(Hoffman A.G. 1991).

1. Intoxication with foolishness. It is characterized by high spirits with carelessness, complacency, antics, disinhibition of drives, infantile forms of behavior. 2. Intoxication with hysterical features. It is characterized by demonstrativeness, theatricality, the desire to attract attention, demonstrative suicidal attempts, violent scenes of despair. This type of intoxication does not occur when drinking alcohol alone. 3. Intoxication with depressive manifestations. It is characterized by a depressed mood with melancholy, anxiety. Suicidal attempts are possible. Intoxication is accompanied by motor and speech retardation. Usually this form of intoxication is an expression of psychogenic or endogenous depression and exposes existing affective disorders. 4. Intoxication with explosiveness or dysphoric variant of intoxication. It is characterized by a predominance of a gloomy mood with irritability, a tendency to verbal and physical aggression. This form of intoxication is typical for patients with organic brain damage (vascular, post-traumatic) and for persons with psychopathic character traits. 5. Epileptiform intoxication. This form of intoxication is characteristic of persons with epileptoid character traits. It is characterized by constantly manifesting discontent, captiousness, gloomy affect, readiness to commit aggressive acts. Unlike pathological intoxication, this form of intoxication is not accompanied by amnesia. 6. Pseudoparanoid intoxication. It 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; possible ideas of jealousy, condemnation. It is observed in individuals with paranoid character traits. 7. Hallucinatory-delusional intoxication. This form of intoxication occurs in patients with alcoholism with a long history of the disease, the presence of alcoholic encephalopathy and pronounced personality changes. Intoxication is accompanied by the appearance of perceptual delusions, sensory delusions and delusional behavior. After sobering up, the delusions of perception disappear. Fragmentary memories remain of the state of intoxication. Intoxication ends most often with the onset of sleep. This form of intoxication differs from pathological intoxication by the presence of neurological disorders - ataxia, dysarthria, the ability to maintain speech contact, to navigate in a stop. Hallucinatory-delusional intoxication can occur repeatedly throughout life. pathological intoxication.

PATHOLOGICAL DRUNKING.

Acute transient psychosis, proceeding in the form of twilight clouding of consciousness. Persons who have committed a crime in a state of pathological intoxication are recognized as insane and do not bear criminal liability.

A psychoactive substance (surfactant) is any substance (natural or synthetic) that can change mood, physical state, self-awareness, perception of the environment, behavior, or give other psychophysical effects desirable from the consumer’s point of view, and cause systematic use mental and physical dependence.

There are three groups of psychoactive substances: alcohol, drugs and toxic substances. The latter also include drugs with a psychotropic effect (the so-called psychotropic drugs) approved for medical use by the Pharmacological Committee of the Russian Federation and not included in the official “List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation”.

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.

Under dope understand a substance that meets the following criteria:

a) has a specific effect on mental processes - stimulating, euphoric, sedative, hallucinogenic, etc. (medical criterion);

b) non-medical consumption of the substance is on a large scale, the consequences of this acquire social significance (social criterion);

c) in accordance with the procedure established by law, it is recognized as a narcotic drug and included in the list of narcotic drugs by the Ministry of Health of the Russian Federation (legal criterion).

Non-listed psychoactive substances are commonly referred to as toxic . They have all the psychotropic properties of drugs, they have common patterns of addiction formation with drugs. Moreover, addiction in substance abuse is often more pronounced. If the Criminal Code of the Russian Federation does not provide for criminal liability for the illegal acquisition, storage, manufacture, processing, shipment and sale of these substances, then they are not considered drugs.

Due to the fact that currently in our country there is an increase in the use and abuse of psychoactive substances, a doctor of any specialty should know the features of taking an anamnesis, physical examination and the possibility of express diagnosis of patients with suspected substance abuse.

Collection of anamnesis: Usually, these patients tend to deny the fact of use or underestimate the dose due to fear of the consequences that admission to the use of psychoactive substances may entail. Therefore, if you suspect the use of PAS, you should strive to obtain objective information from other sources. At the same time, the doctor must understand that the patient will seek to downplay or completely deny the fact of the use of PAS.

It should be borne in mind that substance abuse often coexists with mental disorders (depression, anxiety), which in itself is also the cause of their occurrence. Patients can self-medicate using both prescription and non-medical medications. When examining a patient with symptoms of depression, anxiety or psychosis, it is necessary to exclude the possibility that these disorders could be caused by the use of psychoactive substances.

On physical examination it should be determined whether the patient's somatic disease is associated with the use of PAS. Thus, if symptoms of HIV infection, abscesses, bacterial endocarditis, hepatitis, thrombophlebitis, tetanus, abscesses, scars from intravenous or subcutaneous injections are suspected or detected, it is necessary to exclude intravenous or subcutaneous administration of surfactants. In patients who inhale cocaine or heroin, displacement or perforation of the nasal septum, nasal bleeding, and rhinitis are often observed. Patients who smoke refined cocaine, crack, marijuana, or other drugs (including inhalants) often suffer from bronchitis, asthma, and chronic respiratory diseases.

If substance use is suspected, it is highly likely to use rapid tests for the detection of narcotic substances in urine. Domestic tests have proven themselves well, which make it possible to establish with very high certainty whether the patient uses certain drugs. The availability of tests for the determination of one or several surfactants at once opens up wide opportunities for early diagnosis. The simplicity of diagnostic testing, the ability to determine narcotic substances of the opium group within five days, and cannabinoids - within 2 weeks after the last use, makes it possible to use them in medical institutions, everyday life, educational institutions, during examination, etc.

Medical records should include a detailed description of the substance used, not the category to which it belongs. Also indicate the method, dose and frequency of administration, if express testing was carried out - its results. It should be borne in mind that rapid tests, as well as laboratory research methods in diagnosing addiction to PAS, are only of auxiliary importance, since the very fact of PAS detection in the patient's body is not a basis for making a diagnosis. The main method in the diagnosis of the disease remains the method of clinical examination.

Alcoholism and alcoholic (metalcohol) psychoses

Alcoholic hallucinosis

Alcoholic hallucinosis - the second most common psychosis in a patient with alcoholism. The duration of the existence of the second stage of alcoholism by the time of the onset of the first hallucinosis in life in 90% of cases exceeds 5 years, the age of patients ranges from 25 to 40 years. Psychosis occurs in the first days after the cessation of alcohol abuse. The previous binge is usually at least 3-4 days. Most patients have an additional pathology: residual effects of organic brain damage, various somatic diseases.

The prodromal stage of alcoholic hallucinosis is an alcohol withdrawal syndrome that is more severe than is typical for this patient. This is due to the fact that before the onset of the first hallucinosis in life, the duration of binge increases or the daily dosage of alcohol increases. The severity of the withdrawal syndrome is less than with the development of delirium, convulsive seizures occur very rarely

The clinical picture of psychosis is dominated by true verbal hallucinations; the patient's consciousness is not clouded. Hallucinations are true, usually have content that is unpleasant for the patient: threats, insults, abuse. The patient is called "an alcoholic, a drunkard", threatened with reprisals. There is no criticism of hallucinatory experiences, while the patient's consciousness is not grossly disturbed, auto- and allopsychic orientation is preserved. The behavior of patients is usually determined by the content of hallucinations. Especially dangerous for others and the patient himself are imperative hallucinations. Unstable secondary delusions of persecution, relationships may join. The mood background corresponds to the theme of hallucinations, often the patient is alert, anxious, sometimes depressed.

Treatment of patients with alcoholic hallucinosis is carried out in a psychiatric hospital. The main treatment is the elimination of productive psychotic symptoms. For this purpose, psychotropic drugs are prescribed: haloperidol, tizercin, etaperazine. Mandatory components of complex treatment are detoxification, vitamin therapy (especially group B), nootropics. All patients who have had alcoholic hallucinosis are shown proper anti-alcohol treatment.

Alcoholic paranoia (delusions of jealousy)

Alcoholic paranoia (alcoholic delusions of jealousy, alcoholic delusions of adultery) – a chronic form of meth-alcohol psychosis with a predominance of primary paranoid delusions occurs exclusively in men, the average age of onset of the disease is about 50 years.

Alcoholic paranoia occurs predominantly in individuals with psychopathic traits. They are characterized by such characterological properties as incredulity, a tendency to regulation, sthenicity, egocentrism, excessive demands, stagnant affects, a tendency to form overvalued ideas. These character traits are especially noticeable during the period of alcoholic excesses.

Usually delirium is monothematic, develops gradually and inconspicuously. At first, separate delusional statements are observed only during the period of intoxication, and after sobering up, the patients refuse the accusations, explaining the unfounded claims by the fact that they were drunk. Then jealous fears begin to speak out and in a state of a hangover. Gradually, a persistent systematized delirium of jealousy is formed. Patients delusionally interpret the actions of their wife or mistress, meticulously examine the body, carefully check women's underwear, trying to find confirmation of their thoughts. Often delusional and affective illusions can arise: the folds on the pillow are regarded as a mark from the lover's head, the spots on the floor in the bedroom are interpreted as traces of sperm. Usually at this stage in the development of delusions, a conflict arises in family relationships, which leads to the rejection of intimacy. This further strengthens the patient's confidence in his wife's infidelities. The content of delusional experiences, reflecting the characteristics of relationships and conflicts encountered in life, retains a certain plausibility. In this regard, the people around the patient do not consider his condition painful for a long time.

Often, to prove their innocence, patients force their wives to confess to infidelity. If a woman does not withstand requests, threats, beatings and confesses to supposedly committed infidelities, this only strengthens the patient in his rightness.

Further change in psychosis may be associated with the appearance of retrospective delusions. The patient begins to assert that his wife is cheating on him not only now, but did it before, even in the first years of marriage, moreover, she gave birth to children not from him. In support of his words, the patient cites a lot of real facts, interpreted in a delusional way. Behavior towards children becomes consistent with delirium. Sometimes the transformation of a monothematic delusional syndrome is complicated by delusional ideas of poisoning, witchcraft, or damage, usually associated with a pre-existing delusion. Often in these cases, the repressed-malicious affect and continued drinking may result in delusional behavior with acts of violent aggression against wives. A fairly common form of delusional behavior of such patients is the murder of a spouse, usually committed in a state of alcoholic behavior. Aggressive behavior towards an imaginary opponent, even a personified one, is rarely observed.

Patients are usually hospitalized as involuntary hospitalization due to the danger of their behavior to others. Criticism to the ideas of jealousy usually does not appear in the process of antipsychotic therapy, but patients stop delusionally evaluating the actions of others, the behavior becomes harmless for loved ones. Discharge from the hospital is possible only in case of de-actualization of delirium.

53. Atypical alcohol intoxication: definition, variants and clinical manifestations.

Sometimes the state of mild and moderate alcohol intoxication is accompanied by significant deviations from the described pictures of typical intoxication of the corresponding degrees. Unlike typical intoxication, with altered forms, any one group of symptoms characteristic of intoxication is sharply enhanced, the sequence of their appearance is disturbed, or disorders arise that are not at all characteristic of intoxication.

1. Intoxicated with explosiveness. After a short period of euphoria or without it, suddenly (sometimes for a minor reason) there is irritation with discontent, hostility, even anger and a corresponding change in behavior and statements. Such states are short-lived, replaced by relative calm and even complacency, but during intoxication they can be repeated repeatedly.

2. Intoxication with hysterical features. Propensity for loud phrases, posturing with sharp transitions from one extreme to another, for example, self-praise, followed by self-flagellation. Light self-harm, imitation of suicide are possible. There are primitive motor reactions such as astasia-abasia, motor storm, hysterical seizure, "imaginary death reflex".

3. Intoxication with depressive affect. Depressed mood has various shades - with a predominance of gloomy gloominess, a dysphoric component, anxiety, hopelessness, in some cases with a feeling of acute melancholy. Ideomotor retardation is usually insignificant. The possibility of suicide is quite high.

4. Intoxication with paranoid mood. In some cases, these are expressed, mostly catathymically conditioned ideas of jealousy, condemnation, diffuse suspicion in relation to others. In others, unsystematized ideas of relation and persecution appear. There may also be verbal illusions, elementary auditory hallucinations.

5. Intoxication with pronounced speech motor "excitation and increased affect- an agitated, manic-like form of intoxication. Stupidity with antics, clowning, childish behavior, with a penchant for inappropriate jokes and witticisms, unmotivated laughter. Often increases sexual desire. With altered forms of simple alcoholic intoxication, as a rule, not only auto- and allopsychic orientation is preserved, but also the experiences and behavior of the drunk are associated with actual events. However, memories of the period of intoxication here are more fragmented compared to ordinary intoxication. Atypical forms of simple intoxication are found in persons suffering from chronic alcoholism, in psychopathic individuals, patients with oligophrenia, with residual phenomena of organic damage to the central nervous system, and erased forms of mental illness. In some cases, the toxic effect of alcohol is enhanced by the simultaneous use of alcoholic beverages and various medications.
54. Pathological alcohol intoxication: criteria, variants and clinical manifestations.

Pathological alcohol intoxication- this is a psychotic form of alcohol intoxication with severe disorders of consciousness and the absence of physical signs of intoxication. There are 2 forms: 1. delirious (paranoid). 2. epileptoid. Pathological intoxication is an acute transient psychosis in the form of twilight stupefaction. Soon after taking small and much less often large doses of alcohol, a deep stupefaction suddenly develops. It is accompanied by pronounced affective disorders, mainly reform of anxiety, fear, anger or frenzied rage, and only occasionally in the form of increased mood. There are delusions and hallucinations, reflecting the prevailing affect. Motor excitation develops. Usually, two main tendencies can be identified in the actions of patients - defense with an attack and violent destructive actions and the desire to avoid danger. Motor excitation can be chaotic, often in the form of stereotypically repetitive actions. Much more often, behavior externally retains expediency and purposefulness with rather complex actions, sometimes requiring not only good coordination of movements, but also great strength and dexterity. More often there is a silent motor excitation. Less often, patients pronounce single words, short phrases, or make inarticulate cries. If movement disorders predominate in the clinical picture, then they speak of epileptoid form pathological intoxication, and with severe delirium and hallucinations - deliriant. The duration of pathological intoxication ranges from several minutes to several hours. Usually it ends in a deep sleep and then either completely amnesiac or leaves a vague memory of individual fragments of mental disorders. Pathological intoxication can also develop in healthy individuals, but more often occurs in people with various organic diseases of the central nervous system, including those suffering from alcoholism, with sluggish or latent epilepsy, and in psychopathic individuals. The emergence of pathological intoxication is facilitated by various debilitating factors - forced insomnia, mental or physical fatigue, psychogenic disorders, malnutrition, affective disorders in the form of dysphoria.
55. Criteria and options for alcohol degradation of personality.

Diagnosis of alcohol intoxication carried out through clinical research and biochemical tests. The main clinical signs of alcohol intoxication are the smell of alcohol from the mouth, the behavior of the subject, the features of his speech and motor skills, and vegetative-vascular symptoms. Biochemical methods for detecting alcohol vapor in exhaled air are based on its ability to oxidize various reagents with a change in their color - potassium permanganate (Rappoport test) and chromic anhydride (Mokhov-Shinkarenko test). For the quantitative determination of alcohol in the blood, urine, exhaled air, stomach contents, gas chromatographic and spectrographic methods are used.

Diagnosis of alcoholism based on physical and laboratory signs, as well as on the use of special tests (questionnaires). Physical signs include: obesity or weight loss, arterial hypertension, hand tremors, sensory disturbances in the limbs and movement disorders, muscle wasting, sweating, enlarged parotid glands, redness of the face, spider veins, traces of injuries, burns, tattoos, breast enlargement and a number of others. signs. A combination of 6 or more signs indicates regular alcohol consumption. Laboratory indicators include the detection of high concentrations of alcohol in the blood (or other fluids - saliva, urine, sweat, tears) in the absence of external signs of intoxication. Alcoholism develops: liver damage (hepatitis, cirrhosis), acute renal failure, heart damage (tachycardia, heart failure), blood systems (mild anemia with macrocytosis, folate deficiency, thrombocytopenia, granulocytopenia, abnormal liver function tests (including increased blood y-glutamyltransferase), hyperuricemia, hypertriglyceridemia, decreased levels of K, Mg, Zn and P in serum), chronic gastritis, pancreatitis, peripheral nerve damage, sexual disorders, memory disorders, etc. A feature of alcoholic damage to internal organs is the possibility of a significant improvement in the patient's condition with abstinence from alcohol (even without medication) and a rapid deterioration after the resumption of its use.

Treatment of chronic alcoholism carried out in stages. At the first stage (symptomatic treatment), drunken states and hangover disorders are stopped, and the somatic condition of the patient is normalized. In the second stage (active treatment), the glorious task is to permanently suppress the craving for alcohol. At the third stage, supportive therapy, consolidation and further development of attitudes towards a teetotal lifestyle are carried out. Throughout the complex anti-alcohol treatment, in addition to drugs, it is necessary to use psychotherapy.

Symptomatic treatment stage carry out activities: 1) detoxification with thiol preparations - 15-20 ml of a 30% solution of sodium thiosulfate intramuscularly or intravenously 2) vitamin therapy - B vitamins, ascorbic acid, nicotinic acid 3) psychotropic drugs are prescribed for a pronounced mental component of a hangover syndrome; tranquilizers are used - diazepam (seduxen), phenazepam. 4) sleeping pills - eunoktin (radedorm), adalin. 5) anticholinergic drugs, primarily amizil and metamizil 6) insulin therapy from 2 to 8 IU of insulin daily. The diet should be dominated by foods rich in mineral salts.

On the stage of active treatment apply conditioned reflex and sensitizing methods. Conditioned reflex method based on the development of a negative reflex (vomiting) to the smell and taste of alcohol. For this purpose, the action of emetics (apomorphine, emetine) is combined with a small (30-50 ml) amount of alcohol consumed by the patient. sensitization method- the goal of this type of therapy is not only to permanently suppress the craving for alcohol, but also to make it physically impossible to take it. With the resumption of drunkenness, various, very painful, and often life-threatening somatic disorders appear. Antabuse (teturam) is most widely used, less cyamide (tempozil), metronidazole (flagyl), furazolidone. Antabuse is prescribed daily at 0.5 g in the morning, and with distinct asthenia - at 0.15-0.25 g in the evening. Trials start in a week. On the day of the test in the morning, give 0.75-1 g of Antabuse. The test is carried out under ambulatory conditions at the end of the working day, i.e., approximately 8-9 hours after taking Antabuse. First give 30-50 ml of vodka, later you can give up to 100 ml. Antabuse-alcohol reaction begins after 5-15 minutes, manifests itself in various vegetative disorders and lasts from 1 to 2 hours. Psychotherapy starts with the first visit to the doctor. Methods and types of psychotherapy for alcoholism are largely determined by the personal attitudes of the doctor.

Supportive care takes at least 5 years, of which the first 3 years the patient is on the active, and the next 2 years (in the absence of recurrence) on the passive account. The patient must always visit the narcologist accompanied by the next of kin, preferably one and the same. This relative should see to it that the appointments of the vran at home are carried out. The frequency of visits to the doctor is different, for example, in the first 6 months - 1-2 times a month, in the next 6 months - at least once every 2 months, then - at least twice a year. Therapy at this stage includes the use of drugs that prevent the resumption of alcoholism, the normalization of the mental state, various general somatic treatment and psychotherapy.
57. Clinic and course of alcoholic delirium.

Metal-alcoholic psychoses- protracted and chronic disorders of mental activity in the form of exogenous, endoform and psycho-organic disorders that occur in the II and III stages of the development of alcoholism. Allocate: delirium, hallucinosis, delusional psychosis.

Delirium (white fever). The first attack of delirium is usually preceded by a long drinking bout. In the prodrome, lasting days, weeks and even months, sleep disorders with nightmares, fears, frequent awakenings and vegetative symptoms predominate, and in the afternoon asthenic phenomena and changeable affect in the form of fearfulness and anxiety. Delirium develops most often 2-4 days after the cessation of drinking, against the background of severe hangover disorders or their reverse development. The development of delirium is preceded by single or multiple convulsive seizures; episodes of verbal illusions or figurative delirium are possible. Delirium begins with an influx of figurative representations and memories that appear in the evening and intensify at night; visual illusions are not uncommon, in some cases visual hallucinations lacking volume - “cinema on the wall” with the preservation of a critical attitude towards them, transient disorientation or incomplete orientation in place and time. In the advanced stage, complete insomnia appears, illusions become more complicated or are replaced by pareidolia, and true visual hallucinations occur. Multiple and mobile micropsy hallucinations predominate - insects, small animals, fish, snakes, as well as threads, wire, cobwebs; less often, patients see large, including fantastic animals, people, humanoid creatures - "wandering dead". With the deepening of delirium, auditory and among them verbal, as well as olfactory, thermal and tactile hallucinations appear, including those localized in the oral cavity. Behavior, affect and themes of delusional statements correspond to the content of hallucinations. Motor excitation predominates with fussy efficiency. Speech consists of a few, fragmentary short phrases or words. Attention is super distractible. Figurative delusions of persecution or physical destruction predominate, less often delusional ideas of a different content. The patient feels a sharply slowed down or, on the contrary, accelerated time. Patients are highly suggestible. Periodically and for a short time spontaneously weaken and even almost completely disappear the symptoms of psychosis - the so-called lucid intervals. The psychosis worsens in the evening and at night. Even without treatment, the symptoms of delirium disappear within 3-5 days. Recovery comes critically - after a deep long sleep. The lytic ending of psychosis is more common in women. Delirium is often replaced by various intermediate syndromes. Men usually have asthenic, mild hypomanic, and delusional disorders; women are dominated by depression. Delirium is always accompanied by neurological and somatic, primarily somatovegetative disorders: hyperemia of the skin, primarily of the face, tachycardia, fluctuations in blood pressure, tachypnea, liver enlargement, icterus of the sclera. delirium options. Hypnagogic delirium limited to numerous, vivid, in some cases scene-like dreams or visual hallucinations when falling asleep and when closing the eyes. Visual hallucinations disappear when the eyes are opened. Delirium without delirium Fussy excitement prevails with marked tremor and sweating. Sensory and delusional disorders are absent or rudimentary. Abortive delirium - is determined by the development of sparse, and in some cases, isolated visual illusions and micropsy hallucinations that do not create the impression of certain, but
especially complete situations, as in the case of extended forms of de-
lyria. Systematized delirium - multiple, scene-like (with a sequentially developing plot or in the form of separate situations) visual hallucinations predominate. Their content is determined mainly by various scenes of pursuit, often adventurous, with flight or pursuit, in which routes and modes of transport of shelter change. Delirium with severe verbal hallucinations- verbal hallucinatory disorders have frightening or life-threatening content for the patient. Ideas of physical destruction predominate in delusional statements. Unlike systematized delirium, which always has a system of evidence, with this variant, delusional statements are not supported by arguments. It is possible to identify distinct symptoms of figurative delusions (confusion, delusional ideas of staging, a symptom of a positive twin that spreads to many surrounding people). The depth of clouding of consciousness, despite the abundance of productive disorders, is insignificant. Delirium with mental automatisms - mental automatisms arise when the typical or at the height of systematized delirium becomes more complicated when delirium is combined with pronounced verbal hallucinations. All the main variants of psychic automatism can arise - ideational, sensory, motor, but all three never occur at the same time. Motor automatism occurs against the background of oneiroid stupefaction of consciousness and is manifested primarily by objective sensations of transformations that occur with the patient's body or its parts (limbs, internal organs, etc. disappear or change). At the same time, patients not only feel the impact, but also see its results. Delirium with occupational delusions (occupational delirium, delirium with occupational delusions)- psychosis can begin as a typical delirium with subsequent transformation of the clinical picture. Typically, the predominance of relatively simple motor acts of a stereotyped content occurring in a limited space, reflecting individual everyday actions - dressing and undressing, collecting or laying out bed linen, counting money, lighting matches, certain movements during drinking, etc., actions are less often observed reflecting some episode connected with professional activity. In the initial period of delirium with occupational delirium, there are multiple variable false recognitions. Psychosis is accompanied by complete amnesia. Delirium with mumbling (Mumbling, "mumbling" delirium)- replaces other delpriozny syndromes. Delirium is characterized by a combination of profound confusion and special motor and speech disorders with severe neurological and somatic symptoms. Patients do not react at all to the environment, verbal communication with them is impossible. Motor excitation occurs in an extremely limited space - “within the bed” (palpation, smoothing, grasping, pulling, or, on the contrary, pulling on a blanket or sheet, the so-called stripping - carthology, fingering), i.e., manifested by rudimentary movements without the simplest solid motor acts. Speech excitation is a set of the same or different syllables, interjections, individual sounds. At times, both motor and speech excitation disappear. Upon recovery, the entire period of the disease is completely amnesiac.

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 intentional) 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.

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 deterrent factors ("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 blurry. 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:

A dysphoric variant of intoxication is a state when, instead of the euphoria characteristic of simple alcoholic intoxication, from the very beginning a gloomy mood arises 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 version 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, which most often manifest themselves 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.