How long does it take to treat delirium tremens? Delirium tremens: symptoms, consequences, treatment! Mixed forms of delirium tremens

Alcohol addiction affects many people who drink occasionally. Unfortunately, the disease is rarely detected in its early stages. Often an alcoholic spends many years either hiding his addiction from loved ones or denying its existence, refusing to consult a specialist. In both cases, the patient does not receive timely medical care. As a result, chronic alcoholism is formed. One of the characteristic complications of chronic alcohol dependence is attacks of delirium tremens.

Delirium tremens, which in the official language of medicine is called delirium tremens, is an acute alcoholic psychosis that occurs in alcoholics after emerging from a drunken state. Typically, this condition is typical for a patient in the second and subsequent stages of alcohol dependence. This disorder is preceded by long-term alcohol abuse, which leads to somatic pathologies, headaches, sleep disorders, general ailments, etc.

The clinical picture of delirium tremens is quite bright. From the outside, this condition looks very unpleasant, since the patient is tormented by distinct realistic hallucinations, he loses temporal and spatial orientation, is unable to control himself and is aggressive towards others. In other words, the person behaves like crazy. Let us dwell on the specific manifestations of this disorder.

So, recognizing the pathology is not difficult. An attack of fever is accompanied by the release from the subconscious of all the fears an alcoholic has, which are under control when sober. After heavy drinking, the patient experiences hallucinations in the form of all kinds of devils, witches, sorcerers, various mythical creatures, enemies, pursuers, murderers, some animals, insects, etc. The patient sees all this in reality.

Narcologists consider the first symptoms of delirium tremens to be:

1. Patient restlessness;
2. Excessive concern;
3. Anxiety;
4. Sleep disorders associated with persistent insomnia;
5. Moderate hyperthermic manifestations;
6. Excessive sweating;
7. Frequent jumps in blood pressure towards hypertension;
8. Tachycardic symptoms;
9. Pale skin, up to a bluish tint;
10. Pathologically low muscle tone;
11. Ataxic signs;
12. Reflex hyperactivity;
13. Dehydration;
14. Metabolic acidosis, which is characterized by a decreased acid-base balance of the blood;
15. Excessive content of metabolic products in the body such as urea, creatinine, etc.;
16. Violations of the chemical composition of the blood, etc.

The first manifestations are complemented by the inappropriate behavior of an alcoholic who screams, swears, rushes into empty space and fights with an imaginary opponent. Or vice versa: the patient may run somewhere, as if fleeing from someone. Therefore, during an attack, it often happens that patients jump out of windows, without even thinking about what floor they are on, which often leads to their death.

Persons susceptible to the disease

Of course, people who do not have a tendency to abuse alcohol cannot have delirium tremens. And in people who occasionally drink alcohol, such a disorder is hardly possible. Signs of delirium tremens are usually observed in alcoholics who have a significant history of addiction (more than 5 years) and are approximately at the 2-3 stage of alcoholism.

Typically, fever occurs after a long binge. This condition is provoked by withdrawal syndrome and manifests itself approximately on the second or third day after stopping alcohol, most often at night or in the evening.

However, there are cases when fever occurs in people who once overdid it with alcohol.

How long does delirium tremens last?

Experts distinguish several stages of fever, differing in symptoms and duration:

Threatening delirium (first stage)

Usually occurs in the first 2 days after stopping binge drinking. Clinical manifestations such as hyperthermia, incoherent muttering, hallucinogenic images, tremors and fear, excessive anxiety and fussiness appear in the evenings, although it happens that such signs occur even during the day. This condition lasts about a couple of days, and then goes away on its own. If you drink alcohol at this stage, you can eliminate the symptoms of threatening delirium;

Complete delirium (second stage)

It is dangerous to treat on your own, so the patient requires mandatory hospitalization. Clinical manifestations are striking, and traditional visions are supplemented by tactile and auditory hallucinations. The patient constantly imagines that they want to kill him, that they are persecuting him, that they are weaving intrigues and conspiracies against him. The second stage may last one or two days. In the presence of pathologies accompanying alcoholism (such as severe injuries, a history of delirium, deep alcoholic depression), the completed delirium quickly moves to the next third stage;

Life-threatening delirium (third stage).

At this stage, the patient's speech becomes incoherent, there is no reaction to others, his blood pressure drops, his pupils dilate, and convulsive muscle contractions appear. Essentially, this is the active phase of acute psychosis. This condition lasts up to 5 days. This stage is dangerous because the risks of coma or cerebral edema increase. In addition, it is at the third stage of delirium that an irreversible disruption of the functionality of most intraorganic structures occurs.

In general, the timing of each stage may shift somewhat and depend on the individual characteristics of the patient and his health, alcohol history and duration of binge drinking.

Treatment

If the patient experiences the first signs of delirium tremens, it is necessary to hospitalize him in a narcological clinic, where he will be provided with the necessary medical care. If delirium is ignored, then there is a high probability that one of these attacks will end in death for the patient. Particularly dangerous signs indicating an urgent need for medical intervention are convulsive muscle contractions, hyperthermia up to 40 ° C, excessive aggressiveness, dehydration, high blood pressure and cerebral edema.

After hospitalization, the patient is usually prescribed detoxification therapy, after which the following is indicated:

• psychotropic drugs like Haloperidol, Relanium, Droperidol;
• drugs to normalize respiratory and cardiac activity (Cordiamin, Korglikon);
• agents that restore water-salt balance and metabolic metabolism.

Detoxification is carried out by infusion therapy, hemosorption, and Lasix (1% solution) is administered to prevent swelling of brain tissue. To relieve psycho-emotional overexcitation, drugs like Seduxen, Diphenhydramine, Sodium oxyburate, etc. are recommended.

For alcoholic delirium, therapy is carried out in specialized wards. The duration of fever with qualified therapy usually does not exceed an 8-day period. During the daytime the patient feels well, but at night he begins to suffer from hallucinations. Sometimes all it takes to recover is a long, deep sleep.

Consequences

Delirium causes damage to the entire body, leading to unpredictable consequences. The patient may recover completely or die. The severity of the consequences and outcome of the attack are determined by the strength of health and the degree of ethanol poisoning of the body. In practice, narcologists most often encounter the following consequences of alcoholic tremens:

1. Severe vitamin deficiency;
2. Chronic psychoses;
3. Renal pathologies, cirrhosis, encephalopathy;
4. Pulmonary inflammation;
5. Problems with cardiac functions;
6. Circulatory disorders;
7. Liver pathologies, failure;
8. Amnesia;
9. Dangerous dehydration leading to swelling of brain tissue.

More often, patients who have overcome an attack of delirium fear for their health and try to get rid of the addiction forever in order to avoid a relapse of the disease. According to statistics, such patients, even with a small amount of alcohol, can experience an acute attack of delirium, and it will be much stronger than the first. In such a situation, it can be very difficult to save the patient, especially with fever against the background of long-term drinking.

Help at home

It is not recommended to treat the symptoms of delirium tremens at home, since delirium is considered a dangerous condition that can cause the death of the patient. Therefore, in such situations, you should immediately contact a narcologist-psychiatrist.

Before the doctor arrives, you should try to put the patient to bed. You need to give him more water. If the patient is violent, then even tying him to the bed is acceptable. It is better to apply cold on your head. It is necessary to calm the patient by all means; you can give him valerian, motherwort or some kind of sleeping pill. The main thing is not to leave him alone, so that the patient does not injure himself or others.

If difficulties arise with hospitalization, and for some reason it is impossible, then it is necessary for the patient to fall asleep. For this, it is recommended to use sleeping pills, but it is strictly forbidden to mix them with alcohol. With home treatment, fever can last from 2 to 20 days. However, in order to avoid possible complications, it is still strongly recommended to hospitalize the patient in a specialized medical institution to provide qualified care.

In most cases, delirium tremens is very easy to identify. But the patient will not be able to diagnose himself. He believes that his inappropriate behavior is completely normal. A sick person may react aggressively if he is told that he is sick.

In medicine, delirium tremens is called delirium tremens. People may call it a squirrel. Very often they say about a person who has delirium tremens that he “caught a squirrel”

The disease most often manifests itself against the background of alcoholism as a result of prolonged drinking bouts. It is less common in people who have drank a large amount of alcoholic beverages at one time. In exceptional cases - with a single dose of a small amount of alcoholic beverages.

The most common first symptom of delirium tremens is the patient's complaints about insects crawling next to him and on his body. At the same time, when examining a person, no beetles or spiders are found.

If no measures are taken at the first stage, the patient begins to hear voices that mock and insult him in every possible way.

If loved ones do not call specialists, the situation gets worse. The alcoholic begins to see various creatures, bandits, corpses, animals that are chasing him and trying to harm him.

A person can see anything, but with delirium tremens, the presence of hallucinations is a mandatory symptom.

In addition to hallucinations, a person who has gone on a drinking binge may become very talkative. His behavior changes quite dramatically. To his loved ones, he can vividly recall a situation that happened many years ago. In this case, the accuracy of memories will be very high. If you recognize delirium tremens at this stage, you can avoid many negative consequences.

Another symptom may be a sharp manifestation of feelings of jealousy towards those people about whom the patient was previously indifferent. As a result, an alcoholic may commit rash and dangerous actions. In his opinion, this will speak of masculinity and heroism. But in fact, it can cause danger of harm to both oneself and others.

A person suffering from delirium tremens is characterized by sudden mood swings: good nature, joy and peace can at one moment be replaced by aggression, anger and hatred.

If the patient is not provided with qualified medical care, the result of delirium tremens can be a heart attack, stroke, cirrhosis of the liver, or coma. A patient with delirium delirium can cause fatal injuries to himself and others due to hallucinations.

Every third person who has had delirium tremens suffers from pneumonia.

The most common outcome of delirium tremens is death. But it is also possible for the disease to become chronic. The patient may become permanently demented. A person cannot remember basic things. For example, the name of the doctor who treats the patient, the time of year, the day of the week and even the year. The most terrifying thing about all this is that this process is irreversible.

A patient with delirium tremens experiences the following symptoms:

1. The skin becomes pale. That is why the disease acquired such a name.
2. A person's temperature can rise to 40°C.
3. The patient has hand tremors.
4. Feelings of chills may be followed by increased sweating. At the same time, others can smell a specific smell.
5. The patient's heart rate is rapid. The pressure rises.
6. Having done an ultrasound, you can see that the liver is enlarged.

The following changes will also be visible in the patient’s blood tests:

1. Increased nitrogen concentration in the blood.
2. The acid-base balance in the body of a patient with delirium tremens shifts towards acidity.
3. A noticeable increase in the erythrocyte sedimentation rate.
4. Typically the formation of leukocytosis.

Delirium tremens has several types. Each has its own course of symptoms.

1. Classic delirium tremens. Symptoms appear gradually, smoothly moving from one stage to another.
2. Atypical delirium tremens is a recurrence of delirium. Externally, the disease is very similar to schizophrenia.
3. Lucid delirium. The disease differs from others in that its onset is very acute. Instead of auditory and visual hallucinations, the patient experiences increased anxiety, loss of coordination of movements and tremors of the limbs. The patient is characterized by unreasonable fear.
4. Abortive delirium tremens manifests itself in the form of fragmentary hallucinations. The patient may suddenly develop delusional ideas, the essence of which is clear to him alone.
5. Occupational delirium is initially very similar to the classic form. But when the stage of hallucinations occurs, the patient is dominated by repetitive actions and movements. Often they resemble the professional responsibilities of the sick person.
6. Mumbling delirium most often develops after other forms of the disease. The patient's condition is close to fatal. He practically cannot walk. And lying on the bed, he mutters something, rubs himself with his hands, or tries to drive non-existent insects from his body. If emergency care is not called immediately, the patient will most likely die.

What are the signs of delirium tremens typical for men?

It is men who are more susceptible to delirium tremens when drinking alcohol. This is due to several factors:

1. Alcoholism is more common in men than in women.
2. The male psyche is more susceptible to change.
3. The presence of traumatic brain injuries can contribute to the appearance of acute alcoholic psychosis, which is also more typical for the stronger sex.

In addition to all the standard signs, men may experience a sudden loss of interest in alcohol. In some cases, it is even possible to feel a complete disgust for alcoholic beverages. As delirium tremens develops, the patient may develop insomnia, followed by nightmares. Also, a man with delirium tremens is very susceptible to mood swings. A sharp increase in arousal may occur.

What are the signs of delirium tremens typical for women?

If a woman experiences delirium tremens, it will be somewhat more difficult to treat. This is due to the form of alcohol dependence in women. Unlike men, women develop addiction very quickly and have not only a physical, but also a psychological nature.

In addition to all the above symptoms, women may experience the following symptoms:

1. Headache.
2. Noise in ears.
3. Loss of appetite.
4. Dehydration of the body.
5. Cramps in the limbs at night.

If a loved one develops this disease, it is necessary to immediately call an ambulance and admit the patient to a medical facility. There he will be offered qualified medical care. At home, treatment can only worsen the situation and lead to dire consequences.

Treatments for delirium tremens

If, after a long period of drinking, against the background of withdrawal symptoms, a person experiences hallucinations, then loved ones should urgently call an ambulance team. This will be the first step towards recovery.

The patient will have to be assigned to a psychiatric hospital. Treatment will be comprehensive. First, the patient’s symptoms of insomnia, tremor, increased excitability are relieved and alcohol intoxication is reduced.

Doctors will act in two directions at once: somatic treatment and restoration of the patient’s psyche. Doctors need to normalize the water-salt balance in the patient’s body.

Delirium tremens can affect the patient's liver, kidneys, heart and respiratory organs. Therefore, doctors prescribe drugs to restore these organs. To prevent myocardial infarction, doctors prescribe Corglicon and Niketamide. To prevent the formation of cerebral edema, the diuretic Lasix is ​​usually prescribed.

The patient is injected with vitamin C and B in large dosages. Sedatives, including benzodiazepines, are also used. If the patient has a history of convulsions, then the patient must additionally use antiepileptic drugs. In some cases, in order to better eliminate psychosis in the patient, Carbamazepine is used. But if the patient has severe delirium tremens, then this drug is contraindicated.

What to do if a loved one has delirium tremens?

Initially, you need to call an ambulance and call a team. But when emergency care is on the way, you must try to reassure the patient as much as possible. It would be ideal if he could be put to bed.

If a person shows aggression, attacks others or tries to injure himself, then he must be tied up. It is imperative to remove away all objects with which a person can cause harm to himself or others.

As a rule, during delirium tremens the patient is diagnosed with dehydration. Therefore, it is important not to forget to give the patient clean water to drink. It must be kept cool. To do this, you can place a damp towel on his forehead.

The patient needs to calm down. This can also be done with the help of herbs. For example, using an infusion of mint, lemon balm or chamomile decoction. It is important that the patient is not allergic to these drugs.

Content

Answer yourself this question: would you like to save your loved one? Can such pain be tolerated? How much money have you already spent on ineffective treatment? That's right - it's time to end this! Do you agree? That is why we decided to publish an exclusive interview with Yuri Nikolaev

The disease occurs against the background of long-term poisoning of the body with alcohol products. It is an unpleasant and dangerous consequence of prolonged drinking. Alcoholic delirium causes severe mental disorders, domestic homicides, or suicides. This pathological situation can occur both in people suffering from alcoholism (stage 2-3 of the disease), and in individuals who have received severe poisoning from alcohol-containing products. The consequences caused by fever pose a threat not only to the alcoholic himself, but also to those around him and loved ones.

The consequences of binge drinking and the resulting pathology include: brain damage; severe diseases of the cardiovascular system; liver and pancreas diseases caused by alcohol intoxication; mental problems (dementia, amnesia, aggression, psychosis, depression); committing murder or suicide. Alcoholic delirium is dangerous because in 10% of cases it can lead to death. As can be seen from what is written above, there are no harmless results. Experts in the field of alcoholism treatment talk about three scenarios for the development of delirium tremens:

• ends with minimal traumatic results;
• becomes chronic;
• coma and death.

Mental effects

After a long binge and constantly repeating alcohol abuse, the brain is affected. Alcoholic delirium aggravates its course (increase in body temperature up to 40 degrees, rapid heartbeat, tremor, insomnia) the effect it has on the brain. Irreversible processes may occur. Against the background of delirium, alcoholic dementia develops in the future. A person does not remember basic things, becomes forgetful, unnecessary, and absent-minded. Dementia will progress, there is no turning back in this case.

Hundreds of articles have been written about the treatment of Alcoholism, and a lot of advice has been given. MARIA K. shared her personal experience of getting rid of an addiction with us. Her personal experience of treating her husband for alcoholism.

As a result, there is a possibility that the addicted person will be at risk of epilepsy in the future. With frequent epileptic seizures, respiratory and cardiac arrest may occur, resulting in death.

Fever in some cases turns into chronic mental illness: hallucinosis (patients constantly experience auditory deceptions; such people are called “voice carriers”) and paranoid. From these provisions, if medical care is not provided in a timely manner, it is easy to return to alcoholic delirium. Depression, alienation, degradation, psychosis, attacks of schizophrenia - all illnesses are consequences of fever.

Outcomes for human organs and systems

Alcohol has a destructive effect on all human systems. Delirium tremens is an accelerating factor. It promotes accelerated destruction of cells in the liver, brain, gastrointestinal tract, and cardiovascular system. For the liver, everything can end in fatty degeneration and cirrhosis, a fatal condition.

Alcohol causes atrophy of the walls of the stomach and small intestine. Stomach ulcers and pancreatitis will accompany a person who suffers from delirium tremens. There is a risk of bleeding in the gastrointestinal tract. When brain cells are destroyed, the alcoholic will sooner or later reach a state of alcoholic encephalopathy. If you do not stop drinking, the condition will worsen and lead to nervous, mental and autonomic disorders.

With encephalopathy, a person does not orient himself in space, cannot care for himself and make decisions. Becomes an incapacitated member of society.

The condition of progressive cardiomyopathy is dangerous for the cardiovascular system. The structures of the heart muscle are damaged. The heart turns into a “fat bag” and can no longer perform a pumping function, which also threatens death.

The hematopoietic system cannot function properly; alcohol has a detrimental effect on chemical processes in the body. Alcohol delirium, which occurs once, will be repeated if the person does not stop abusing. The more attacks of white disease, the more organs will be affected. Acquired diseases will become chronic. As a result, the patient increases the likelihood of death significantly.

Bull's heart: the internal organs of a drinking person

Tragic consequences

The disastrous results of pathology are that a person suffering from an illness is dangerous to himself and the people around him. When auditory and visual hallucinations appear, a person can be attacked, maimed, or killed. The patient does not control himself and is capable of causing harm to himself, even committing suicide.

Hallucinations appear 5-6 days after the end of the binge. To avoid tragic consequences, the patient needs long sleep, often resorting to medication. Medicines and dosage must be prescribed by a doctor, otherwise, if the rules of administration are not followed, the condition can be aggravated, which will lead to depression of respiratory and cardiac activity, and death is likely.

Alcohol delirium is a particularly dangerous condition for a person suffering from addiction. If medical care is not provided in a timely manner, the patient may fall into a coma. Also, in the acute course of the disease with pronounced symptoms, the risk of death increases.

To avoid dire consequences, an alcoholic should be withdrawn gradually from long-term abuse. Make sure the patient gets plenty of sleep. It is best to contact specialists who will select treatment and help detoxify the body. This will help reduce the likelihood of developing an insidious disease and its consequences.

And a little about the author’s secrets

Do your family or friends experience these symptoms? And you understand firsthand what it is:

• The attraction to alcohol becomes a priority desire, and it is almost impossible to fight it.
• A severe, pronounced hangover syndrome occurs.
• The maximum dose of alcohol that a patient can drink is determined: contrary to data on doses of alcohol that are lethal for the human body (a little more than a liter), an experienced alcoholic can drink up to one and a half liters of vodka and still survive.
• Personality deformation progresses, the patient suffers from a whole range of various disorders, including:

1. increased irritability to the point of aggressiveness;
2. imbalance, rapid mood swings; general weakness that occurs even with minor exertion;
3. deformation of strong-willed character traits;
4. decreased ability of the patient to concentrate during periods of sobriety;
5. a significant change in priorities in life: monotonous desires are formed, associated exclusively with drinking alcohol.

• The memory and mental abilities of a drinking person deteriorate significantly.
• The patient begins to suffer from severe episodic mental disorders, such as:

1. delirium tremens;
2. hallucinations;
3. alcoholic
4. epilepsy;
5. paranoia.

Now answer the question: would you like to save your neighbor? Can such pain be tolerated? How much money have you already wasted on ineffective treatment? That's right - it's time to end this! Do you agree? That is why we decided to publish an exclusive interview with Yuri Nikolaev, in which he revealed the secrets of getting rid of alcohol addiction.

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Delirium tremens (delirium tremens), or acute metal-alcohol psychosis, is observed in patients with alcohol dependence in stages II-III of the disease and is characterized by a combination of delirium syndrome and severe somato-vegetative, neurological disorders.

What causes delirium tremens?

The main causes of delirium tremens:

• heavy and prolonged binges;
• use of alcohol substitutes;
• severe somatic pathology;
• organic brain damage.

The pathogenesis of alcoholic delirium is not fully known; disturbances in the metabolism of CNS neurotransmitters and severe, primarily endogenous, intoxication are presumably of great influence.

Symptoms of delirium tremens

According to epidemiological studies, most often the first delirium tremens develops no earlier than 7-10 years of the existence of the advanced stage of alcoholism. Alcoholic delirium usually develops at the height of alcohol withdrawal syndrome (most often on the 2-4th day) and, as a rule, manifests itself in the evening or at night. Early signs of approaching delirium tremens are restlessness and restlessness of the patient, severe anxiety and persistent insomnia. Signs of excitation of the sympathoadrenal system are increasing - pallor of the skin, often with a bluish tint, tachycardia and arterial hypertension, hyperhidrosis, moderate hyperthermia. The always present autonomic disorders (ataxia, muscle hypotonia, hyperreflexia, tremor) are expressed to one degree or another. Characteristic disturbances in the water-electrolyte balance (dehydration, hyperazotemia, metabolic acidosis, etc.), changes in the blood picture (leukocytosis, shift of the leukocyte formula to the left, increased erythrocyte sedimentation rate, increased bilirubin content, etc.), low-grade fever are observed.

Autonomic and neurological disorders occur before the onset of disorders of consciousness and persist for a long time after their reduction. Then the disorders described above are joined by pareidolic illusions (flat images of changeable, often fantastic content, usually their basis is a really existing drawing, ornament, etc.). The illusory perception of the environment is quickly replaced by the appearance of visual hallucinations. Psychotic disorders can be unstable: when the patient is activated, hallucinatory disorders can be temporarily reduced and even disappear completely.

Reduced forms of delirium tremens

Hypnagogic delirium is characterized by numerous vivid, scene-like dreams or visual hallucinations when falling asleep or closing the eyes. An increase in psychotic symptoms is noted both in the evening and at night, characterized by mild fear, an affect of surprise, and somato-vegetative symptoms typical of a delirious disorder. The content of hallucinations is varied: there may be frightening pictures (for example, a dangerous chase) and adventurous adventures. In some cases, the patient is transported to a hallucinatory environment, which indicates partial disorientation. When opening your eyes or waking up, a critical attitude towards what you see is not immediately restored and this can affect the behavior and statements of the patient. Hypnagogic delirium tremens lasts, as a rule, 1-2 nights, and can be replaced by metal-alcohol psychoses of different structure and form.

Hypnagogic delirium tremens of fantastic content (hypnagogic onirism) differs from the variant described above in the fantastic content of abundant, sensually vivid visual hallucinations, the scene-like nature of hallucinatory disorders with a sequential change of situations. It is noteworthy: when the eyes are opened, the dreams are interrupted, and when they are closed, they are resumed again and, thus, the development of the hallucinatory episode is not interrupted. With this form of delirium, it is often not the affect of fear that predominates, but interest and surprise. Another distinctive feature is disorientation in the environment (as a constant sign). The duration and outcomes are similar to the hypnagogic delirium variant.

Hypnagogic delirium tremens and hypnagogic onirism are not identified in ICD-10 as separate nosological forms.

Delirium without delirium, delirium tremens without delirium tremens (delirium lucidum, trembling syndrome) - I. Salum. (1972) (F10.44*) - an atypical form, characterized by the absence of hallucinations and delusions in the clinical picture. Occurs acutely. The main disorders contain neurological symptoms, expressed to a significant degree: distinct, rough tremor, ataxia, sweating. Disorders of orientation in time and space are transient. The affect of anxiety and fear is constant. The behavior is dominated by confusion, fussiness, restlessness, and excitement. The course of this form of delirium is short-term - 1-3 days, recovery is often critical. Transition to other forms of delirium is possible.

With abortive delirium tremens (F0.46*), prodromal phenomena are usually absent. In the clinical picture, isolated visual illusions and microscopic hallucinations are observed; Among other hallucinatory disorders, acoasmas and phonemes are most often observed. The affect of anxiety and fear is similar to other forms of delirious stupefaction. Delusional disorders are rudimentary, behavioral disorders are unstable and transient. Neurological disorders are not pronounced.

With the abortive course of delirium and relatively shallow clouding of consciousness, patients may have critical doubts about the reality of what is happening, even during hallucinatory experiences. The patient’s degree of criticality towards the experiences he has suffered increases with recovery and the associated disappearance of delirious symptoms. The duration of abortive delirium is up to 1 day. The output is critical.

Typical or classic delirium tremens

In typical delirium tremens, the symptoms flicker from several hours to a day, after which the hallucinations become permanent. Alcoholic delirium undergoes several successive stages in its development.

Prodromal period

During this period, which usually lasts several days, sleep disorders predominate (nightmarish, frightening dreams, fears), changeable affect with predominance is characteristic, and asthenic complaints are constant. In 20% of cases, the development of delirium tremens is preceded by grand mal and, less commonly, abortive epileptic seizures, most often occurring on the first or second day of the existence of alcohol withdrawal syndrome. On the 3-4th day from the onset of alcohol withdrawal syndrome, epileptic seizures are rare. In other cases, delirium may develop after an episode of verbal hallucinations or an outbreak of acute sensory delirium. When diagnosing alcoholic delirium, one should not forget about the possible absence of a prodromal period. I

First stage

Changes in mood that were present in the prodrome of the disease become more noticeable, and a rapid change of opposite affects is observed: depression, anxiety or fearfulness are easily replaced by euphoria, causeless fun. Patients are excessively talkative, restless, restless (akatasia). Speech is rapid, inconsistent, slightly incoherent, and attention is easily distracted. Facial expressions and movements are lively, fast, sharply changing. Disorientation or incomplete orientation in place and time is often observed. Orientation in one’s own personality, as a rule, is preserved even in the advanced stages of delirium tremens. Patients are characterized by mental hyperesthesia - a sharp increase in susceptibility when exposed to various stimuli, sometimes even indifferent ones. There are influxes of vivid memories, figurative ideas, visual illusions; Sometimes episodes of auditory hallucinations occur in the form of acoasms and phonemes, various elements of figurative delirium are noted, and in the evening all symptoms increase sharply. Night sleep is disturbed, frequent awakenings in a state of anxiety are observed.

Emotional and psychomotor agitation, rapid changes in affect are significant diagnostic signs for distinguishing delirium tremens from alcohol withdrawal syndrome with a predominance of the mental component. In differential diagnosis, it is necessary to distinguish between the initial stage of development of delirium tremens and a hangover state, characterized by a typical monotonous depressed-anxious affect.

Second stage

The clinical picture of stage 1 is accompanied by pareidolia - visual illusions of fantastic content. They can be black and white or color, static or dynamic. Hypnagogic hallucinations of varying intensity are characteristic. Sleep continues to be intermittent, with frightening dreams. During awakenings, the patient cannot immediately distinguish a dream from reality. Hyperesthesia increases, photophobia increases. Light intervals are possible, but they are short-lived. Dream-like experiences alternate with a state of relative wakefulness, with stupor.

Third stage

At stage III, complete insomnia is observed, and true visual hallucinations occur. Characteristic are visual zoological hallucinations (insects, small rodents, etc.), tactile hallucinations (most often in the form of a very realistic sensation of the presence of a foreign object - a thread or a hair in the mouth), verbal hallucinations are possible, mainly of a threatening nature. Orientation in place and time is lost, but remains in one’s own personality. Hallucinations in the form of large animals or fantastic monsters occur much less frequently. Affective disorders are labile, fear, anxiety, and confusion predominate.

At the height of delirious disorders, the patient is an interested spectator. Hallucinations are scene-like or reflect certain situations. may be single or multiple, often colorless. As delirium tremens deepens, auditory, olfactory, thermal, tactile, and hallucinations of the general senses also join. According to different data, hallucinatory phenomena are not just diverse, but complexly combined, combined. Visual hallucinations in the form of cobwebs, threads, wires, etc. are often encountered. Disorders of the body diagram come down to sensations of changes in the position of the body in space: surrounding objects begin to swing, fall, and rotate. The sense of time changes; for the patient it can be shortened or lengthened. Behavior, affect, delusional statements correspond to the content of hallucinations. Patients are fussy and have difficulty staying in place. Due to the prevailing affect of fear, patients try to run away somewhere, leave, hide, shake something off themselves, knock it down or rob it, and turn to imaginary interlocutors. Speech in this case is abrupt, consisting of short phrases or individual words. Attention becomes hyper-distracted, mood is extremely changeable, facial expressions are expressive. For a short time, bewilderment, complacency, surprise, despair alternate one another, but fear is most often and most constantly present. In delirium, delirium is fragmentary and reflects hallucinatory disorders; the content here is dominated by delusions of persecution, physical destruction, and, less often, jealousy and adultery. Delusional disorders in delirium are not generalized; they are affectively intense, specific, unstable, and completely dependent on hallucinatory experiences.

Patients are highly suggestible. For example, if a patient is given a sheet of clean white paper and asked to read what is written, he sees text on this sheet and tries to reproduce it (Reichardt's symptom); the patient starts a long conversation with the interlocutor if you give him a switched-off telephone receiver or some other object called a telephone receiver (Aschaffenburg symptom). When pressing on the closed eyes and asking certain specific questions, the patient experiences corresponding visual hallucinations (Lillmann's symptom). It should be borne in mind that signs of increased suggestibility arise not only at the height of psychosis, but also at the very beginning of its development, and at its end, when acute symptoms are reduced. For example, you can cause persistent visual hallucinations in a patient after the end of delirium, if you force him to peer at shiny objects (Bechterew's symptom).

Another interesting point: symptoms of psychosis can weaken under the influence of external factors - distractions (conversations with a doctor, medical staff). A typical symptom of awakening.

In stage III of typical delirium tremens, light (lucid) intervals can be observed, while patients experience significant asthenic symptoms. In the evening and at night, there is a sharp increase in the severity of hallucinatory and delusional disorders, and psychomotor agitation increases. anxiety can reach raptus levels. By morning, the described state turns into soporous sleep.

This is where the development of delirium tremens ends in most cases. The recovery from psychosis is usually critical - after deep, long sleep, but it can also be lytic - gradual; symptoms can be reduced in waves, with alternating weakening and resumption of psychopathological symptoms, but at a less intense level.

The patient's memories of the mental disorder experienced are fragmentary. He can remember (often in great detail) the content of painful experiences. hallucinations, but does not remember and cannot reproduce what was happening around him in reality, his behavior. All this is subject to partial or complete amnesia.

The end of delirium tremens is accompanied by intensely expressed emotional-hyperesthetic weakness. The mood is changeable: alternation of tearfulness, depression, elements of faint-heartedness with causeless sentimental contentment and enthusiasm are observed; asthenic reactions are required.

After reduction of the clinical picture of delirium, transitional syndromes are observed in some cases. These include residual delusions, an uncritical attitude towards the experience or individual delusional ideas, mild hypomanic (more often in men), as well as depressive, subdepressive or asthenic-depressive states (more often in women).

The structural-dynamic characteristics of the thought process partially change, but no pronounced incoherence or disintegration of thinking is observed. After exiting the psychotic state, a slowdown, a small product of notes, is noted. thinking, but it is always quite consistent and coherent. Possible manifestations of a kind of alcoholic reasoning, alcoholic humor

The course of delirium tremens is usually continuous (in 90% of cases), but can be intermittent: 2-3 attacks are observed, separated by light intervals lasting up to a day.

The duration of alcoholic delirium averages from 2 to 8 days; in a small percentage of cases (up to 5), delirium can last up to days.

Mixed forms of delirium tremens

Alcoholic delirium can become structurally more complicated: it is possible to add delusional experiences, the emergence of ideas of self-blame, damage, attitudes, persecution. Hallucinations can become more complex, scene-like (everyday, professional, less often religious, battle or fantastic). In such cases, it is permissible to talk about mixed forms of delirium tremens, among them systematized delirium and delirium with pronounced verbal hallucinations are distinguished. These forms are not highlighted in ICD-10.

Systematized delirium tremens

The development of stages I and II does not differ from the course of typical delirium tremens. At stage III, multiple scene-like visual hallucinations begin to dominate the clinical picture. The content is dominated by scenes of persecution, while the patient is always the object of assassination attempt and pursuit. The patient’s behavior is dictated by the experiences he experiences: he tries to run away, hide, find a safe place to hide from his pursuers. The affect of fear is pronounced, constant, persistent. Less common are visual hallucinations with a predominance of public spectacles or erotic scenes, witnessed by the patient. Some authors emphasize the constancy of drinking plots. In such cases, the affect of surprise and curiosity predominates. Visual hallucinations coexist with a variety of illusions, pareidolia, false recognitions, false, constantly changing orientation in the environment. In this case, we talk about the development of visual hallucinosis in the structure of alcoholic delirium.

Delusional statements are interconnected with the content of hallucinations, are of a stating nature and change depending on changes in hallucinations. The harm, thanks to the sequence of the story and the “crazy details,” resembles a systematized one.

The clouding of consciousness does not reach a deep level, since the patient, upon emerging from a painful state, is able to reproduce the content of painful experiences. Autonomic and neurological disorders are shallow. The duration of psychosis is several days to a week or more. If the course of psychosis has acquired a princely character, then the way out is always logical, with residual delirium.

Delirium tremens with severe verbal hallucinations

In this case, we talk about the development of verbal hallucinosis in the structure of delirium. Along with the characteristic intense visual, thermal, tactile hallucinations, body diagram disorders, and visual illusions, there are constant verbal hallucinations. The contents of hallucinations are similar to other types of delirium tremens, usually of a frightening nature. That is why affect is determined primarily by anxiety, tension, and fear. Delusional statements resemble those in systematized delirium. However, in this case it should be noted: delusional statements are not supported by argumentation, so there is no need to talk about systematized delirium. In addition, signs of figurative delusion are identified - confusion, ideas of delusional staging, a symptom of a positive double, spreading to many people. Orientation in place and time is slightly impaired: the depth of confusion, despite the abundance of productive disorders, is insignificant. Neurological and autonomic disorders are also not pronounced. The duration of psychosis ranges from several days to several weeks. In the latter case, painful disorders disappear gradually, with residual delirium.

Severe delirium tremens

The identification of the group of severe delirium tremens is associated with severe somatovegetative and neurological disorders, features of psychopathological disorders, as well as the possibility of death. Severe delirium usually occurs in stage II-III or III alcoholism with high tolerance and constant use of alcohol. The development of severe delirium is often preceded by convulsive seizures. There are two forms of severe delirium - professional and excruciating.

Occupational delirium tremens (delirium with occupational delirium) F10.43*

Psychosis can begin with typical disorders; subsequently, a transformation of the clinical picture is observed, as a rule, its worsening. In this case, the intensity of hallucinatory phenomena decreases, the delusion of persecution weakens or disappears. Affective disorders become monotonous. Movement disorders and patient behavior also change. Instead of well-coordinated actions that vary in content, requiring dexterity, strength, and significant space, monotonous movements of a limited scale and stereotypical nature begin to predominate. Patients perform their usual activities, including professional ones: dressing and undressing, counting money, signing papers, washing dishes, ironing, etc. Distraction by external stimuli in this state gradually decreases, and in the future may disappear completely. In the initial period of delirium with professional delirium, changeable false recognition of surrounding persons and constantly changing false orientation in the environment are observed. Self-awareness is always preserved. As the condition worsens, false recognitions disappear, movements become more and more automated. Symptoms of stunning appear already during the day, this also indicates a deterioration in the condition.

Professional delirium tremens is usually accompanied by complete amnesia. Less commonly, individual memories related to the onset of psychosis are retained in memory. As the condition worsens, occupational delirium may turn into delirium; transitional states may also occur in the form of transient dysmnestic, Korsakov's syndrome or pseudoparalysis.

Delirium tremens (delirium with muttering) F10.42*

Usually occurs after occupational delirium, less often - after other forms of delirium tremens with their autochthonous unfavorable course or the addition of intercurrent diseases. Delirium tremens can develop very quickly, within a few hours or days, with virtually no hallucinatory-delusional experiences. This condition is characterized by a combination of deep confusion of consciousness, specific motor disorders and severe somatoneurological disorders. Motor excitation is also observed within the local population; it is limited to the rudimentary movements of grasping, pulling, smoothing, and robbing (carphology). Myoclonic twitching of different muscle groups and choreoform hyperkinesis are often noted. Speech stimulation - a set of simple, short words, syllables, interjections; the voice is quiet, devoid of modulation. Symptoms of stunning increase as the condition worsens; they occur at night and during the day. Recovery is possible, after which the entire period of psychosis is amnesic.

It should be noted that with persistent delirium tremens, the leading place in the clinical picture may be occupied by neurological and autonomic disorders. With it, tachycardia, sudden changes in blood pressure are noted, more often its decrease until the development of collaptoid states, muffled heart sounds, hyperhidrosis, the development of oliguria up to anuria (an unfavorable clinical symptom); subcutaneous hematomas often occur (capillary fragility, blood clotting disorders); hyperthermia (up to 40-41 °C), tachypnea, shallow, intermittent breathing are observed. Neurological symptoms include ataxia, tremor, hyperkinesis, symptoms of oral automatism, muscle tone disorders, and stiffness of the neck muscles; possible urinary and fecal incontinence (unfavorable clinical sign).

As the clinical picture becomes more severe, amentia-like disorders, speech and motor incoherence appear.

Atypical delirium tremens

Atypical forms of delirium tremens include psychotic states with the presence in the clinical picture of disorders characteristic of the endogenous process (schizophrenia). In these cases, symptoms characteristic of delirium tremens coexist with symptoms of mental automatism or are accompanied by oneiric clouding of consciousness. Atypical delirium tremens often occurs after repeated psychoses. Such clinical forms are not identified in ICD-10 in the form of delineated syndromes; in this case, it is justified to classify such conditions as withdrawal syndrome with delirium other (F10.48*).

Delirium tremens with fantastic content (fantastic delirium, alcoholic oneiroid, oneiroid delirium)

The prodromal period is dominated by multiple photopsia, acoasmas, elementary visual hallucinations, and episodes of figurative delusions. The development of alcoholic oneiroid occurs according to the type of complication of the clinical picture. Psychosis may begin as fantastic hypnagogic or classic delirium. During the daytime, visual and verbal hallucinations, figurative delusions, and delusional disorientation may occur. Lucid intervals are characteristic. On the 2-3 days, usually at night, the clinical picture becomes more complicated: scene-like visual and verbal hallucinations appear, delusional disorders of fantastic content, multiple false recognitions are observed, motor excitement from complex coordinated actions turns to disordered, chaotic.

The content of the experienced hallucinations is often of a fantastic nature; frightening visions are noted - wars, disasters, travel to exotic countries. In the minds of patients, events of everyday and adventure-fantastic content are intricately intertwined, without any particular sequence. Hallucinatory pictures are usually fragmentary and unfinished. Another interesting observation: with open eyes the patient is a spectator, with closed eyes he is a participant in the events taking place. At the same time, patients always have a feeling of rapid movement in space.

When scene-like visual hallucinations prevail in the clinical picture, general drowsiness and immobility increase; the condition resembles substupor or stupor. Tom, however, being in a state of inhibition, the patient answers questions, but only after repeated repetitions, in monosyllables. As with other types of delirium, autopsychic orientation is preserved, orientation in place and time is false. Double orientation is often observed - the coexistence of correct and false ideas. The patient's facial expressions resemble those of oneiroid - the frozen facial expression turns into a frightened, preoccupied, surprised one. In the initial stages of psychosis, the affect of fear predominates. With further complication of the clinical picture, fear disappears, replaced by curiosity, surprise, close to complacency. From time to time the patient tries to go somewhere, but with persuasion or slight coercion he calms down. There is no negativism.

The duration of psychosis is from several days to a week, the recovery is critical, after a deep, long sleep. Painful memories persist for quite a long time; the patient talks about them in detail even after a long period of time. After psychosis, in some cases, residual delusions remain.

Delirium tremens with oneiric disorders (alcoholic onirism)

Delirium tremens with oneiric disorders is characterized by a shallow depth of stupefaction and a significantly lower severity of the illusory-delusional component compared to oneiric delirium. From the very beginning, the hallucinations are vivid. According to various authors, with onirism there are no pseudo-hallucinations of ordinary content, and mental automatisms are not expressed. Psychosis ends critically, after deep sleep, on the 6-7th day from its onset.

Delirium tremens with mental automatisms

Mental automatisms arise when typical or highly systematized delirium becomes more complex, when delirium is combined with pronounced verbal hallucinations or in oneiric states. Mental automatisms are transient, incomplete, and almost all of their variants are observed - ideational, sensory, motor. More often, automatisms occur in isolated form, sometimes there are combinations of them (ideational with sensory or motor with sensory); however, according to many authors, three types of automatisms are never encountered simultaneously. When delirium is reduced, automatisms disappear first. The duration of psychosis varies up to 1.5-2 weeks. The outcome is critical; with the lytic variant, the formation of residual delirium is possible.

Differential diagnosis of delirium tremens

It is necessary to carry out a differential diagnosis of alcoholic delirium and delirious disorders resulting from acute intoxication with drugs with an anticholinergic effect (atropine, diphenhydramine, etc.), stimulants (cocaine, zphedrine, etc.), volatile organic substances, in case of an infectious disease, surgical pathology (acute pancreatitis , peritonitis), febrile states of various origins.

Differential diagnosis of alcoholic and intoxicating delirium tremens

If problems arise with diagnosing a delirious state, the help of an infectious disease specialist or surgeon may be necessary.

Treatment of delirium tremens and alcoholic encephalopathies (F10.40*)

Modern treatment tactics for delirium tremens, regardless of its severity, are aimed at reducing intoxication of the body, maintaining vital functions or preventing their impairment. Already with the development of early signs of delirium, plasmapheresis is prescribed with the removal of 20-30% of the volume of circulating plasma. Then infusion therapy is carried out. Such tactics can significantly alleviate the course of psychosis, and in some cases, prevent its further development. The method of choice for detoxification therapy for typical delirium tremens is forced diuresis: massive infusions of solutions in a volume of 40-50 mg/kg under the control of central venous pressure, electrolyte balance, acid-base state of the blood, plasma glucose and diuresis; If necessary, diuretics and insulin are prescribed. Enterosorbents are also used as part of detoxification therapy.

It is necessary to replenish electrolyte losses and correct the acid-base state. Loss of potassium is especially dangerous, as it can cause tachyarrhythmias and cardiac arrest. For potassium deficiency and metabolic alkalosis, a 1% solution of potassium chloride is prescribed intravenously slowly, not more than 150 ml/day. If renal function is impaired, potassium preparations are contraindicated in each clinical situation, doses are set depending on the indications of water-electrolyte balance and acid-base status. To eliminate metabolic acidosis, buffer solutions containing so-called metabolizable anions of organic acids (acetate, citrate, malate, gluconate), for example, sterofundin, acesol and other solutions are used intravenously slowly under the control of acid-base balance.

Large doses of vitamins are added to solutions for intravenous infusion (thiamine - up to 1 g / day, pyridoxine, ascorbic and nicotinic acids).

Drugs that enhance metabolism are prescribed (1.5% solution of meglumine sodium succinate 400-800 ml intravenous drip 4-4.5 ml/min for 2-3 days or cytoflavin 20 40 ml in 200-400 ml 5% glucose solution intravenous drip 4- 4.5 ml/min for 2-3 days).

Cytoflavin is the first complex neurometabolic drug developed on the basis of modern knowledge and discoveries in the field of molecular biology of cellular respiration and clinical medicine.

Cytoflavin is a harmonious neuroprotective composition that promotes safe and rapid recovery from withdrawal symptoms.

After the first day of treatment, headache, sweating, weakness, and irritability disappear. After a course of therapy, sleep normalizes and affective disorders are reduced. Cytoflavin is well tolerated and safe.

• Composition: in 1 ml of the drug: succinic acid - 100 mg, nicotinamide - 10 mg, riboxin - 20 mg, riboflavin - 2 mg.
• Indications: toxic (including alcoholic) encephalopathy, alcohol withdrawal syndrome.
• Contraindications: individual intolerance to the components of the drug.
• Method of administration and dosage: 10 ml of solution intravenously diluted with 200 ml of glucose 2 times a day for 5 days.
• Packaging: ampoules with injection solution No. 10, No. 5.

Also necessary are agents that improve the rheological properties of blood (dextran (reopolyglucin) 200-400 ml/day], cerebral circulation (instenon solution 2 ml 1-2 times a day or 2% solution of pentoxifylline 5 ml in 5% glucose solution 1-2 2 times a day). Use nootronic drugs that do not excite the central nervous system [Semax - 0.1% solution 2-4 drops and nose 2 times a day or hopantenic acid (pantogam) 0.5 g 3 times a day), and hepatoprotectors |ademetionine (heptral) 400 mg 1-2 times a day, thioctic acid (espa-lipon) 600 mg 1 time a day|. Medicines and measures aimed at preventing hypoxia and cerebral edema are also indicated: 10% solution of meldonium (mildronate) 10 ml once a day or 5% solution of Mexidol 2 ml 2 3 times a day. 25% magnesium sulfate solution 10 ml 2 times a day, oxygen therapy, hyperbaric oxygenation, cranial hypothermia, etc. Careful monitoring of the patient’s vital functions (respiration, cardiac activity, diuresis) and timely symptomatic therapy aimed at maintaining them are necessary (for example, prescribing cardiac glycosides for heart failure, analeptics for respiratory dysfunction, etc.). The specific choice of drugs and solutions for infusion, drug and non-drug therapy should be based on the existing disorders in each specific case.

Treatment of delirium tremens and acute encephalopathies

It should be noted that in delirium tremens, the antipsychotic activity of existing psychotropic drugs has not been proven. They are prescribed for psychomotor agitation, severe anxiety and insomnia, as well as for the presence and history of convulsive seizures. Drugs of choice: benzodiazepine drugs 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip up to 0.06 g/day; 0.1% solution of phenazepam 1-4 ml intramuscularly or intravenously drip up to 0.01 g/day and short-acting barbiturates sodium thiopental, hexobarbital (hexenal) up to 1 g/day intravenously drip under constant monitoring of breathing and circulation. In case of severe delirium tremens (occupational, excruciating) and acute alcoholic encephalopathies, the administration of psychotropic drugs is contraindicated.

It is important to know!

In recent years, our country has seen an increase in the incidence of chronic alcoholism (alcohol dependence), and there has been a noticeable increase in the incidence of a condition such as alcoholic psychosis, which most accurately reflects the prevalence and severity of chronic alcoholism (alcohol dependence).

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Metal-alcohol psychoses are severe mental disorders that appear after prolonged and frequent consumption of alcoholic beverages. Typically, such manifestations are characteristic of people who are in the last stages of development of chronic alcoholism.

The most famous and common psychosis is delirium delirium. It appears approximately on the second or third day after leaving the hospital. Characteristic signs of alcoholic delirium are various hallucinations that pose a threat to alcoholics.

Why does this disease occur? How to determine the symptoms of approaching delirium tremens? Can delirium develop after a long binge of drinking alcohol? These questions can increasingly be found on the Internet, which means that there are a lot of drinkers in the modern world. And relatives simply need to know how to recognize the onset of the disease and what to do with the patient when it is diagnosed.

Causes of alcoholic delirium

Delirium tremens develops at the moment of abrupt cessation of alcoholic beverages. This is due to the fact that in chronic alcoholics it has long been incorporated into metabolic processes, and its lack causes acute metabolic disorders, which significantly affects the brain.

Accordingly, this leads to pathological changes in the entire central nervous system, which not every absolutely healthy person can withstand. All this affects mental health, causing mental disorders, one of which is delirium.

In addition, with prolonged consumption of alcohol, the body is subject to severe intoxication caused by acetaldehyde, the main metabolite of ethanol, which is a very strong toxin that destroys almost all internal organs and has a detrimental effect on the peripheral nervous system and brain.

In the most common cases, delirium tremens occurs during withdrawal syndrome, as one of the manifestations of severe. But such a disease can also develop if a person has not drunk alcohol at all for a long time, and then gets drunk, as they say, “to hell.” In any case, delirium tremens occurs exclusively in people who drink. If a person refuses to drink alcohol, then he should not be afraid of “squirrels”.

The main causes of the occurrence and development of delirium tremens:

• sudden refusal of alcohol after binge drinking;
• drinking surrogates or cheap low-quality alcohol;
• single consumption of large doses of alcoholic beverages;
• long-term, developed with constant consumption of alcohol in large quantities.

Who is susceptible to delirium tremens

Alcoholic delirium develops in the second or third stage of chronic alcoholism. Typically, the alcohol “experience” is five to seven years of continuous drinking. However, it is worth remembering that women can develop delirium tremens much earlier, around the third or fourth year of alcohol abuse. Since they are more susceptible to the effects of alcohol and drink too much faster than men. In women, the symptoms of this disease are most pronounced.

Clinical picture

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Also, older alcoholics are more susceptible to delirium than younger ones. According to statistics, this disease is typical for people over the age of forty.

Most prone to delirium tremens:

• people with a history of traumatic brain injuries or diseases of the central nervous system: arachnoiditis, encephalitis, meningitis;
• persons suffering from chronic alcoholism who have been drinking alcohol for five years or more;
• persons with chronic infectious diseases;
• people who have already experienced an attack of delirium once.

The main signs by which delirium tremens can be recognized are hallucinations. The patient's behavior changes significantly, and consciousness is distorted. Gestures and facial expressions correspond to the visions that overcome an alcoholic. Attacks of delirium are always accompanied by complete disorientation in time and space, unreasonable strong fear and panic, unmotivated aggression and increased excitability. Often such people talk loudly and incoherently to themselves, lose control over themselves and can even commit suicide.

Symptoms of this disease include:

1. Visual hallucinations. They often begin with illusions that arise on the edge of consciousness, becoming more clear and vivid over time. Usually patients see things that once frightened them. In most cases these are insects or small animals, snakes. Many people feel like they are stuck in a web or entangled in ropes and cannot get out. Ordinary interior items begin to move, speak, and gradually change shape, turning into fantastic creatures. Devils or dead people are also often seen.
2. Auditory hallucinations. Rustling, rustling, hissing snakes, slamming doors or windows, knocking - all this is quite clearly heard by a person in an attack of delirium tremens. But the worst thing is the voices that threaten, warn, scream in horror or beg for help. Often, trying to get rid of auditory hallucinations, patients attempt suicide.
3. Tactile hallucinations most often involve touching. The patient always thinks that something is crawling on him, that someone is touching, biting, pinching or stroking him.
4. Gestures, facial expressions, movements - everything reflects the genuine horror that a person experiences in his personal nightmares. The fear or disgust experienced is clearly written on the face, the movements resemble attempts to extricate oneself from non-existent shackles, the patient tries to brush off and fight off the fantastic creatures attacking him.

While in hallucinatory delusions, alcoholics can harm themselves and others nearby. Often, in an attempt to escape from someone, they fall under cars or jump out of windows. There are many cases where patients tried to commit suicide in order to get rid of obsessive visions.

Attacks usually begin in the late afternoon and worsen at night. By morning, everything usually stops, but without proper treatment, when darkness falls, the disease progresses again. On average, an attack of delirium tremens lasts about five days, during which the patient has virtually no sleep.

If medical assistance is not provided in a timely manner, the attack of delirium drags on for two to three weeks, the disease progresses to a severe stage and often entails serious and severe consequences, including death.

An attack of delirium tremens ends quite abruptly, hallucinations and nightmares simply disappear, and the patient falls into a life-saving restorative sleep, at the end of which weakness, lethargy, depression and irritation are observed.

Signs of the onset of delirium tremens

Delirium tremens begins to progress at night. During the daytime, her symptoms subside significantly. Harbingers of the onset of the disease are:

• the appearance of an aversion to alcohol, a sharp cessation of drinking alcohol;
• increased excitement, turning into complete apathy;
• anxiety, suspiciousness, restlessness, constant incoherent speech;
• tremor of the limbs, facial muscles and eyelids;
• restless sleep, accompanied by nightmares, gradually turning into insomnia;
• the appearance of visual and auditory hallucinations;
• high fever, chills, headache, tinnitus;
• loss of appetite, increased sweating and rapid heartbeat.

These are the first clear signs of the onset of delirium tremens. Subsequently, the attack intensifies, the hallucinations become brighter and clearer. If any symptoms appear, you should immediately seek medical help to prevent possible unpleasant consequences.

Self-treatment in such cases is contraindicated, as it can end badly. Therefore, you need to urgently call an ambulance and, if possible, provide first aid.

To do this you should:

• do not leave the patient unattended;
• put him in bed, tie him down with improvised means if necessary;
• apply a cold compress to the forehead, and if the patient’s condition allows, give him a cold shower.

Then you should wait patiently for medical help.

Delirium tremens can only be treated in a hospital. Therapy includes several stages:

• use of psychotropic, sedative and hypnotic drugs: Diazepam, Haloperidol, Relanium, Nitrazepam;
• administration of anticonvulsants: Carbamazepine and others;
• infusion therapy to relieve symptoms of intoxication, the following solutions are used for droppers: glucose, isotonic solution, Hemodez;
• taking medications to restore water and electrolyte balance in the body;
• treatment of concomitant diseases: cerebral edema, heart and liver pathologies.

Treatment is aimed at alleviating the patient’s condition and preventing serious consequences. You can protect yourself from a new attack of delirium tremens only by getting rid of a bad and dangerous habit forever.

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Finally

Delirium tremens is a severe mental disorder in which significant changes occur in the patient’s consciousness. He hears different voices and is haunted by monstrous images. In addition to everything else, a number of somatic symptoms are added in the form of chills, fever and sweating, headache, rapid heartbeat and others. It is necessary to treat such a disease only in a hospital setting, and in order to finally get rid of it and prevent recurrent attacks, it is necessary to quit drinking forever.

Drawing conclusions

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