Alcoholic psychosis: What to remember

The article is professionally consulted by Master, Doctor Bui Ngoc Phuong Hoa - General Internal Medicine - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital

Alcohol abuse can cause serious mental disorders, affecting not only personal and family life but also social problems.

Alcohol is a beverage containing Ethyl (Ethanol), the chemical formula is CH3-CH2-OH. Alcohol use causes effects on the body such as:
1.1 Absorption and metabolism Approximately 10% of alcohol intake is absorbed in the stomach. The remaining alcohol is absorbed in the small intestine. The concentration of alcohol in the blood peaks after 45-60 minutes depending on the state of the stomach (when fasting, alcohol absorption is faster than when full). About 90% of alcohol absorbed into the body is metabolized in the liver. The remaining 10% is excreted by the kidneys and lungs.
1.2 Effects of alcohol on the brain Alcohol has the ability to inhibit the nervous system, causing cross-tolerance. With an alcohol concentration of 0.05% in the blood, thought and judgment processes become lax or stagnant. At a blood alcohol concentration of 0.1%, voluntary movements become clumsy. Alcohol poisoning occurs when the blood alcohol concentration is 0.1 - 0.15%. At a concentration of 0.2%, the function of the entire motor area of ​​the brain was inhibited. At 0.3%, the patient was confused and comatose. From 0.4 to 0.5%, the patient falls into a coma.
1.3 Effects of Alcohol on Other Organs Alcohol damages many organs. Long-term alcohol use can cause brain atrophy, cerebellar degeneration, epilepsy, peripheral neuropathy, hepatitis, cirrhosis, myopathy, cardiomyopathy, gastritis, gastric ulcer, pancreatitis ,... People with chronic alcoholism are often deficient in thiamin, vitamin B12, nicotinic acid and folate. During pregnancy, if the mother uses alcohol, it will be toxic to the fetus, possibly causing deformities to the baby.

Alcohol can cause mental disorders. Alcohol use psychosis can be caused by acute alcohol intoxication or by chronic alcohol poisoning (alcoholism). Alcohol-related mental disorders include:
2.1 Alcohol dependence and abuse Definition of Alcohol Abuse: Persistent use of alcohol to the extent that it affects an individual's entire functioning, often leading to alcohol dependence; Alcohol dependence: The use of alcohol to the extent that it adversely affects health, physical and mental health. There are three common types: Continuous heavy alcohol use; Only drink heavily on weekends or when things go wrong at work; Heavy drinking lasts a few days to a week, alternating with periods of not drinking. Treatment The goal of treatment for an alcohol use disorder is to prolong alcohol cessation.
Cognitive treatment: It is necessary to let the patient know that he has an alcohol problem in order to cooperate in the treatment process; Psychosocial: The patient needs to recognize the harmful effects of alcoholism on the family; Chemotherapy: Use Disulfiram (Antabuse), Naltrexone (Revia) exactly as prescribed by your doctor for each specific case. 2.2 Alcohol intoxication (drunk) Definition Drinking a sufficient amount of alcohol to cause behavioral changes.
Common drunkenness: There may be mental disorders such as: emotional instability, anger, anxiety, behavioral disturbances, ... accompanied by symptoms of alcohol intoxication. These psychiatric disturbances are short-lived as long as the pharmacological effects of alcohol are present. When the pharmacological effect of alcohol wears off, these symptoms will disappear on their own; Pathological drunkenness: An acute mental disorder that occurs when intoxicated. After consuming alcohol in low doses, the subject developed an acute psychotic state. Subjects may have dangerous behaviors, lose control of their consciousness. The psychosis will go away after the hangover is over. There are 3 types of pathological drunkenness: Drunk with predominant delusions, drunk with predominant hallucinations, and drunk with predominant motor agitation. The consequences of alcohol intoxication can be car accident, injury, broken bones, criminal activity, murder or suicide,...
Treatment Pay attention to the patient's nutrition, especially supplements. thiamine, vitamin B12 and folate supplements; Monitor for complications such as assault, coma, injury, falls,... 2.3 Alcohol-induced psychosis Definition Psychosis due to alcohol or chronic alcohol intoxication. Psychotic disorder consisting of persistent hallucinations, mainly visual and auditory hallucinations, without delirium, usually occurring within 2 days of alcohol dependence in alcoholics. Alcoholic psychosis can be chronic and the clinical picture closely resembles schizophrenia. This is a rare condition, the ratio of men to women is 4/1, usually in people with a history of drinking alcohol more than 10 years.
Treatment Principles of alcohol psychosis are staged therapy, symptom relief, combined treatment of mental disorders and treatment of alcohol poisoning or alcohol withdrawal, monitoring and comprehensive care. Treatment is based on stages:
Acute stage: Includes treatment for alcohol detoxification (treatment of alcohol withdrawal syndrome) and treatment for mental disorders. The treatment for alcohol detoxification is high-dose B-vitamin therapy, intravenous and oral rehydration with electrolytes, anxiolytic, anti-vegetal nervous system disorder, and medical treatment. Treatment of mental disorders depends on the specific clinical situation and the patient's condition. Patients with paranoia, hallucinations, agitation; depression ; mania; anxiety will be prescribed using different drugs with appropriate dosages; Subacute and stable stage: Continue treatment with antipsychotics, antidepressants, anxiolytics and mood stabilizers,... with appropriate doses as prescribed by the doctor; Post-psychotic phase: Psychosocial rehabilitation to prevent relapse, help patients reintegrate into family and community.

2.4 Alcohol withdrawal syndrome Definition Alcohol withdrawal syndrome is a manifestation of chronic alcoholism, which occurs when alcohol is lacking or stopped. The patient will have symptoms of restlessness, irritability, restlessness, sadness, anxiety, fear, insomnia or nightmares, cardiac arrhythmias (palpitations, palpitations, tremors or severe). rather than generalized convulsions). These symptoms should be relieved or disappear quickly when drinking small amounts of alcohol.
Home Care Treatment: People with mild alcohol withdrawal can be treated at home. Relatives need to be present to monitor the patient's condition, promptly take the patient to the hospital when symptoms worsen; Hospitalization: When the symptoms of alcohol withdrawal syndrome get worse, the patient needs to be hospitalized so that the doctor can monitor the condition and prevent the risk of complications. You may need intravenous fluids to prevent dehydration and medication to relieve symptoms; Medication: Cases of alcohol withdrawal syndrome are usually treated with benzodiazepines. In addition, patients are given vitamin supplements to replace essential vitamins lost due to alcohol use, helping to prevent complications and nutritional deficiencies caused by chronic alcoholism. 2.5 Delirium (withdrawal delirium) Definition Delirium is a condition that usually occurs after cessation or reduction of alcohol intake in patients with a history of alcohol dependence, less common than with alcohol withdrawal and without symptoms. Symptoms are:
Delirium: Confusion, delirium, not aware of the surrounding environment. The patient feels like seeing horrible scenes such as being attacked by wild animals, having the feeling of insects crawling on the body or hearing unreal voices. As a result, patients with delirium tremens have extremely dangerous behaviors such as attacking people for no reason, burning houses, killing people,... Tremor: The patient has tremors in the limbs, whole body, even tongue. may be accompanied by symptoms of unsteady walking, profuse sweating, ... the disease is often severe at night. Treatment Record vital signs every 6 hours, observe the patient regularly; Reduce nerve stimulation factors, adjust electrolytes and treat comorbidities such as infections, traumatic brain injuries,... If the patient is dehydrated, rehydrate; Use drugs such as Chlordiazepoxide (Librium), Thiamine, Folic Acid, Multivitamin, ... with the dose and duration of use as prescribed by the doctor; Use sleeping pills to put the patient to sleep; Treat malnutrition if present; Avoid antipsychotics because they can trigger seizures. 2.6 Memory disorders Definition Memory disorders are common in people who drink a lot of alcohol for a long time. This alcohol-related mental disorder is also known as Wernicke encephalopathy (acute neurological symptoms) and Korxakoff syndrome (chronic condition).
Wernicke encephalopathy: An acute condition caused by thiamine deficiency (because of chronic alcoholism). Patients have symptoms of nystagmus, ophthalmoplegia, total confusion, making up stories, somnolence, inability to distinguish, mild delirium, insomnia due to anxiety, fear of the dark, etc. With treatment, Wernicke encephalopathy may disappear after a few days or weeks or may progress to Korsakoff syndrome; Korsakoff syndrome: Often associated with chronic alcoholism, caused by thiamine deficiency. Manifestations of the disease are that the patient often forgets the forward and reverse directions, makes up stories, disordered force orientation, and polyneuritis. Treatment of Wernicke's encephalopathy: Thiamine therapy is indicated until the ophthalmoplegia resolves, possibly requiring additional magnesium. With this treatment, most symptoms will be reversed; Korsakoff syndrome: Treat with thiamine, possibly clonidine and propranolol, and appropriate fluid resuscitation. Alcohol-related psychosis can cause many unpredictable consequences for the patient himself, his family, and society as a whole. Therefore, everyone should pay attention to limit the use of alcohol. When there are manifestations of alcohol-related psychosis, patients and families should cooperate with doctors to treat the disease promptly and effectively.
Psychological Clinic - Vinmec International General Hospital is the address for outpatient examination and treatment for psychological and mental health problems. With modern equipment, a team of professional doctors and specialized psychotherapies, patients with alcohol-related mental disorders will be best diagnosed and treated to achieve the highest efficiency.