ALCOHOLISM
Alcoholism is a chronic mental illness caused by alcohol abuse, characterized by a pathological craving for alcohol and the associated physical and mental consequences of alcohol intoxication of increasing severity.
The primary link in the development of alcoholism is acute alcohol intoxication with its characteristic clinical manifestations of intoxication, predisposing to the development of the disease.
Alcoholism, like any human disease, arises and develops as a result of a combination of environmental and genetic factors, representing a violation of the adaptation of the body and personality to the social environment, associated with certain pathobiological mechanisms.
Pathological attraction to alcohol has pronounced dominant properties, prevailing over other motivations in human behavior. As a result, alcohol is consumed not so much for the sake of anything, but in spite of many negative consequences, among which are the violation of family, friendship, labor and other social ties, conflicts with the law, signs of deteriorating health, and regularly occurring painful hangovers. The continuation of the systematic consumption of alcohol, despite all these circumstances, is the surest diagnostic criterion for a pathological craving for alcohol. This criterion is used by modern clinicians as a key sign of alcoholism in general, which indicates the exceptional importance of the pathological craving for alcohol in the pathogenesis and clinical picture of the disease.
"Syndrome of alcohol dependence".
In the ICD-10, all alcohol disorders are concentrated in section V "Mental and behavioral disorders". They form the subsection "Mental and behavioral disorders due to the use of psychoactive substances"
(headings F10 - F11).
Syndromedependenciesfromalcoholincludes: 1) a strong desire to take alcohol or an urgent need for alcohol;2) impaired ability to control its consumption;3) the emergence of a tendency to drink alcohol the same way both on weekdays and on weekends, despite social constraints ("narrowing the repertoire" of consumption); 4) progressive neglect of alternative pleasures and interests; 5) continued drinking despite obvious harmful effects; 6) withdrawal syndrome;7) hangover;8) increased tolerance to alcohol.
The diagnosis of alcoholism should be based on criteria that are both sufficiently sensitive and specific. Such criteria are best served by clinical syndromes and the sequence of their change during the course of the disease.
PREVALENCE
The generally accepted statistical indicators of the incidence and morbidity of alcoholism do not reflect the real situation much, since the number of identified and registered patients to a large extent depends on the activity of the narcological service. This has been especially evident recently (since 1990), when the strict system of mandatory dispensary registration, active detection and semi-compulsory involvement in treatment of patients with alcoholism ceased to operate. Therefore, to assess the drug situation, a number of indirect indicators are used: the dynamics of alcohol consumption in a particular region, mortality from liver cirrhosis, the incidence of alcoholic psychosis, crime, traffic accidents, injuries, the number of divorces, etc. Each of these indicators taken separately, of course, ambiguous and debatable, but in combination they are quite informative.
CLASSIFICATION OF ALCOHOLIC MENTAL DISORDERS
Mental disorders caused by alcohol use are usually divided into groups depending on the duration of its use: arising after single or episodic use and resulting from repeated use over a significant period of time (chronic use), as well as depending on the presence and absence of psychotic disorders.
Groups of alcohol disorders:
I. Acute alcohol intoxication:
simple alcohol intoxication;
altered forms of simple alcohol intoxication;
pathological intoxication. P. chronic alcoholism;
III. Alcoholic (methalcohol) psychoses.
Like any other classification of human diseases, the above division of alcoholic pathology is somewhat schematic and conditional. In clinical practice, other diagnostic classifications are also used, which will be given when considering chronic alcoholism.
ACUTE ALCOHOL INTOXICATION
According to the ICD-10, acute alcohol intoxication is a transient condition following the ingestion of alcohol that causes disturbances or changes in physiological, psychological or behavioral functions and responses.
If all cerebral functions affected by alcohol are conditionally divided into mental, neurological and autonomic, then it can be even more conditionally considered that a mild degree of alcohol intoxication is manifested mainly by mental disorders, an average degree by the occurrence, in addition to them, of obvious neurological disorders, severe degree - violations of vital autonomic functions with the actual cessation of mental activity and deep inhibition of motor and reflex activity. Strictly speaking, any degree of alcohol intoxication is characterized by the effect of alcohol on all three of these areas of function, but since mental functions are violated earlier and more strongly than others, these disorders should be considered leading.
Simple alcohol intoxication
Alcohol intoxication can be defined as a psychopathological syndrome, the structure of which depends on the dose of alcohol taken, the time elapsed from that moment, and on the biological and psychological characteristics of a person who has undergone alcohol intoxication. The degrees of alcohol intoxication are the stages of the dynamics of this psychopathological syndrome.
Although simple alcohol intoxication is a mental pathology in a clinical sense, in a legal sense it is not and does not relieve a person of responsibility.
The given narrowly clinical definition of alcohol intoxication as a psychopathological syndrome is opposed to its broad interpretation as inadequate: behavior or as a state in which "normal reactions to the external environment change. In this understanding, the assessment of behavior and the degree of its adequacy depend largely on the specific environmental conditions, their for example, at a blood alcohol concentration of 0.4 mmol / l, when there are no clinical signs of intoxication, the skill of transport drivers drops by 32%. On the contrary, in the habitual and unhurried activity of a person, it is difficult to detect any deviations in reactions when he uses, for example, a glass of beer.
Thus, the clinical diagnosis of simple alcohol intoxication does not have a universal meaning - it is used only when the appropriate need arises. In other cases, diagnosis is limited to special tests and departmental guidelines apply.
Degrees of alcohol intoxication. As already noted, the symptoms of alcohol intoxication are determined primarily by the concentration of alcohol in the blood. At low concentrations in the blood, a stimulating effect prevails.
A mild degree of alcohol intoxication, in which the concentration of alcohol in the blood is from 20 to 100 mmol / l (20-100 mg of alcohol per 100 ml of blood), is usually characterized by an increase in mood, verbosity, acceleration of associations, an increase in the amplitude of emotional reactions, a decrease in self-criticism, instability attention, impatience and other signs of the predominance of mental excitation over inhibition. At the same time, some neurological (impaired coordination of fine movements, nystagmus) and vegetative (hyperemia of the face, increased heart rate and respiration, hypersalivation) disorders can be observed.
In case of moderate intoxication (alcohol concentration e blood from 100 to 250 mmol / l), mental reactions lose their vivacity, thinking becomes slow, unproductive, judgments - trivial and flat, speech - perseverative and blurred. Understanding and correct assessment of the surroundings are sharply difficult. Emotional reactions are coarsened, become brutal, the mood tends to gloom, anger or dull indifference.
Neurological disorders during moderate intoxication are manifested in ataxia, uncoordinated movements, dysarthria, weakening of pain and temperature sensitivity. Hyperemia of the face is replaced by cyanotic coloration and pallor, nausea and vomiting often occur.
Severe alcohol intoxication (with a blood alcohol concentration of 250 to 400 mmol / l) is expressed by depression of consciousness - from stupor and somnolence to coma. Sometimes there are epileptiform seizures. At higher concentrations of alcohol in the blood (up to 700 mmol / l), death from respiratory paralysis can occur.
The maximum tolerated concentration of alcohol is variable. A case is described when a person remained awake and could participate in a conversation with a blood alcohol concentration of over 780 mg%.
The duration of alcohol intoxication depends on many factors (gender, age, racial characteristics, addiction to alcohol), but most of all - on the amount of alcohol consumed and its metabolic transformation in the body.
After moderate and especially severe alcohol intoxication, post-intoxication phenomena remain for several hours the next day - headache, thirst, poor appetite, weakness, weakness, nausea, vomiting, dizziness, tremor. Of great practical importance is a decrease in working capacity, the severity of which depends both on the "alcoholic" factor and on the individual characteristics of the drinker. In many respects it is determined by the nature of work. For example, even in experienced pilots, after a slight intoxication, a decrease in professional skills is noted within 14 hours.
With age, as well as in the process of systematic alcohol abuse, the time required to fully restore the normal state increases, and the violations become more severe and diverse. With the continuation of the systematic abuse of alcohol, a "symptom of decompensation of well-being" is formed. In these cases, the state of health remains poor for 1-2 days after drinking. The next stage may be the development of postintoxication syndrome into alcohol withdrawal syndrome.
Altered forms of simple alcohol intoxication
Symptoms of acute alcohol intoxication largely depend on the "soil" that alcohol affects. The presence of such soil (consequences of previously transferred diseases, injuries, as well as emerging pathology) leads to the emergence of altered forms of alcohol intoxication. Among them are the following:
The dysphoric variant of intoxication is a state when, instead of the euphoria characteristic of simple alcoholic intoxication, from the very beginning there is a gloomy mood with irritability, anger, conflict, and a tendency to aggression. In other words, a mild degree of intoxication with its emotional background resembles an average degree, i.e. as if it carries the beginning of a more difficult state. Such features of alcohol intoxication are often observed in patients with chronic alcoholism, as well as in various kinds of organic brain failure.
The paranoid variant of intoxication is characterized by the appearance of suspicion, resentment, captiousness, a tendency to interpret the words and actions of others as a desire to humiliate, deceive, ridicule, win in rivalry; jealous feelings and the aggression connected with them are possible. Similar traits of behavior in intoxication are found in some psychopathic personalities - epileptoid, paranoid, primitive (especially if they are chronically alcoholic).
Alcohol intoxication with hebephrenic features is manifested by foolishness, stereotypy, antics, chaotic debauchery, monotonous onomatopoeia, senseless riot. Such pictures can be observed in the presence of a latent schizophrenic process, as well as in adolescents and young men.
Alcohol intoxication with hysterical traits - in the presence of appropriate personal prerequisites (egocentrism, a desire to be in the spotlight, a tendency to "exploit" the sympathy of others, the desire to make a vivid impression, exceeding ambitions over abilities), alcohol intoxication brings to life hysterical mechanisms that are most often manifested as demonstrative suicidal attempts, theatrical woeful affect, stormy scenes of despair, "madness", etc.
Pathological intoxication
The term "pathological intoxication" does not quite accurately reflect the essence of this phenomenon: it is not so much the result of alcohol intoxication, but rather an expression of a kind of idiosyncrasy to alcohol, which can occur with a certain combination of a number of factors (overwork, forced insomnia, psychogenia, organic cerebral insufficiency, etc.). .). The picture of pathological intoxication and outwardly bears little resemblance to alcohol intoxication, since there are no violations of statics and coordination of movements, as well as pantomimic features characteristic of the appearance of an intoxicated person.
Essentially, pathological intoxication is a transient psychosis, and syndromologically, it is a twilight state of consciousness. Two of its forms are distinguished - epileptoid and paranoid, which differ in the predominance of certain disorders.
In the epileptoid form, painful symptoms are expressed in the form of total disorientation, the absence of any contact with the surrounding reality, a sharp motor excitation with the affect of fear, anger, anger, with silent, senseless and cruel aggression, which sometimes has the character of automatic and stereotyped actions.
In the paranoid form, the patient's behavior reflects delusional and hallucinatory experiences of frightening content. The same is evidenced by individual words, cries, commands, threats, although in general the patient's speech production is scarce and incomprehensible. Motor activity has a relatively ordered character, takes the form of complex and purposeful actions (escape using transport, defense, attack, committed with great force).
Pathological intoxication arises suddenly and just as suddenly breaks off, often ending in deep sleep. It lasts from several minutes to several hours, leaving behind asthenia, headache, total or partial amnesia. Complete amnesia is more typical for the epileptoid form, partial - with fragmentary, sometimes very colorful, memories - for the paranoid form.
CLINICAL MANIFESTATIONS AND PATTERNS OF THE COURSE
The basis of the clinical picture of alcoholism is three syndromes - pathological craving for alcohol, alcohol withdrawal syndrome and alcohol degradation of personality.
These main syndromes are among the common features that unite all clinical variants of alcoholism. They are sequentially formed in the course of the development of the disease. Consider each of the major syndromes.
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Alcohol intoxication
Table of contents
- Introduction
- 3. Pathological intoxication
- Conclusion
- Bibliographic list
Introduction
Alcohol is the most commonly used psychoactive substance. Alcohol-containing drinks from the standpoint of pharmacology, toxicology and narcology are a narcotic substance. But since alcohol is not listed as controlled as a drug, alcoholism is not legally considered a drug addiction. In the system of organizing drug treatment for the population, alcoholism occupies a leading place and represents the main form of diseases in this group.
Ethyl alcohol acts mainly on the central nervous system. It causes a characteristic alcoholic excitation. First of all, under the influence of alcohol, the activity of the cerebral cortex is disrupted, and with an increase in its concentration in the blood, cells of the spinal cord and medulla oblongata are affected. Spinal reflexes suffer only with deep intoxication. Under the influence of alcohol, the reactivity and efficiency of cortical cells decrease, which leads to the disruption of complex conditioned connections. Excitation, characteristic of alcoholic intoxication, does not in any way indicate the true stimulating effect of alcohol. It causes inhibition of the inhibitory processes of the cerebral cortex, leading to the release of subcortical centers, which determines the picture of alcoholic excitation. In large doses, alcohol also depresses the subcortical centers, which can lead to a coma. Under the influence of alcohol, the coordination of the antagonist muscles is disturbed, which leads to inaccurate movements: the gait of the intoxicated becomes shaky, uncertain (to a large extent this is also due to the dysfunction of the vestibular apparatus).
Alcohol, acting mainly through the central nervous system, is a strong stimulant of the secretion of the gastric glands, but the gastric juice secreted at the same time is poor in enzymes, and its digestive capacity is reduced. The local effect of alcohol on the gastrointestinal tract is also significant, the prolonged hyperemia and stagnation in the blood vessels caused by it lead to degenerative changes in the parenchymal elements of the mucous membrane, which becomes smooth and eroded.
Alcohol enhances the motor function of the stomach, and therefore the evacuation of its contents occurs faster. When taken orally, under normal conditions, about 20% of the alcohol taken is absorbed in the stomach, and the remaining 80% in the small intestine. Alcohol diffuses into the wall of the stomach and small intestine, most of it enters unchanged directly into the bloodstream. Another part of the alcohol penetrates the wall of the stomach and small intestine and enters the abdominal cavity, from there it is absorbed by the large surface of the peritoneum and only then enters the bloodstream.
The purpose of this work is to review the activities of law enforcement officers with atypical and acute reactions when drinking alcohol.
1. Simple alcohol intoxication
Simple alcohol intoxication can manifest itself in mild, moderate and severe degrees.
A mild degree of simple alcohol intoxication (usually with a blood alcohol concentration of 1-1.5%) is manifested by a feeling of warmth, flushing of the skin, increased heart rate, increased appetite, and sexual desire. Attention is easily distracted, the pace of thinking accelerates, inconsistency and superficiality begin to predominate in it. In movements, there is a large scope, impetuousness, and a decrease in accuracy. The mood improves, there is a feeling of cheerfulness and contentment, pleasant thoughts and associations prevail, the perception of what is heard and seen has a predominantly positive color. Fluctuations in the emotional background, if they occur, are shallow (slight resentment, annoyance, impatience with a touch of irritation) and soon pass. Speech becomes louder and faster, but there are either no articulation disorders, or, more rarely, they are slightly expressed. The critical attitude both to one's condition and to the duties performed decreases. After some time from the onset of intoxication, elated mood is gradually replaced by lethargy and indifference, physical activity gives way to relaxation; thinking becomes slower. The state of fatigue is growing, there is a desire to sleep. After a mild degree of intoxication, which lasts an average of several hours, no unpleasant mental and physical sensations are noted, memories of the period of intoxication are preserved.
The average degree of simple alcohol intoxication (blood alcohol concentration from 1.5 to 3%) is characterized by more severe behavioral changes. Speech becomes dysarthritic and louder due to an increase in the threshold of auditory perception. Representations are formed with difficulty, their content is monotonous. The slowdown of the associative process makes it impossible to choose a synonym or replace a difficult word. There are frequent repetitions of the same phrases. Attention switches slowly, only under the influence of strong stimuli. The ability to critically assess one's capabilities and the actions of others is sharply reduced. This leads to the emergence of various kinds of conflicts, which are due to the overestimation of the intoxicated own personality and the disinhibition of drives and desires. The surrounding situation is assessed only fragmentarily, as a result of which inadequate, including illegal, actions are often committed. Movements become uncertain, motor skills are even more upset and symptoms of ataxia appear. Practically all persons with moderate intoxication have gross violations of handwriting, staggering with a tendency to fall in the Romberg position, and weakness in the reaction of pupils to light. It should be emphasized that a person who is in a state of moderate intoxication, despite the symptoms described above, is capable of very correct and accurate remarks not only to those around him, but also to himself, i.e. mental disorders are always dissociated.
Moderate intoxication is usually replaced by deep sleep. Upon awakening, the consequences of intoxication are felt: weakness, lethargy, weakness, dry mouth, thirst, a feeling of heaviness in the head, in some cases irritability or depressed mood. Physical and mental performance is reduced. About the events that took place during the period of intoxication, especially those that were not emotionally significant, memories are vague, with individual episodes being remembered.
A severe degree of simple alcohol intoxication (the concentration of alcohol in the blood is from 3 to 5% and above) is determined by the appearance of symptoms of stupor of consciousness of various depths. In the most severe cases, an alcoholic coma develops. Neurological disorders are always observed: cerebellar ataxia, muscle atony, amimia, severe dysarthria. Vegetative disturbances intensify: respiration is reduced up to its pathological forms, the tone of the cardiovascular system decreases, cyanosis of the extremities and hypothermia appear. Vestibular disorders are often observed: dizziness, nausea, vomiting. In some cases, epileptiform seizures occur. Possible involuntary discharge of urine and feces. After severe intoxication has passed, adynamic asthenia is observed for several days, initially accompanied by ataxia, dysarthria, and various autonomic disorders. Anorexia and sleep disturbances are characteristic. Severe intoxication is usually accompanied by complete amnesia - the so-called. narcotic amnesia.
2. Atypical forms of simple alcohol intoxication
These are states of mild or moderate acute alcohol intoxication, in which (compared to simple intoxication) an excessively sharp increase or, conversely, weakening of some disorders occurs, or the sequence of their occurrence is disturbed, or symptoms develop that are not characteristic of simple alcohol intoxication.
Mental disorders undergo the greatest modification; much less - neurological. Altered forms of simple alcohol intoxication usually occur under various concomitant conditions: on pathological grounds (psychopathy, oligophrenia, mental illnesses of various genesis, with residual organic brain damage, early onset of alcoholism, developed alcoholism, simultaneous use of alcohol and drugs, combined intake of various types of alcoholic beverages, in cases where intoxication is preceded by a somatic disease or it occurs against its background, as well as in case of lack of sleep, overwork or psychogenic disorders.The selected options reflect the prevailing psychopathological disorders.
Explosive variant of a modified simple alcohol intoxication. The state of euphoria is expressed weakly and easily spontaneously or under the influence of external insignificant circumstances by transient outbursts of sharp discontent, irritation or anger. Accordingly, the content of statements and behavior change. Usually these outbreaks are short-lived, alternating with relative calm and even complacency, but during intoxication they are repeated repeatedly.
Dysphoric variant of altered simple alcohol intoxication. A persistent state of tension prevails, accompanied by discontent, gloom, hostility or anger. In almost all cases, a low-dreary affect can be detected. Hostility and anger spread to everything seen and heard: the intoxicated becomes picky, caustic, cocky, looking for a reason to quarrel. A feeling of somatic discomfort and hyperesthesia are often detected. The above violations can be observed for several days after the alcoholic excess.
A hysterical version of a modified simple alcohol intoxication. The behavior of an intoxicated person is always designed for the viewer. There is a simulated affect with a tendency to loud phrases, recitations, the content of which usually comes down to unfairly received insults. Often in statements that are distinguished by pathos, various accusations against others, self-praise or, on the contrary, exaggerated self-reproach, predominate, fantasizing is often observed.
A depressive version of a modified simple alcohol intoxication. The clinical picture is dominated by a depressed mood of varying severity and shades. As a rule, the euphoria of the initial period is either absent or short-lived. In relatively mild cases, there is a subdepressive affect with tearfulness, unpleasant memories, self-pity. In more severe cases - longing, a feeling of hopelessness, anxiety, which are accompanied by self-reproach and suicidal thoughts. Due to the lack of motor inhibition in this state, the likelihood of suicidal attempts is high.
Altered simple alcohol intoxication with impulsive actions, as a rule, is observed in patients with schizophrenia and is usually accompanied by sexual perversions - homosexual acts, exhibitionism, flagellation. Pyromania and kleptomania are much less common.
Altered simple alcoholic intoxication with a predominance of somnolence. After a short and mild period of euphoria, a state of drowsiness occurs, quickly turning into sleep.
The manic version of a modified simple alcohol intoxication is manifested by an elevated mood with carelessness and complacency, short outbursts of irritation, various "naughty" actions, annoying pestering, inappropriate jokes, loud laughter, and increased responsiveness to the environment. The picture of intoxication may resemble a manic state of organic genesis, less often - hebephrenic excitement.
With all the listed forms of altered simple alcoholic intoxication, symptoms of ordinary intoxication, expressed to varying degrees, are always observed: deterioration in motor skills, articulation, changes in behavior depending on environmental conditions, and intact orientation.
The most severe in terms of clinical manifestations and social consequences are such altered forms of simple alcohol intoxication as epileptoid and paranoid. Their very name emphasizes the well-known similarity with the main types of pathological intoxication.
Epileptoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is determined by rapidly increasing motor excitation with the effects of irritation or anger towards others. The state deepens under the influence of opposition and is complicated by aggressive violent acts. Initially, aggression is usually selective and directed at persons directly related to the behavior of the intoxicated. As motor excitation intensifies, aggressive actions spread to everyone who is nearby. The disturbances of coordination of the movement observed earlier usually decrease or absolutely disappear. At the height of arousal, movement disorders and statements can become stereotyped, but a semantic connection with the situation of the initial period of intoxication is always preserved. Moreover, the intensity of speech-motor excitation and the aggressive actions associated with it is subject to certain fluctuations, depending on the verbal reactions of others. At the height of the episode, there is no complete separation of the intoxicated from the real situation. Mental disorders disappear critically, followed by drowsiness or sleep. Quite often there is amnesia of the period of pronounced excitement.
3. Pathological intoxication
Pathological intoxication is a hyperacute transient psychosis caused by alcohol intake. After taking a relatively small amount of alcohol, twilight stupefaction suddenly develops. There is a detachment from the environment, accompanied by disorientation of all kinds, but the usual automated actions remain, in particular the ability to move on foot or in transport. As a rule, the episode is completely amnesic. In the field of view of psychiatrists, those cases of pathological intoxication usually fall in which twilight clouding of consciousness is accompanied by productive disorders - figurative delirium, motor excitation, affective disorders (fear, rage, frenzy), visual hallucinations of a frightening nature, i.e. there is a "psychotic" form of twilight clouding of consciousness. In this state, socially dangerous acts are often committed. The actions of patients are entirely determined by the psychotic disorders that have arisen, the real situation does not matter for their actions. In the behavior of persons in a state of pathological intoxication, two main tendencies are usually revealed: defense with the desire to destroy the source of danger and flight from a life-threatening situation. Often these two tendencies coexist. With a certain degree of conventionality, two main forms of pathological intoxication are distinguished - epileptoid and paranoid, or hallucinatory-paranoid (more common).
In the epileptoid form of pathological intoxication, intense motor excitation predominates, usually in the form of meaningless and chaotic, aggressive actions of a stereotypical nature. The affect of frenzied anger and rage predominates, speech production is very poor, sometimes motor excitation is mute. Hallucinatory-delusional disorders are usually rudimentary.
In the paranoid (hallucinatory-paranoid) form of pathological intoxication, figurative delusions predominate, the content of which is usually situations that threaten the life of the intoxicated person. The environment is perceived in an altered (illusory-delusional) plan. In a state of motor excitation, the ability to perform sequential and complex actions that outwardly look purposeful is often retained. Both motor and speech reactions are caused by psychopathological disorders, primarily delirium and altered affect. Much less often, frightening visual hallucinations predominate in the clinical picture; as a rule, these are isolated rather than scene-like phenomena. Oppressive, haunting, relatively simple visual hallucinations predominate.
alcohol intoxication pathological simple
Approximately in 2/3 of cases, pathological intoxication is replaced by deep sleep, and in the rest - by a sharp psychophysical exhaustion. A very common symptom of pathological intoxication is amnesia of a psychotic episode (almost 90%), with more than half having complete, and the rest partial.
There is evidence that in 10% of cases there are repeated states of pathological intoxication.
Pathological intoxication can occur in practically healthy individuals, but much more often a psychotic episode develops against the background of permanent and temporary additional hazards. The former include residual effects of transferred organic (TBI, neuroinfections) diseases. Of the temporary additional hazards, overwork, lack of sleep, increased or decreased ambient temperature, sudden temperature changes, intercurrent somatic and infectious diseases, as well as previous psychogenies are more common.
Forensic psychiatric examination qualifies pathological intoxication as a state of insanity, in connection with which persons who have committed socially dangerous acts in this state are exempted from criminal liability.
4. Treatment of acute alcohol intoxication
With mild and moderate degrees, general and local warming is recommended, inside 10-15 drops of ammonia in 100 ml of water.
In moderate and severe cases: gastric lavage, subcutaneous injection of 0.25-0.5 ml of apomorphine hydrochloride solution (to induce vomiting), bladder catheterization in case of urinary retention. In a coma - the introduction of cardiac drugs, intravenously, 100 mg of pyridoxine (vitamin B6), up to 1 liter of saline with 15-20 ml of 40% glucose. With strong motor excitement, vitamin B12 is recommended at a dose of 50-100 mg. The introduction of barbiturates is contraindicated!
In cases of severe coma - venipuncture with the withdrawal of up to 200 ml of blood, subcutaneous saline - 800-1000 ml. With asphyxia - inhalation of oxygen, artificial respiration, cytiton (1 ml of a 0.15% solution in / in), lobelin (1 ml of a 1% solution of s / c), inhalation of a mixture of 90% oxygen and 10% carbon dioxide.
A medical examination to determine the state of intoxication is a complex event that fulfills the social order of society, including the fulfillment of legal, medical, metrological, moral and ethical requirements.
Since the examination is carried out in accordance with the requirements of applicable laws and other regulatory documents, its consequences can lead to serious consequences for the person being examined.
A feature of the medical examination is that not only specialists involved in this particular activity are involved in the examination, but also non-specialists in the field of medical examination - a wide range of doctors of other specialties and paramedics for whom the medical examination is an additional burden. As a rule, they are not sufficiently familiar with the legal basis of the examination, the procedure for its conduct and the criteria for substantiating the conclusion.
The basis of the medical opinion regarding the conditions associated with the consumption of alcohol is the data of a comprehensive medical examination. After its completion, the exhaled air is taken to examine it for the presence of alcohol. Blood for alcohol testing is taken in exceptional cases: for medical reasons (for example, severe injuries, poisoning, etc.), as well as in cases where, due to the severity of the condition of the person being examined, signs of intoxication cannot be detected.
The conclusion about intoxication is made on the basis of identifying clinical signs of intoxication and positive results of the study of exhaled air for the presence of alcohol. The degree of intoxication is not indicated, since there is no such requirement in legislative acts.
Conclusion
Alcohol intoxication is an acute intoxication caused by the psychotropic effect of drinks containing ethyl alcohol (alcohol), causing inhibition of the central nervous system. In mild cases, it proceeds with ideomotor agitation and vegetative symptoms, in severe cases, with a further deepening of inhibition, the development of neurological disorders and a sharp depression of mental functions, up to coma.
The severity of alcohol intoxication and its clinical features depend not only on the amount of alcohol taken, the rate of intake, air temperature and even its concentration in the blood. It also depends on the individual biological, mental characteristics of the individual - the type of nervous system, personality traits, as well as on his functional state at the moment. For example, the sensitivity to alcohol is sharply increased in psychopathic individuals, in persons with the consequences of craniocerebral injuries, who have had infectious and somatic diseases or central nervous system depletion in the past, and even just overwork immediately before drinking alcohol.
Clinical manifestations of alcohol intoxication are divided into the following main types:
A) simple alcohol intoxication;
B) modified forms of simple alcohol intoxication;
C) pathological intoxication.
Bibliographic list
1. Balabanova L.M. Forensic pathopsychology (issues of determining the norm and deviations). - D.: Stalker, 1998.
2. Dunaevsky V.V., Styazhkin V.D. Drug addiction and substance abuse. - L .: Medicine, 1990.
3. Kirpichenko A.A. Psychiatry: Proc. for honey. in-tov, - Mn .: Vysh. school, 1996.
4. Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M.: "Expert Bureau - M", 1997.
5. Forensic psychiatry. / Ed. G.V. Morozov. - M.: Yur. Lit., 1978.
6. Forensic psychiatry: Textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.
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These are states of mild or moderate acute alcohol intoxication, in which (compared to simple intoxication) an excessively sharp increase or, conversely, weakening of some disorders occurs, or the sequence of their occurrence is disturbed, or symptoms develop that are not characteristic of simple alcohol intoxication.
Mental disorders undergo the greatest modification; much less - neurological. Altered forms of simple alcohol intoxication usually occur under various concomitant conditions: on pathological grounds (psychopathy, oligophrenia, mental illnesses of various genesis, with residual organic brain damage, early onset of alcoholism, developed alcoholism, simultaneous use of alcohol and drugs, combined intake of various types of alcoholic beverages, in cases where intoxication is preceded by a somatic disease or it occurs against its background, as well as in case of lack of sleep, overwork or psychogenic disorders.The selected options reflect the prevailing psychopathological disorders.
Explosive variant of altered simple alcohol intoxication. The state of euphoria is expressed weakly and easily spontaneously or under the influence of external insignificant circumstances by transient outbursts of sharp discontent, irritation or anger. Accordingly, the content of statements and behavior change. Usually these outbreaks are short-lived, alternating with relative calm and even complacency, but during intoxication they are repeated repeatedly.
Dysphoric variant of altered simple alcohol intoxication. A persistent state of tension prevails, accompanied by discontent, gloom, hostility or anger. In almost all cases, a low-dreary affect can be detected. Hostility and anger spread to everything seen and heard: the intoxicated becomes picky, caustic, cocky, looking for a reason to quarrel. A feeling of somatic discomfort and hyperesthesia are often detected. The above violations can be observed for several days after the alcoholic excess.
A hysterical version of a modified simple alcohol intoxication. The behavior of the intoxicated is always designed for the viewer. Often in statements that differ in pathos, various accusations against others, self-praise or, on the contrary, exaggerated self-reproach, predominate, fantasizing is often observed.
Depressive variant of altered simple alcohol intoxication. The clinical picture is dominated by a depressed mood of varying severity and shades. As a rule, the euphoria of the initial period is either absent or short-lived. In relatively mild cases, there is a subdepressive affect with tearfulness, unpleasant memories, self-pity. In more severe cases, there is longing, a feeling of hopelessness, anxiety, which are accompanied by self-reproach and suicidal thoughts. Due to the lack of motor inhibition in this state, the likelihood of suicidal attempts is high.
Altered simple drunkenness with impulsive actions, as a rule, is observed in patients with schizophrenia and is usually accompanied by sexual perversions - homosexual acts, exhibitionism, flagellation. Pyromania and kleptomania are much less common.
Altered simple alcoholic intoxication with a predominance of somnolence. After a short and mild period of euphoria, a state of drowsiness occurs, quickly turning into sleep.
Manic variant of altered simple alcohol intoxication manifested by high mood with carelessness and complacency, short outbursts of irritation, various "naughty" actions, annoying pestering, inappropriate jokes, loud laughter, increased responsiveness to the environment. The picture of intoxication may resemble a manic state of organic genesis, less often - hebephrenic excitement.
With all the listed forms of altered simple alcoholic intoxication, symptoms of ordinary intoxication, expressed to varying degrees, are always observed: deterioration in motor skills, articulation, changes in behavior depending on environmental conditions, and intact orientation.
The most severe in terms of clinical manifestations and social consequences are such altered forms of simple alcohol intoxication as epileptoid and paranoid. Their very name emphasizes the well-known similarity with the main types of pathological intoxication.
Studies have shown that with these forms of intoxication in premorbid, almost half had alcoholism, and every seventh had psychopathy. On neurological examination, half had diffuse neurological symptoms. In 80% of cases, intoxication is preceded by psychogenic disorders, malnutrition, lack of sleep. At the initial stage of intoxication, there are violations characteristic of simple alcohol intoxication. Subsequently, most often under the influence of an external, usually insignificant, but negative factor, the picture of intoxication changes. Typically, such a transformation is observed 1.5 hours after the last alcohol intake. The dose of alcohol is usually 300-700 ml (in terms of vodka). The resulting mental disorders have quite specific features, which makes it possible to distinguish two forms.
Epileptoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is determined by rapidly increasing motor excitation with the effects of irritation or anger towards others. The state deepens under the influence of opposition and is complicated by aggressive violent acts. Initially, aggression is usually selective and directed at persons directly related to the behavior of the intoxicated. As motor excitation intensifies, aggressive actions spread to everyone who is nearby. The disturbances of coordination of the movement observed earlier usually decrease or absolutely disappear. At the height of arousal, movement disorders and statements can become stereotyped, but a semantic connection with the situation of the initial period of intoxication is always preserved. Moreover, the intensity of speech-motor excitation and the aggressive actions associated with it is subject to certain fluctuations, depending on the verbal reactions of others. At the height of the episode, there is no complete separation of the intoxicated from the real situation. Mental disorders disappear critically, followed by drowsiness or sleep. Quite often there is amnesia of the period of pronounced excitement.
A paranoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is also determined by an increase in motor and speech excitation. Against this background, intoxicated people shout out individual words or short phrases, the content of which expresses a situation of tension or danger: “bandits”, “shoot”, “kill”, “run”, “hide”, etc. At the same time, statements appear that reflect the real situation, professional activities, unpleasant events that precede intoxication. Aggressive actions are usually differentiated, performed taking into account the situation, changing depending on the words and actions of others. Characterized by a decrease and even the disappearance of impaired coordination of movements and dysarthria. The statements of the intoxicated are usually somehow connected with specific events taking place around, they do not reflect the internal state and therefore it is more correct to designate them as delusional. Mental symptoms of intoxication usually disappear lytically, in 2/3 of cases amnesia of intoxication is observed.
Simple alcohol intoxication (including all its modified forms) in various manifestations, especially considered in dynamics, retains to one degree or another the main signs of acute alcohol intoxication. In these cases, there is no twilight stupefaction of consciousness. This is evidenced by the safety of the intoxicated contact with the environment. A variety of actions, including inadequate, insufficiently motivated, are usually due to some external and specific reason throughout the duration of intoxication. The actions of the intoxicated, as well as their verbal reactions, are selective, they retain the ability to capture the situation and the changes taking place in it. The appearance or presence of persons capable of counteracting an intoxicated person with unpleasant consequences for him, one way or another affects his actions: he tries to hide, leave, or, conversely, gets even more excited, resists, and sometimes resorts to aggression.
Section 3
Diseases of dependent behavior, the concept of chemical and non-chemical dependence.
Dependent Behavior Disease (Non-Chemical Dependence)) is a chronic psychogenic non-psychotic disorder of personality and behavior. It consists in a staged pathological development of the personality, which leads to the emergence, consolidation and transformation of a pathological need to perform repeated difficult or uncontrollable behavioral acts (episodes of irresistible cravings). The motives for committing them do not have a clear rationalization, they cause damage (medical, psychological, social, material and / or legal) to the patient himself, his family and relatives (co-dependent), third parties and society as a whole. Having a primary psychogenic nature, this mental disorder eventually undergoes non-procedural endogenization and transformation and acquires a specific progressive course. Progression is seen in the appearance and deepening of signs of a kind of impoverishment of the personality and the displacement of the physiological equivalent of pathological activity, for example, normative sexuality,
pathological behavior.
"Disease of dependent behavior" (chemical dependence or drug addiction, alcoholism, substance abuse)- denotes a chronic mental illness caused by the non-medical use of psychoactive substances (PSA) that can artificially change the mental state of a person: cause fun (euphoria), calm (sedation), excitement and increased activity (stimulation), hallucinations and other mental disorders. When chemical dependence occurs, the mental, physical and social functioning of the patient directly depends on the intake of the corresponding substance: outside of intoxication, it is sharply hampered, narrowed. The state of comfort, both mental and physical, is possible only in the presence of a narcotic substance in the body.
BZP classification:
Forms of the disease of dependent behavior associated with the use of psychoactive chemicals (chemical dependence - CPD):
BDHD associated with alcohol consumption,
BDPH associated with the consumption of sedative herbal and synthetic chemicals,
CVD associated with the consumption of stimulant plant and synthetic chemicals
the substances
· BDPH associated with the consumption of herbal and synthetic chemical psychodysleptics.
Non-Chemical Addiction Related Behavioral Disorders (BCDs):
1. BZPH associated with the pathology of craving for food - corresponds to section F50 of the ICD-10:
anorexia nervosa - corresponds to taxon F50.0 ICD-10,
Bulimia nervosa - corresponds to taxon F50.2 ICD-10.
2. BZPH associated with the pathology of sexual desire - corresponds to section F65 of the ICD10:
fetishism - corresponds to taxon F65.0 ICD-10,
fetishistic transvestism - corresponds to taxon F65.1 ICD-10,
exhibitionism - corresponds to taxon F65.2 ICD-10,
voyeurism - corresponds to taxon F65.3 ICD-10,
Pedophilia, parthenophilia - correspond to taxon F65.4 ICD-10
sadism, masochism, sadomasochism - correspond to taxon F65.5 ICD-10
Sexual asphyxia syndrome - correspond to taxon F65.8 ICD-10,
gerontophilia - corresponds to taxon F65.8 ICD-10,
zoophilia - corresponds to taxon F65.8 ICD-10,
Frottage - corresponds to taxon F65.8 ICD-10.
3. BZPNH associated with other pathological drives - corresponds to section F63 of the ICD-10::
pathological attraction to gambling (pathological gambling) - corresponds to taxon F63.0 ICD-10,
Pathological attraction to arson (pyromania) - corresponds to taxon F63.1 ICD-10,
pathological attraction to theft (kleptomania) - corresponds to taxon F63.2 ICD 10,
trichotillomania, trichotillophagy, onychophagia - correspond to taxa F63.3 and 63.8 of ICD-10,
Pathological attraction to the Internet (Internet addiction, virtual reality) - corresponds to taxon F63.8 ICD-10,
Pathological attraction to shopping (oniomania, shopaholism) - corresponds to taxon F63.8 ICD-10.
Acute alcohol intoxication: stages of alcohol intoxication, atypical alcohol intoxication, pathological intoxication - a clinical picture, general medical and social significance.
Acute alcohol intoxication (alcohol intoxication is a symptom complex of mental, vegetative and neurological disorders caused by the action of alcohol. Its manifestations depend on many factors - the amount of alcohol consumed, the activity of alcohol-splitting enzyme systems, the type of personality, the mental and physical state of a person, as well as accepted in that or different society forms of behavior in the use of alcoholic beverages, etc.
Classification of forms of acute alcohol intoxication
1. Simple alcohol intoxication.
Mild degree
Average degree
Severe degree
Alcoholism
2. Atypical forms of simple alcoholic intoxication
dysphoric
paranoid
hysterical
depressive
Hebephrenic
Epilentoid
Somnolentnoe
With impulsive actions
Explosive
3. Pathological intoxication
The epileptoid form
The paranoid form
Simple alcohol intoxication is the most common type of acute alcohol intoxication. The degree of severity and form of mental. neurological and vegetative disorders in this case depends on the dose of alcohol taken, gender, age, somatic condition, psychological characteristics of the individual, her emotional state, the strength of the drink and the form of its intake.
There are 3 degrees of severity of alcohol intoxication:
Light degree Simply alcohol-salt intoxication occurs when the concentration of alcohol in the blood is from 20 to 100 mmol / l (20100 Mr alcohol per 100 Mr blood) and is characterized by a decrease in active inhibition. Feelings of mental and physical comfort appear. The mood rises. People feel the desire to speak MHoro, feel cheerful and energized. social contacts are made. Personalities are shy. In this state, it is easier to start conversations with strangers, joke, laugh. Troubles are experienced more easily. calmer. Subjectively, a person in a state of mild intoxication feels an increase in efficiency, but this feeling is deceptive, since attention is not concentrated, it is easily distracted, the pace of thinking accelerates, and associations are superficial. The critical assessment of one's condition, the volume and quality of the work performed decrease, the number of errors increases. Vegetative disorders are manifested by: hyperemia, tachycardia, bulimia, hypersexuality. Usually people in a mild degree of intoxication do not commit
any immoral or criminal acts. After a few hours, the signs of intoxication disappear, some appear drowsiness, weakness. Memory for the entire period of intoxication is preserved.
Average degree occurs when the concentration of alcohol in the blood is from 100 to 250 mmol/l and is characterized by a decrease in the excitation process. Mood changes from euphoric to irritable, dissatisfied. Excessive resentment appears, He is satisfied with what is happening, which determines the statement and actions drunkenly. The ability to correctly assess what is happening is reduced, this often leads to unseemly, and sometimes illegal actions. The process of thinking slows down, judgments become flat, speech is slurred with perseverations, it is difficult for an intoxicated person to choose words, dysarthria appears. The threshold of auditory perception rises, so speech becomes loud. Attention is difficult to switch, handwriting is grossly disturbed, ataxia occurs, movements become uncoordinated, pain and temperature sensitivity is weakened. Face hyperemia is replaced by cyanosis, pallor. Some experience nausea and vomiting. The average degree of intoxication is replaced by deep sleep, after which efficiency decreases, weakness, irritability or mood depression appear. Lack of appetite, dry mouth, heaviness in the head, discomfort in the heart. Some events occurring in a state of intoxication are remembered indistinctly.
Severe degree. It develops at a concentration of alcohol in the blood from 250 to 400 mmol / l and is manifested by depression of consciousness from stupor, somnolence to coma. Expressed neurological disorders, ataxia, muscle atony, dysarthria, amimia. There are vestibular disorders: nausea, vomiting, dizziness, ringing in the ears. Visual acuity decreases, orientation in the area is disturbed. There are psychosensory disorders, illusions. Cardiac activity weakens, blood pressure and body temperature decrease. Loss of interest in others. The intoxicated person looks drowsy and soon falls into a narcotic sleep, sometimes in uncomfortable positions and inappropriate places. During sleep, involuntary urination and defecation sometimes occur. With a blood alcohol concentration of up to 700 mmol / l, death from respiratory paralysis can occur. The next day after a severe degree of intoxication, post-intoxication phenomena are more pronounced and longer than after an average degree. Severe intoxication is accompanied by complete amnesia. The time required to fully restore normal well-being increases with the age of the patient and the history of alcohol abuse. In some cases, the state of health remains poor up to 2 days after drinking.
Atypical forms:
Dysphoric form.
Instead of euphoria, malice, irritability, anger, a gloomy mood appear, leading to conflict and aggressiveness. An intoxicated person experiences a feeling of discomfort, hyperesthesia appears. Anger spreads to everything around, accompanied by captiousness, causticity, the search for a reason for quarrels. This state may persist for several days. This form of intoxication usually develops with an organic pathology of the brain.
paranoid form
It is characterized by the appearance of suspicion, resentment, captiousness. Intoxicated people inadequately evaluate the words and actions of others as a desire to humiliate, deceive, ridicule. Motor and verbal excitement intensifies, drunk people shout out separate phrases or words, indicating the danger that threatens them.
This form of intoxication is often accompanied by aggression towards others, independent of their words and actions. The paranoid form develops in primitive personalities, paranoid and epileptoid psychopaths.
hysterical form
Behavior intoxicated designed for the audience. The movements are theatrical (stormy scenes of despair, throwing, wringing hands) sometimes with an element of puerilism. The statements are pathetic with various accusations against others, self-praise or exaggerated self-reproach. Demonstrative suicidal acts are rarely committed. This form of intoxication usually develops in persons with hysterical character traits.
depressive form
Instead of euphoria, a depressed mood prevails.
Tearfulness, unpleasant memories, self-pity, feelings of anxiety, anguish, ideas of self-blame and suicidal thoughts appear. The risk of suicide attempts in
in this case is high.
Manic form
An elevated mood prevails with carelessness, generosity, accompanied by inappropriate jokes, various "naughty" actions. Behavior some"
intoxicated is manifested by foolishness, stereotypy, antics, echolalia. Such forms are typical for adolescents and young men.
epileptoid form
Characterized by motor excitation with irritability, aggravated by opposition from others. Drunk people are aggressive at first
in relation to those who make a remark to them, or I try to calm them down, and then the aggression spreads to everyone who happened to be nearby. However, even at the height of the episode
there is no complete separation from reality. Mental disorders are reduced critically with subsequent sleep. Quite often the period of excitation is amnesiac.
Somnolent form
After a short euphoria, soon after taking alcohol, a deep sleep sets in, sometimes turning into a stupor or coma.
explosive form
The state of euphoria under the influence of minor external factors is replaced by sharp discontent, irritability, anger. These outbreaks are usually short-lived
lively, alternating with periods of rest, but repeatedly repeated against the background of intoxication. Simple alcohol intoxication, including ero atypical forms, retains the main signs of acute alcohol intoxication, while productive (psychotic) forms of consciousness disorder do not occur. Diversity
nye actions and statements drunkenly have a selective focus. The presence of persons capable of resisting, with unpleasant consequences for the drunk, affects ero behavior. The intoxicated always have
the possibility of contact with others.
Pathological intoxication different from typical alcoholic psychoses. It is rare and does not depend on previous abuse of alcoholic beverages. Since the likelihood of pathological intoxication does not depend on the amount of alcohol consumed, typical signs of intoxication (impaired coordination, speech disorder) are not mandatory. Pathological intoxication occurs suddenly. In a person who had obvious signs of intoxication, after the onset of pathological intoxication, they disappear. He loses contact with others, looks strange, unusual, often does not respond to
appeal to him. Prerequisites for the emergence of pathological
intoxication, are insomnia, fatigue, worries about conflict situations. Pathological intoxication is regarded as a disease state.
There are 2 main variants of pathological intoxication - epileptiform and paranoid.
epileptiform variant Suddenly, a sharp motor excitation develops with
intense, senseless, chaotic aggressive actions, performed with incredible cruelty, viciousness, often have the character of automatisms and stereotypes. Motor excitation and aggressive actions are determined by fear, anger, they are not connected with reality. Those who are in a twilight state of consciousness do not die, but attack imaginary enemies with malice and fury
more often silently, sometimes with a cry or indistinct muttering. Excitation ends suddenly with a transition to a state of relaxation, inactivity, followed by sleep, after which complete amnesia of everything perfect.
With paranoia
Characterized by sudden onset of delusional ideas, early contact with reality, psychomotor agitation with fear, anger, senseless, impulsive
Stereotypical movements. Hallucinations and delusions are frightening for the subject of character. Being in their power, such persons can perform a number of complex and orderly actions. Sometimes they can make contact with others, warn of danger, but their speech is usually fragmentary in the form of separate words, phrases, Always clear, laconic, having the character of orders, threats and reflecting a painfully distorted perception of reality in their content.
When diagnosing pathological intoxication, it is not necessary to take into account each symptom separately (lack of motor disorders, partial or complete amnesia, terminal sleep, the presence of automatism and stereotypes, disorientation, lack of motivation for the crime), but the combination of most of them, which allows us to consider that the condition that develops after taking alcohol is psychotic.
In the development of pathological intoxication, an important role play factors that temporarily weaken the body (fatigue, lack of sleep, malnutrition, high ambient temperature), in combination with residual symptoms of organic pathology of the brain, accompanied by CSF hypertension.
Complicatedintoxication- this is a painful condition that occurs after taking relatively small doses of alcohol, manifested by pronounced intoxication with psychomotor agitation, irritability, anger, hatred, and some stupor. Such intoxication proceeds in waves and sometimes with a predominance of short-term mental disorders.
The atypical dynamics and clinical manifestations of acute alcohol intoxication in such cases are due to additional factors: the presence of mental illness (alcoholism, psychopathy, oligophrenia, residual effects of organic CNS damage, schizophrenia, epilepsy); factors that asthenize the body (lack of sleep, colds, infectious diseases, gross deviations in diet), increased toxic effect of alcohol with combined use (accidental, situational or deliberate) of alcoholic beverages and medications (sedatives, analgesics, hypnotics, etc.). Instead of alcoholic euphoria, such persons may experience a depressive state with anxiety, suicidal attempts, etc.
Depending on the dominant psychopathological symptom, atypical variants of alcohol intoxication are distinguished: with explosiveness, hysterical traits, depressive effect, paranoid mood, pronounced motor speech excitement and increased affect, etc. With altered variants of alcohol intoxication, as a rule, there is no gross violation of all types of orientation. Subjective sensations and behavioral reactions are not significantly divorced from real events. Unlike simple intoxication, these variants of the period of intoxication are often partially or completely amnestic. Persons who have committed a crime in a state of complicated alcohol intoxication are recognized as sane.
Pathologicalintoxication- this is a short-term acute psychosis that occurs suddenly, after drinking, as a rule, small doses of alcohol, in the clinical picture of which twilight clouding of consciousness is predominant with severe affective disorders (fear, horror, anxiety, anger, rage), delirium, hallucinations of frightening content, complete preservation of coordination of movements, motor excitation (often destructive socially dangerous illegal tendencies and actions), subsequent: deep sleep, amnesia (full or partial) of the period of a psychotic episode, mental and physical exhaustion.
Pathological intoxication is pathogenetically associated with epilepsy, the consequences of traumatic brain injuries, infections, intoxications, chronic alcoholism, vascular lesions of the brain, psychopathy and severe neurosis. The etiological factor is alcohol taken in one dose or another. Additional factors in the etiology of pathological intoxication are psychogenic (strong excitement, fear, fear, anger, anger, quarrel, jealousy), overwork, insomnia, staying in poorly ventilated rooms, pregnancy, menopause, condition after infections, intoxication.
With a certain degree of conventionality, two main clinical forms of pathological intoxication are distinguished: epileptoid and hallucinatory-noparanoid. Examination of persons who have committed unlawful acts in a state of pathological intoxication is carried out in the conditions of a forensic psychiatric department of a psychiatric hospital or a psycho-neurological dispensary.
Persons who have committed crimes in a state of pathological intoxication are recognized as insane and are not subject to criminal liability.
