Alcoholic abstinence syndrome
Alcoholic abstinence syndrome – a complex of the pathological symptoms arising at alcoholics at refusal of the use of alcoholic drinks. On manifestations reminds a hangover, however differs from it in a number of additional signs, including duration. Develops only at patients with 2 and 3 stages of alcoholism, in the absence of alcoholic dependence it is not observed. Is followed by perspiration, heartbeat, trembling of hands, an incoordination of movements, frustration of a dream and mood. Transition in alcoholic deliriya is possible (delirium tremens). Treatment – infusional therapy.
Alcoholic abstinence syndrome
Alcoholic abstinence syndrome (cancellation syndrome) – the complex of psychological, neurologic, somatic and vegetative frustration which is observed after the termination of reception of alcoholic drinks. Develops only at the people suffering from alcoholic dependence. Arises at the 2nd stage of alcoholism. A part of manifestations of this syndrome is similar to a usual hangover, however at a hangover there is no number of symptoms, including – insuperable thirst for alcohol. The hangover passes within several hours, the abstinence syndrome lasts several days.
Time period from the beginning of the regular use of alcoholic drinks before emergence of an alcoholic abstinence syndrome fluctuates from 2 to 15 years. Dependence between time of emergence of this state, gender and age of patients is observed. So, at young men and teenagers signs of abstinency are observed in 1-3 years after the beginning of abuse of alcohol, and in 2-5 years the disease becomes long and pronounced. At women this syndrome appears approximately in 3 years of regular reception of alcohol.
Pathogenesis of an alcoholic abstinence syndrome
After receipt in an organism ethanol is split in several ways: with alcohol dehydrogenase enzyme participation (mainly in cells of a liver), by means of catalase enzyme (in all cages of an organism) and with participation of mikrosomalny etanolokislyayushchy system (in cells of a liver). Ethyl aldehyde – the highly toxic connection exerting negative impact on work of all bodies and causing hangover symptoms becomes an intermediate product of metabolism in all cases.
At the healthy person alcohol is split mainly by means of alcohol dehydrogenase. At the regular use of alcohol alternative options of metabolism of alcohol become more active (with participation of a catalase and mikrosomalny etanolokislyayushchy system). It leads to increase in amount of ethyl aldehyde in blood, to its accumulation in bodies and fabrics. Ethyl aldehyde, in turn, exerts impact on synthesis and disintegration of dopamine (the chemical interacting with nervous cages).
Long alcohol intake leads to exhaustion of reserves of dopamine. At the same time alcohol itself connects to receptors of nervous cages, filling the arisen shortage. At the first stage of alcoholism the patient in a sober state suffers from the insufficient stimulation of receptors caused by a lack of dopamine and lack of the alcohol replacing it. Mental dependence is so formed. At the second stage of alcoholism the picture changes: the termination of reception of alcohol involves compensation failure, in an organism not only disintegration, but also dopamine synthesis sharply amplifies. Level of dopamine increases that brings to emergence of the vegetative reactions which are the main symptoms of an abstinence syndrome.
Change of level of dopamine caused such symptoms as sleep disorders, concern, irritability and increase HELL. Expressiveness of an abstinence syndrome directly depends on dopamine level. If its contents is trebled in comparison with norm, the abstinence syndrome passes in alcoholic deliriya (delirium tremens). Along with influence on the level of neurotransmitters, ethyl aldehyde negatively influences ability of erythrocytes to connect oxygen. Erythrocytes deliver less oxygen in fabric that leads to violations of exchange and oxygen starvation of cages of various bodies. Against the background of a fabric hypoxia there is a somatic symptomatology characteristic of an abstinence syndrome.
Depth of defeat of an organism at abstinency exerts impact on duration of this state. The usual hangover proceeds only several hours. Abstinency on average lasts 2-5 days, the maximum of symptomatology is usually observed on third day, at height of failure of compensation mechanisms owing to the alcohol intake termination. In hard cases the residual phenomena of abstinency can remain within 2-3 weeks.
Symptoms and classification of an alcoholic abstinence syndrome
There are several classifications of an alcoholic abstinence syndrome taking into account severity, time of emergence of certain symptoms, and also clinical options with prevalence of this or that symptomatology. At the 2nd stage of alcoholism mark out three severity of abstinency:
- 1 degree. Arises upon transition from the first stage of alcoholism to the second. Appears at short-term hard drinkings (usually – lasting no more than 2-3 days). The asthenic symptomatology and violations from the autonomic nervous system prevails. Is followed by heartbeat, dryness in a mouth and the increased perspiration.
- 2 degree. It is observed "in a heat" the second stage of alcoholism. Appears after hard drinkings lasting 3-10 days. Neurologic frustration and symptoms from internals join vegetative violations. HELL, nausea and vomiting, feeling of a turbidity and weight in the head, gait violations, trembling of hands, a century and language is followed by reddening of skin and whites of the eyes, heartbeat, fluctuations.
- 3 degree. Usually arises upon transition from the second stage of alcoholism to the third. It is observed at hard drinkings lasting over 7-10 days. Vegetative and somatic symptoms remain, but pass into the background. The clinical picture, generally is defined by mental violations: frustration of a dream, nightmares, uneasiness, sense of guilt, sad mood, irritation and aggression in relation to people around.
At the third stage of alcoholism the abstinence syndrome becomes pronounced and includes all listed above signs. It is necessary to consider that manifestations of abstinency can vary, expressiveness and prevalence of these or those symptoms depends not only on an alcoholism stage, but also on duration of concrete hard drinking, a condition of internals etc. Unlike a hangover, the abstinence syndrome is always followed by the invincible thirst for alcohol amplifying in the second half of day.
Taking into account time of emergence distinguish two groups of symptoms of abstinency. Early symptoms arise within 6-48 hours after refusal of reception of alcohol. If the patient resumes the use of alcoholic drinks, these signs can disappear completely or be softened significantly. After refusal of alcohol of the patient it is uneasy, excited, irritable. Heartbeat increase, trembling of hands, perspiration, increase HELL, disgust for food, diarrhea, nausea and vomiting is noted. The tone of muscles is lowered. Violations of memory, attention, judgments etc. come to light.
Late symptoms are observed within 2-4 days after the termination of the use of alcoholic drinks. Treat mainly violations of the mental sphere. Mental disorders arise against the background of aggravation of some early symptoms (heartbeat, excitement, perspiration, trembling of hands). The condition of the patient quickly changes. Obscuring of consciousness, a hallucination, nonsense and epileptic seizures are possible. The nonsense is formed on the basis of hallucinations and usually has paranoid character. The nonsense of prosecution is most often observed.
As a rule, early symptoms precede late, however this regularity is noted not always. In mild cases late symptoms can be absent. At some patients the late symptomatology develops suddenly, against the background of a satisfactory general condition, at absence or weak expressiveness of early manifestations of abstinency. Separate late symptoms can gradually be reduced, without passing in alcoholic deliriya. At emergence of all signs and progressing of late symptomatology delirium tremens develops. In some cases the epileptic seizure, and other symptoms becomes the first manifestation of abstinency (including early) join later.
Allocate 4 options of a course of an alcoholic abstinence syndrome with prevalence of symptomatology from various bodies and systems. This division has great clinical value as allows to establish what bodies suffered as a result of abstinency stronger and to pick up the most effective therapy. This classification includes:
- Neurovegetative option. The most widespread option of a course of an abstinence syndrome, "basis" on which other manifestations "are built on". HELL, trembling of hands, the puffiness of the person increased by perspiration and dryness in a mouth is shown by sleep disorders, weakness, lack of appetite, tachycardia, fluctuations.
- Cerebral option. Frustration from the autonomic nervous system are supplemented with unconscious states, dizzinesses, an intensive headache and hypersensibility to sounds. Attacks are possible.
- Somatic (visceral) option. The clinical picture is formed at the expense of pathological symptoms from internals. Easy yellowness a skler, an abdominal distension, diarrhea, nausea, vomiting, short wind, arrhythmia, pains in epigastralny area and area of heart comes to light.
- Psychopathological option. Mental violations prevail: uneasiness, changes of mood, fear, the expressed frustration of a dream, short-term visual and acoustical illusions which can pass into hallucinations. Orientation in space and time worsens. Thoughts of suicide and attempts of a suicide are possible.
Regardless of option of a current of abstinency, this state is always followed by violations of mentality and thinking of the patient. During this period all changes of the personality, characteristic of alcoholism, come to the forefront, become "more convex", noticeable from outside. Inertness and unproductiveness of thinking of the patient attracts attention. The patient badly perceives explanations and instructions, quite often acts and answers inattentively, in his answers and speeches there is no ease and the spontaneity characteristic of usual informal communication. The humour and irony are absent or are simplified and hardened.
At young people uneasiness, at elderly – decrease in mood prevails. Patients feel a hopelessness, suffer from sense of guilt because of impossibility to refrain from alcohol intake and the acts made in state of intoxication. In certain cases there are panic attacks. Depression alternates with the commitment episodes caused by strengthening of thirst for alcohol. In this state patients without remorse deceive relatives, pick locks or run away from the house through a balcony, elicit money at acquaintances and strangers, commit thefts etc.
Treatment of an alcoholic abstinence syndrome
Treatment of an abstinence syndrome is performed by experts in the field of narcology. Patients with easy forms of abstinency can receive the help of the narcologist at home or on an outpatient basis. The scheme of treatment includes intravenous drop injection of salt solutions, vitamin therapy, dezintoksikatsionny therapy (intake of absorbent carbon), means for restoration of functions of various bodies and improvement of activity of nervous system. Sick appoint benzodiazepines – medicines which reduce uneasiness, have soothing, somnolent and anticonvulsive effect and at the same time influence the autonomic nervous system, promoting elimination of vegetative violations.
The indication for hospitalization is exhaustion, considerable dehydration, the expressed hyperthermia, strong trembling of extremities, a century and language, hallucinations, epileptic seizures and violations of consciousness. Hospitalization is necessary in the presence of somatic pathology, including – gastrointestinal bleeding, respiratory insufficiency, a heavy liver failure, pancreatitis, heavy bronchitis and pneumonia. Patients are also hospitalized in the presence of mental disorders (schizophrenia, maniac-depressive psychosis, an alcoholic depression) and at identification in the anamnesis of episodes of alcoholic psychosis.
The aid program the patient in stationary conditions includes medicamentous therapy (the scheme of out-patient treatment is supplemented with neuroleptics, anticonvulsive medicines, hypnotic drugs, tranquilizers, nootropa, means for correction of mental and somatic violations), a special diet, a plasma exchange and other non-drug ways of therapy. Treatment is carried out after the corresponding inspection. Patients are under observation of the narcologist.
The forecast at an alcoholic abstinence syndrome
In mild cases all phenomena of an abstinence syndrome without treatment disappear during the period up to 10 days, at treatment without hospitalization (at home or on an outpatient basis) – during the period up to 5 days. The forecast at heavy abstinency depends on a form of frustration, expressiveness of mental violations and weight of somatic pathology. The heaviest current is observed at prevalence of psychopathological symptomatology and transition to alcoholic deliry. Neurovegetative and visceral options proceed easier and have smaller duration.
It is necessary to remember that abstinency is a sign of already developed alcoholic dependence. If the patient continues to take alcohol, over time the phenomena of abstinency will be aggravated, and alcoholism will progress. At emergence of an abstinence syndrome it is necessary to address the narcologist who will recommend the most effective scheme of treatment of alcoholism (installation of the coding implant, drug treatment of alcoholism, gipnosuggestivny therapy, coding across Dovzhenko, etc.) and will advise the suitable program of rehabilitation.