as a rule, well remember their experiences and behavior in a state of psychosis.

Reduced acute alcohol hallucinations

Acute hypnagogic verbal hallucinosis

When falling asleep, there are acoisms or simple in form and neutral in content verbal hallucinations - individual words, singing, etc. After waking up, these disorders disappear. Affective disorders are presented by a depressed-anxious mood. The duration of psychosis does not exceed several days. One should not forget: a hypnagogic hallucinosis can be replaced by an expanded hallucinosis of a more complex structure.

[2], [3], [4]

Acute abortive hallucinosis

May be limited to simple verbal hallucinations of neutral content. With the complication of the psychopathological structure, hallucinations can become threatening, blaming, imperative, addressed directly to the patient. Accordingly, the delusional concept is not formed, there are affective disorders in the form of anxiety, fear, behavior changes, motor excitement is growing, the critical attitude towards the experienced disorders disappears. The duration of this psychosis is from a few hours to a day. The output is critical. Sometimes abortive hallucinosis precedes unfolded hallucinatory psychoses.

[5], [6],

Acute alcoholic hallucinosis (classical)

Acute alcoholic hallucinosis usually begins in the background of hangover disorders, accompanied by anxiety symptoms, paranoid mood, vegetative disorders, and in women - against depressive disorders. Nevertheless, sometimes a hallucinosis develops after a long, daily drunkenness accompanied by insomnia.

Symptomocomplex of acute alcoholic hallucinosis includes true auditory hallucinations, their delusional interpretation, affect of fear.

The onset of the disease is usually acute. Within a few weeks there may be precursors in the form of anxiety, anxiety, depressed mood, dizziness, etc. Psychosis develops, usually in the evening or at night. The patient is seized with a strong anxiety, he can not fall asleep or in fear, sweating afterwards, wakes up after a short sleep. At first auditory hallucinations are elementary - noise, ringing, crackling, rustling, whispering, screaming, single simple words. In the future they quickly assume the character of a monologue, a dialogue and in the final stage - a polyvocal verbal hallucinosis in the form of successively replacing each other scenes connected by the unity of the topic. As a rule, voices speak about the patient in the third person, but sometimes they directly address him. There are a lot of voices, they are quiet, they are loud, reaching to a roar. They talk together, intertwining, arguing and cursing. The content of hallucinations is unpleasant for the patient color. These are various threats, accusations, condemnation of the patient for past deeds, especially for excessive drunkenness and related consequences. Voices confer, argue, discuss what to do with the sick and how to punish him. They can be not only accusatory, but also. Protecting the patient. The patient, of course, is a witness of such disputes, but sometimes becomes a participant. The topics discussed are always related to the real events of the present or past life of the patient. With the influx of hallucinatory experiences, there is a brief inhibition and detachment, one can qualify as a phenomenon of a hallucinatory substructure or stupor.

Delusional ideas are closely related in content to hallucinations, so they are fragmented, sketchy and not systematized. With unfolded hallucinosis, the affects of fear, anxiety, despair prevail. The patient is always the mind of events, his behavior corresponds to the content of hallucinations and delusions. In the first days of the patient, under the influence of delirium, he does not see a way out of the created situation, or if we commit mandatory votes, we commit suicidal attempts. In the future, when the affect of anxiety prevails, the patient starts to flee and develops motor excitement. Often patients in this state resort to desperate self-defense, barricade doors, hammer windows, disconnect communication facilities, create their own alarm system, etc. Such behavior of the patient is called "situation and one situation". Often in such a state, patients begin to defend themselves, turning into aggressors, waiting for invisible enemies, armed with sharp objects, with cold or firearms. At the next stage the patient from the persecuted turns into a pursuer. This can lead to unforeseen consequences: it can attack random people in self-defense, because in this state everything surrounding it is treated in a threatening sense. Attachment of delirious disorders (usually at night time increases the frequency of different forms of misconduct, but in the future, the behavior of patients can become sufficiently ordered there, masking their ability to socially dangerous actions.

Anxiety in alcoholic hallucinosis, unlike delirium, is absent: it is impossible to convince a patient of his delusional interpretation of the situation or to inspire other hallucinations.

Alcoholic hallucinosis proceeds against a background of uncorrected consciousness, this is evidenced by an unbroken orientation in one's own personality, in the locality, this essentially distinguishes it from the white fever. Only with a thorough clinical and psychopathological study can we note some deafening.

Patients retell the content of painful experiences accurately enough and in detail, external events are also not erased from their memory, the patients reproduce them almost unmistakably consistently. Memory for alcoholic hallucinosis does not suffer. Confabulations are practically not observed.

Psychosis, as a rule, ends critically after a long deep sleep. At the lytic end of a hallucinosis, the intensity of verbal hallucinations first decreases, then the affective charge disappears, and later delusional constructions fade. Critical attitude to the experience does not immediately arise, there may be residual delirium in men (women often have depressive disorders). Duration of acute hallucinosis from several days to 4 weeks.

[7], [8], [9], [10]

Mixed acute alcohol hallucinations

Acute hallucinosis with marked delirium

Distinctive features of this psychosis - a combination of relatively poor, uninvited verbal hallucinations mostly of an alarming nature with a pronounced delusions of persecution. In addition to typical delusional statements. Associated with the content of hallucinations, there are mediated delusional constructions that are not associated with hallucinatory disorders. Delirium in structure - sensual, figurative, this is evidenced by a symptom of confusion, the affect of intense anxiety and fear, an illusory perception of the surroundings, individual false recognitions. Reduction of mental disorders occurs gradually and consistently: affective disorders - verbal hallucinations - delusional disorders. It is often residual raving.

[11],

Acute hallucinosis, combined with delirium

Delirious disorders occur at any stage in the development of a hallucinosis. They join, as a rule, at night. In the initial period and at the end of the hallucinosis, these are single episodes, and at the height of the development of hallucinatory psychosis, you can observe the unfolded symptoms of delirium. Rarely delirium patterns become predominant, more often verbal hallucinosis remains a pivotal disorder. In patients, there are influxes of visual hallucinations, tactile and thermal hallucinations may appear. The affect of fear alternates with euphoria. With such a psychosis, there may be fragmentary symptoms of professional delirium. Reduction of psychopathological disorders begins with the disappearance of symptoms of obscuration of consciousness, further development is similar to acute hallucinosis. The output is usually critical.

[12], [13], [14], [15], [16]

Atypical acute alcohol hallucinations

At an atypical course of acute alcoholic hallucinosis, a combination of symptomatic of hallucinosis proper with onyroid occlusion of consciousness, mental automatisms or depressive symptoms is observed in the clinical picture.

[17], [18]

Acute hallucinosis with onyeroid clouding of consciousness

Oneroid disorders in hallucinosis are more common than in delirium, and are formed at the height of the hallucinosis. The development of this form of psychosis is limited to the stage of an oriented onyroid. In comparison with the onyeroid disorders encountered in delirium, the patients note mainly scenes of fantastic content, representing different world cataclysms, star wars, interplanetary flights and others, however these themes remain plot unfinished, fragmentary, as in restless sleep; often "fantasy" experiences are combined with scenes of drunkenness.

The beginning of a hallucinosis is classical, then a verbal scenic-like hallucinosis joins: the patient has a pronounced affect of fear, he is in the sub-stump. Then there is a figurative delusion with an illusory perception of the surrounding, at night, visual pseudo-hallucinosis, reflecting the content of verbal hallucinations, can develop. The reduction of psychosis begins with onyroid disorders, verbal hallucinosis disappears at the end.

Acute hallucinosis with stupor disorders (alcoholic stupor)

The development of an alcoholic stupor or sub-stage is associated with an alcoholic hallucinosis disorder of the motor sphere. As a rule, the immobility of the patient, his detachment from the surrounding world, and congestion are observed at the height of the hallucinosis. Negativism is absent. The inhibition can be replaced by excitation or alternated with it. The duration of the above disorders is from a few minutes to several hours.

[19], [20], [21], [22]

Acute hallucinosis with mental automatisms

Similar to other, atypically occurring forms of psychosis, mental automatisms are manifested at the height of its development, when forming a polyvocal hallucinosis. They always increase and become more complicated at the same time as the verbal hallucinosis intensifies, mainly in the evening and at night. More often than not, ideatorial automatisms are observed - a sense of openness and anticipation of thoughts, violent thoughts, and mentism. Phenomenon of external influence ("unwinding" of memories). It is noteworthy that the symptom of echoes is, as a rule, not recorded. The development of mental automatisms in the structure of a hallucinosis is always accompanied by an expansion of the content of delusional statements and the emergence of a trend towards their systematization. Have with automatism can occur delirious and onyroid disorders. At the exit from psychosis, psychic automatisms are reduced first.

Subacute (protracted) alcoholic hallucinosis (F10.75)

The subacute includes hallucinosis, lasting from 1 to 6 months. The most common duration of a similar psychosis is 2-3 months.

The onset of psychosis almost completely coincides with that in acute alcoholic hallucinosis; The differences arise later and are usually associated with hallucinations of prominent delusional or depressive disorders. There are often cases of verbal hallucinations that can not be reduced and determine a further clinical picture. By prevalence in a clinical picture of those or other disorders (verbal hallucinations, depressive disorders or delirium), the protracted alcoholic hallucinosis is conventionally divided into three variants.

Subacute alcoholic hallucinosis with predominance of verbal hallucinations

Meet relatively rarely. In the clinical picture, after the reduction of affective disorders and delusions, verbal hallucinations come to the fore. The behavior of the patients is orderly, often the fulfillment of daily and even professional duties is preserved. As a rule, the patient is aware of the presence of the disease.

Subacute alcoholic hallucinosis with predominance of depressive affect

At the height of the development of a hallucinosis, there is a transformation of motor and affective disorders. In the clinical picture, a decreased mood background, depression, pronounced anguish begins to predominate. The intensity of depressive disorders, including depressive delusions, is increasing. There are ideas of self-blame, gradually beginning to prevail over other delusional statements. The reduction of psychosis is gradual, begins with affective disorders.

Subacute alcoholic hallucinosis with a predominance of delirium

As a rule, gradual reduction of sensory disorders occurs at the height of the development of verbal hallucinosis. In the clinical picture, the ideas of attitude and persecution begin to prevail. The affect of anxiety and fear is constant, intense. Patients have a symptom of an adjustment disorder, an increase in psychotic symptoms when the environment changes. The reduction of psychosis begins with the leveling of affective disorders, delirium disappears in the last place.

Chronic alcoholic hallucinations

Chronic alcoholic hallucinosis is a relatively rare disease. Psychosis can begin as an acute alcoholic hallucinosis, less often as an alcoholic delirium. However, according to some authors, chronic alcoholic hallucinosis immediately begins with the development of complex conditions, with simultaneous presence of symptoms of delirium and hallucinosis or hallucinosis combined with depressive-paranoid disorders.

The acute stage of chronic hallucinosis is characterized by extraordinary brightness of visual and auditory hallucinations. The stage lasts 1-2 weeks.

Depending on the prevailing clinical picture, the following firms of chronic alcoholic hallucinosis are distinguished.

[23], [24],

Chronic verbal hallucinosis without delirium

The most frequent form of chronic alcoholic hallucinations. In the prodromal stage, anxiety, acute anxiety, and sleep disorder are markedly expressed. Fall asleep, the sick hear that someone creeps up to them, wants to grab, etc., in fear they jump up, scream. Soon, there are abundant auditory hallucinations. Their content is unpleasant, threatening, commenting or antagonistic hallucinations may join. In an acute period, auditory hallucinations are distinguished by a bright emotional color, and as a result, patients perceive them as a real reality. In the background there are visual hallucinations (insects, small animals, unreal creatures, different shadows, etc.). In an acute period, kinesthetic, tactile, and corporal hallucinations can occur. Against the background of hallucinatory disorders, delusions of persecution or attitudes are formed. Consciousness, like other kinds of hallucinosis, is not violated, but at the height of the development of psychosis it becomes not entirely clear. After 7-10 days, fear in patients decreases, only auditory hallucinations, less threatening than before, remain from the whole spectrum of disorders. Later the patients begin to get used to them. At the same time, external forms of behavior are normalized, patients can perform daily activities, are able to engage in professional activities. Notable changes in memory are not noted for the past, memory for current events suffers a bit. Over time, alcohol hallucinosis loses its intensity. Hallucinations can acquire the character of simple, sometimes disappear completely, appearing only with external stimuli (the so-called reflex hallucinations). Consciousness of the disease appears even in an acute period and persists throughout the course of painful disorders. With the resumption of alcohol consumption, the former symptomatology of hallucinosis reappears and worsens. This form of chronic hallucinosis is stationary and does not progress. Sometimes it lasts for many years, without leading to dementia and decreased personality.

[25], [26], [27],

Chronic verbal alcoholic hallucinosis with delirium

In this case, a characteristic hallucinatory syndrome is accompanied by delirium, which is of a peculiar nature. Unlike the usual, it is amenable to a certain correction and does not have an absurd character. More often in such patients, the delusion of persecution is revealed, which is stereotyped (the patient expounds delusions in the same formulations); Complications of delusional ideas do not occur over time. Under the influence of alcoholic excesses, naturally, exacerbation of painful phenomena occurs periodically. According to intellectual safety this form of chronic alcoholic hallucinosis does not differ from the first variant.

[28], [29], [30]

Chronic verbal hallucinosis with mental automatisms and paraphrenic alteration of delirium

They are considered the most rare form of chronic hallucinosis. Stem disorder is a true verbal hallucinosis. Over time, episodic, and then quite persistent phenomena of psychic automatisms appear first. As a rule, these are ideator automatisms in the form of auditory pseudo-hallucinations, open minds, advanced thoughts, mentism; note individual ideas of impact. With a further course of psychosis, a change in the content of auditory hallucinations and pseudo-hallucinations is observed, megalomaniac delusions are formed. Patients talk about their unusual, special situation, but not in the present, but in the future (will be fabulously rich, receive a high position, be awarded for merit, etc.); very often the content of delirium is a hint of puerilism, childishness. Prevalent labile affect, euphoria is easily replaced by irritability. For this version of psychosis is characterized by sufficient intellectual preservation, but slowly growing organic decline.

[31], [32], [33],

Differential diagnostics

Hallucinosis of all types of flow requires differential diagnosis with schizophrenia complicated by alcoholism.

Hallucinosis, like delirium, is classified according to the main clinical signs along the course and features of psychopathological manifestations. The clinical picture distinguishes: typical, or classical, reduced. Mixed and atypical form of hallucinosis.

[34], [35], [36]

Treatment of alcoholic paranoid (F10.51 *) and acute alcoholic hallucinosis (F10.52 *)

In the treatment of acute alcoholic hallucinations and delusional psychoses, the main place is occupied by psychopharmacotherapy. Drugs of choice - antipsychotics with predominantly antipsychotic effect [for example, haloperidol 5-10 mg 2-3 times a day or risperidone (rispolept) at 4-6 mg / day], with expressed affective disorders additionally prescribed drugs benzodiazepine series (0, 1% solution of phenazepam 2-4 ml intramuscularly or intravenously, lorazepam 2.5 mg, maximum dose 15 mg / day). Apply also nootropic drugs, vitamins, conduct symptomatic treatment.

Treatment of acute hallucinosis and delusional psychosis

Condition	Recommended baking
Acute alcoholic hallucinations and delusional psychosis	Neuroleptics with predominantly antipsychotic action [eg, haloperidol 5-10 mg 2-3 times per day or risperidone (rispolept) at 4-6 mg / day]
	Therapy aimed at stopping affective disorders: a 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip to 0.06 g / day; or 0,1% a solution of phenazepam on 1-4 ml intramuscularly or intravenously drip, up to 0,01 g / day
	Vitaminotherapy: 5% solution of thiamine (vitamin B1) 4 ml intramuscularly; 5% solution of pyridoxine (vitamin B6) 4 ml intramuscularly; 1% solution of nicotinic acid (vitamin PP) 2 ml intramuscularly; 5% solution of ascorbic acid (vitamin C) 5 ml intravenously; 0,01% solution of cyanocobalamin (vitamin B12) 2 ml intramuscularly
	Neurometabolic therapy: picamilon to 0.05 g 3 times a day; aminophenylbutyric acid (phenybut) in 0.25 g three times a day
	Hepatoproteiners: ademethionin 400 mg 1-2 times a day, thiocy acid 600 mg 1 time per day Symptomatic therapy of somatic complications

Treatment of chronic alcoholic psychosis (F10.6 *, F10.7 **)

In protracted and chronic hallucinosis and paranoids (F10.75 *), antipsychotics are mainly used: haloperidol and other preparations of butyrophenone, phenothiazine series or atypical antipsychotics (sometimes in combination). Assign Haloperidol 10-20 mg / day, perphenazine for 8-20 mg / day, risperidone 4-6 mg / day, quetiapine 300-600 mg / day, olanzapine 5-10 mg / day. If the patient has alcoholic delirium jealousy, griftazine is given at 5-15 mg / day or haloperidol at 10-30 mg / day. Various neurometabolic agents (long courses), amino acid preparations and multivitamins are also used. In disorders of the anxiety circle, hydroxyzine is used but 25-75 mg / day.

For chronic encephalopathies (F10.73 *) and Korsakon psychosis (F10.6 *), long-term treatment with nootropic agents, amino acids (methionine at 2 g / day, glutamic acid 1.5 g / day, glycine at 0.05 g / day), drugs that improve the metabolism and blood circulation of the brain (instenon, pentoksifillin, inosine, etc.), polyvitamins.

Treatment of chronic alcoholic psychoses

Condition	Recommended treatment
Protracted and chronic alcoholic psychosis	With the symptoms of psychosis appoint antipsychotic drugs, drugs of choice for long-term therapy - atypical antipsychotics: quetiapine at 150-600 mg / day; olanzapine at 5-10 mg / day. If these drugs can not be used or are ineffective, haloperidol 10-20 mg / day is indicated; perphenazine at 8-20 mg / day; risperidone at 4-6 mg / day; triftazine at 5-15 mg / day
	In affective disorders of the anxiety circle, hydroxyzine is used at 25-75 mg / day
	Neurometabolic therapy: picamilon to 0.05 g 3 times a day; aminophenylbutyric acid in 0.25 g three times a day.
	Vascular means: instenon 1 tablet 3 times a day; cinnarizine 25 mg 2-3 times a day
	Multivitamin preparations: aerovit, complim, glutamevit, center 1 tablet / day
	Course of hyperbaric oxygenation
	Symptomatic treatment of somatic and neurological diseases