Alcoholic paranoid

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

[1], [2],

Causes of alcoholic paranoids

Chronic abuse of alcohol.

[3]

How does the alcoholic paranoid manifest itself?

Acute alcoholic paranoid is manifested sensual (unsystematic, fragmentary) delusions of persecution. Anxious depressive affect, ideas of special significance, physical impact. For an acute alcoholic paranoid, along with a delusional treatment of the surrounding, illusory perception is typical. For example, patients in conversations hear in their address a threat, an emphatically negative attitude, etc. The affect of ashes prevails, against aggressive pursuers aggressive actions are possible.

Isolate abortive, acute and protracted alcoholic paranoids with schizophreniform inclusions.

The abortive alcoholic paranoid most often develops on a background of a drinking-bout, in a state of intoxication. The clinical picture is similar to acute alcoholic paranoids, however the duration of such psychosis is determined by several hours.

In acute alcoholic paranoid prodromal phenomenon lasts 3-5 days, develops in patients during the period of withdrawal symptoms; characterized by a depressed mood, malaise, anxious-fearful affect, a violation of sleep and appetite; vegetative disorders (tremor, sweating, palpitation, etc.), intensifying in the evening and night. Actually, the psychosis develops against the background of the withdrawal syndrome, usually after complete insomnia, in the evening or at night. The state of confusion in patients varies with acute fear and motor anxiety. At the same time, delusions of special significance arise, elementary auditory deceptions in the form of knocking, rustling, coughing, the sound of footsteps, etc., are quickly joined by fragmentary verbal hallucinations with delusions of persecution. Delirium of special significance is transformed into a diffuse-sensual delirium of persecution - simple in content, often addressed to everyday topics or specific situations. Complication of the delirium of delirium depends on illusory-hallucinatory disorders: on their basis delusions of poisoning, physical influence, jealousy develop. In the structure of the paranoid syndrome, along with the delirium of physical impact, there are separate phenomena of mental automatism, characterized by monofabulity, fragmentation, extreme instability. Often observed auditory pseudo-hallucinations, in content simple and specific.

In all cases of acute alcoholic paranoia, short impulsive actions are noted; patients suddenly rush to escape, on the move leave the transport, ask for help, etc. Nevertheless, it should be emphasized that they rarely commit aggressive actions toward imaginary pursuers.

In the evening and at night, patients have elementary visual illusions and hallucinations. The clinical picture of psychosis on average 10-24 days remains untapped and full of psychopathological symptoms. The reverse development of psychosis occurs much more slowly, the regress of psychopathological symptoms is sometimes prolonged to 1-1.5 months. At first, the affect of fear weakens, psychic automatisms, auditory deceptions, and then delusions disappear. According to clinical features, acute alcoholic paranoid is similar to a paranoid "external situation". These clinical variants of psychotic states bring together the development of alcoholic paranoids in a "road situation". Restoration of the critical attitude to the transferred psychosis does not occur immediately, is accompanied by long residual phenomena, post-toxication asthenia and symptoms of a psychoorganic personality defect.

The lingering alcoholic paranoid is evidenced by the transformation of affect and delirium. The affect of fear becomes less intense, anxious-low mood begins to prevail. The sensually illusory component of delirium is also reduced, marking its definite systematization: for example, the patient begins to suspect in an attempt not all of them, but only certain, specific persons. The motives for the persecution also become more concrete and definite. Outwardly, the behavior seems orderly, but suspicion, distrust, and low accessibility of the patient persist. Sometimes it is difficult to distinguish residual raving from a protracted paranoid and the benefit of the latter is the presence of a changed affect. Repeated alcoholic excesses exacerbate the course of the paranoid, psychosis in this case can become recurrent. The duration of psychosis is several months.

Differential diagnosis of alcoholic paranoids

Great difficulty is the delineation of alcoholic delirium and paranoid syndromes of schizophrenia, especially complicated alcohol dependence.

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

Alcoholic paroids	Paranoid schizophrenia complicated by alcohol dependence
An extensive clinical picture of alcoholism precedes. Formation of delirium is always preceded by an exacerbation of alcoholism	There is no clinical picture of alcoholism. Is fragmented or absent alcoholic AS. Systematic intake of alcohol - rarely
There is no dissociation in behavior, typical long antisocial behavior, quarrels and conflicts in the family	Dissociation in behavior is: emotionate. Manifestations do not correspond to actions. Quarrels and conflicts are rare
There is no isolation, alienation, emotional coldness, As a rule, rudeness, self-centeredness prevail, sexual harassment and cruel acts are possible in relation to the object of jealousy	Constant emotional tension, distrustfulness, suspicion, combined with inadequacy, emotional coldness towards wife and children
Delusion is limited, specific in nature (mostly persecution and / or jealousy), always follows from understandable links and depends on the surrounding situation	Delirium is polymorphic diffuse, often transformed, characterized by absurdity and intricacies
Changes in personality according to the organic type (emotional responsiveness, liveliness, alcoholic humor, accessibility, etc.)	Specific violations of thinking Further increase in productive and negative disruptions. In outcome - a specific schizophrenic defect

[4], [5]