Clinic of simple alcohol intoxication, depending on the degree, the level of alcohol in the blood at various degrees of intoxication. Acute alcohol intoxication: stages of alcohol intoxication, atypical alcohol intoxication, pathological intoxication - clinical

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 that are 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 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- Stimulant, 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. So, 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 dependence on 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 reprisal. 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 drunkenness can 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 assessing 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. In contrast to typical intoxication, with altered forms, any one group of symptoms characteristic of intoxication sharply increases, 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 with oligophrenia, with residual phenomena of organic damage to the central nervous system, 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). TO physical features include: obesity or weight loss, arterial hypertension, hand tremors, impaired sensation of 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 other signs. A combination of 6 or more signs indicates regular alcohol use. 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 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 the help of 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 appoint at the expressed 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 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 safety 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. The 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 arises against the background of a 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 that occur in a limited space, reflecting individual everyday actions - dressing and undressing, collecting or unfolding 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, conversely, 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.

Factors predisposing to the development of atypical forms of simple alcohol intoxication are different. These can be residual organic brain lesions, early age of onset of alcohol consumption, combined intake various kinds alcoholic beverages, simultaneous intake of alcohol and drugs, somatic disease accompanied by asthenia, lack of sleep, malnutrition, overwork, psychogenia. In this case, there is an excessive strengthening or weakening of the disorders that accompany intoxication, or a change in their dynamics, as well as the appearance of symptoms that are not characteristic of intoxication. The mental signs of simple intoxication undergo the greatest changes.

Dysphoric form of alcohol intoxication.

Instead of euphoria, malice, irritability, anger, a gloomy mood appear, leading to conflict and. An intoxicated person experiences a feeling of discomfort, hyperesthesia appears. Anger spreads to everything around, accompanied by captiousness, causticity, the search for a reason for quarrels. This state may persist for several days. This form of intoxication usually develops with an organic pathology of the brain.

Paranoid form of alcohol intoxication.

It is characterized by the appearance of suspicion, resentment, captiousness. Intoxicated people inadequately evaluate the words and actions of others as a desire to humiliate, deceive, ridicule. The motor and speech excitement intensifies, the drunks shout out separate phrases or words, testifying to the danger threatening them. This form of intoxication is often accompanied by aggression towards others, independent of their words and actions. The paranoid form of intoxication develops in primitive personalities, paranoid and epileptoid psychopaths.

Hysterical form of simple alcohol intoxication .

The behavior of the intoxicated is designed for the audience. The movements are theatrical (stormy scenes of despair, throwing, wringing hands) sometimes with an element of puerilism. Statements are pathetic with various accusations against others, self-praise or exaggerated self-reproach. Demonstrations are often made. This form of intoxication usually develops in persons with hysterical character traits.

Depressive form of simple alcohol intoxication.

Instead of euphoria, a depressed mood prevails. There are tearfulness, unpleasant memories, self-pity, feeling, longing, ideas of self-blame and suicidal thoughts. The risk of suicide attempts in this case is high.

Manic form of simple alcohol intoxication.

An elevated mood prevails with carelessness, complacency, accompanied by inappropriate jokes, various "naughty" actions. The behavior of some intoxicated is manifested by foolishness, stereotypy, antics, echolalia. Such forms are typical for adolescents and young men.

Epileptoid form of simple alcohol intoxication.

It is characterized by motor excitation with irritability, aggravated by opposition from others. Intoxicated people are initially aggressive towards those who reprimand them or try to calm them down, and then the aggression spreads to everyone who happened to be nearby. However, even at the height of the episode, there is no complete separation from reality. are reduced critically with subsequent sleep. Quite often the period of excitation is amnesiac.

A somnolent form of simple alcoholic intoxication.

After a short euphoria, shortly after drinking alcohol, a deep sleep sets in, sometimes turning into a stupor or coma.

An explosive form of simple alcohol intoxication.

The state of euphoria under the influence of minor external factors is replaced by sharp discontent, irritability, anger. These outbreaks are usually short-lived, alternating with periods of rest, but repeatedly repeated against the background of intoxication.

Simple alcohol intoxication, including its atypical forms, retains the main signs of acute alcohol intoxication, while productive (psychotic) forms of consciousness disorder do not occur. A variety of actions and statements of a drunk have a selective focus. The presence of persons capable of resisting with unpleasant consequences for a drunk influences his behavior. Intoxicated people always retain the possibility of contact with others.

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 damage to the central nervous system, 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 feature, 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 responses 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.

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Alcohol intoxication

Table of contents

Introduction
3. Pathological intoxication
Conclusion
Bibliographic list

Introduction

Alcohol is the most commonly used psychoactive substance. Alcohol-containing drinks from the standpoint of pharmacology, toxicology and narcology are a narcotic substance. But since alcohol is not listed as controlled as a drug, alcoholism is not legally considered a drug addiction. In the system of organizing drug treatment for the population, alcoholism occupies a leading place and represents the main form of diseases in this group.

Ethyl alcohol acts mainly on the central nervous system. It causes a characteristic alcoholic excitation. First of all, under the influence of alcohol, the activity of the cerebral cortex is disrupted, and with an increase in its concentration in the blood, the cells of the spinal cord and medulla oblongata are affected. Spinal reflexes suffer only with deep intoxication. Under the influence of alcohol, the reactivity and efficiency of cortical cells decrease, which leads to the disruption of complex conditioned connections. Excitation, characteristic of alcoholic intoxication, does not in any way indicate the true stimulating effect of alcohol. It causes inhibition of the inhibitory processes of the cerebral cortex, leading to the release of subcortical centers, which determines the picture of alcoholic excitation. In large doses, alcohol also depresses the subcortical centers, which can lead to a coma. Under the influence of alcohol, the coordination of the antagonist muscles is disturbed, which leads to inaccurate movements: the gait of the intoxicated becomes shaky, uncertain (to a large extent this is also due to the dysfunction of the vestibular apparatus).

Alcohol, acting mainly through the central nervous system, is a strong stimulant of the secretion of the gastric glands, but the gastric juice secreted at the same time is poor in enzymes, and its digestive capacity is reduced. The local effect of alcohol on the gastrointestinal tract is also significant, the prolonged hyperemia and stagnation in the blood vessels caused by it lead to degenerative changes in the parenchymal elements of the mucous membrane, which becomes smooth and eroded.

Alcohol enhances the motor function of the stomach, and therefore the evacuation of its contents occurs faster. When taken orally, under normal conditions, about 20% of the alcohol taken is absorbed in the stomach, and the remaining 80% in the small intestine. Alcohol diffuses into the wall of the stomach and small intestine, most of it enters unchanged directly into the bloodstream. Another part of the alcohol penetrates the wall of the stomach and small intestine and enters the abdominal cavity, from there it is absorbed by the large surface of the peritoneum and only then enters the bloodstream.

The purpose of this work is to consider the activities of law enforcement officials with atypical and acute reactions when drinking alcohol.

1. Simple alcohol intoxication

Simple alcohol intoxication can manifest itself in mild, moderate and severe degrees.

A mild degree of simple alcohol intoxication (usually with a blood alcohol concentration of 1-1.5%) is manifested by a feeling of warmth, flushing of the skin, increased heart rate, increased appetite, and sexual desire. Attention is easily distracted, the pace of thinking accelerates, inconsistency and superficiality begin to predominate in it. In movements, there is a large scope, impetuousness, and a decrease in accuracy. The mood improves, there is a feeling of cheerfulness and contentment, pleasant thoughts and associations prevail, the perception of what is heard and seen has a predominantly positive color. Fluctuations in the emotional background, if they occur, are shallow (slight resentment, annoyance, impatience with a touch of irritation) and soon pass. Speech becomes louder and faster, but there are either no articulation disorders, or, more rarely, they are slightly expressed. The critical attitude both to one's condition and to the duties performed decreases. After some time from the onset of intoxication, elated mood is gradually replaced by lethargy and indifference, physical activity gives way to relaxation; thinking becomes slower. The state of fatigue is growing, there is a desire to sleep. After a mild degree of intoxication, which lasts an average of several hours, no unpleasant mental and physical sensations are noted, memories of the period of intoxication are preserved.

The average degree of simple alcohol intoxication (blood alcohol concentration from 1.5 to 3%) is characterized by more severe behavioral changes. Speech becomes dysarthric and louder due to an increase in the threshold of auditory perception. Representations are formed with difficulty, their content is monotonous. The slowdown of the associative process makes it impossible to choose a synonym or replace a difficult word. There are frequent repetitions of the same phrases. Attention switches slowly, only under the influence of strong stimuli. The ability to critically assess one's capabilities and the actions of others is sharply reduced. This leads to the emergence of various kinds of conflicts, which are due to the overestimation of the intoxicated own personality and the disinhibition of drives and desires. The surrounding situation is assessed only fragmentarily, as a result of which inadequate, including illegal, actions are often committed. Movements become uncertain, motor skills are even more upset and symptoms of ataxia appear. Practically all persons with moderate intoxication have gross violations of handwriting, staggering with a tendency to fall in the Romberg position, and weakness in the reaction of pupils to light. It should be emphasized that a person who is in a state of moderate intoxication, despite the symptoms described above, is capable of very correct and accurate remarks not only to those around him, but also to himself, i.e. mental disorders are always dissociated.

Moderate intoxication is usually replaced by deep sleep. Upon awakening, the consequences of intoxication are felt: weakness, lethargy, weakness, dry mouth, thirst, a feeling of heaviness in the head, in some cases irritability or depressed mood. Physical and mental performance is reduced. About the events that took place during the period of intoxication, especially those that were not emotionally significant, memories are vague, with individual episodes being remembered.

A severe degree of simple alcohol intoxication (the concentration of alcohol in the blood is from 3 to 5% and above) is determined by the appearance of symptoms of stupor of consciousness of various depths. In the most severe cases, an alcoholic coma develops. Neurological disorders are always observed: cerebellar ataxia, muscle atony, amimia, severe dysarthria. Vegetative disturbances intensify: respiration is reduced up to its pathological forms, the tone of the cardiovascular system decreases, cyanosis of the extremities and hypothermia appear. Vestibular disorders are often observed: dizziness, nausea, vomiting. In some cases, epileptiform seizures occur. Possible involuntary discharge of urine and feces. After severe intoxication has passed, adynamic asthenia is observed for several days, initially accompanied by ataxia, dysarthria, and various autonomic disorders. Anorexia and sleep disturbances are characteristic. Severe intoxication is usually accompanied by complete amnesia - the so-called. narcotic amnesia.

2. Atypical forms of simple alcohol intoxication

These are states of mild or moderate acute alcohol intoxication, in which (compared to simple intoxication) an excessively sharp increase or, conversely, weakening of some disorders occurs, or the sequence of their occurrence is disturbed, or symptoms develop that are not characteristic of simple alcohol intoxication.

Mental disorders undergo the greatest modification; much less - neurological. Altered forms of simple alcohol intoxication usually occur under a variety of concomitant conditions: on pathological grounds (psychopathy, oligophrenia, mental illness of various genesis, with residual organic brain damage, early onset of alcoholism, formed alcoholism, simultaneous use of alcohol and drugs, combined intake of various types of alcoholic beverages, in cases where intoxication is preceded by a somatic disease or occurs against its background, as well as in case of lack of sleep, overwork or psychogenic disorders.The selected options reflect the prevailing psychopathological disorders.

Explosive variant of a modified simple alcohol intoxication. The state of euphoria is expressed weakly and easily spontaneously or under the influence of external insignificant circumstances by transient outbursts of sharp discontent, irritation or anger. Accordingly, the content of statements and behavior change. Usually these outbreaks are short-lived, alternating with relative calm and even complacency, but during intoxication they are repeated repeatedly.

Dysphoric variant of altered simple alcohol intoxication. A persistent state of tension prevails, accompanied by discontent, gloom, hostility or anger. In almost all cases, a low-dreary affect can be detected. Hostility and anger spread to everything seen and heard: the intoxicated becomes picky, caustic, cocky, looking for a reason to quarrel. A feeling of somatic discomfort and hyperesthesia are often detected. The above violations can be observed for several days after the alcoholic excess.

A hysterical version of a modified simple alcohol intoxication. The behavior of an intoxicated person is always designed for the viewer. There is a simulated affect with a tendency to loud phrases, recitations, the content of which usually comes down to unfairly received insults. Often in statements that differ in pathos, various accusations against others, self-praise or, on the contrary, exaggerated self-reproach, predominate, fantasizing is often observed.

A depressive variant of altered simple alcohol intoxication. The clinical picture is dominated by a depressed mood of varying severity and shades. As a rule, the euphoria of the initial period is either absent or short-lived. In relatively mild cases, there is a subdepressive affect with tearfulness, unpleasant memories, self-pity. In more severe ones - longing, a feeling of hopelessness, anxiety, which are accompanied by self-reproach and suicidal thoughts. Due to the lack of motor inhibition in this state, the likelihood of suicidal attempts is high.

Altered simple alcohol intoxication with impulsive actions, as a rule, is observed in patients with schizophrenia and is usually accompanied by sexual perversions - homosexual acts, exhibitionism, flagellation. Pyromania and kleptomania are much less common.

Altered simple alcoholic intoxication with a predominance of somnolence. After a short and mild period of euphoria, a state of drowsiness occurs, quickly turning into sleep.

The manic variant of a modified simple alcohol intoxication is manifested by an elevated mood with carelessness and complacency, short outbursts of irritation, various "naughty" actions, annoying pestering, inappropriate jokes, loud laughter, and increased responsiveness to the environment. The picture of intoxication may resemble a manic state of organic genesis, less often - hebephrenic excitement.

With all the listed forms of altered simple alcoholic intoxication, symptoms of ordinary intoxication, expressed to varying degrees, are always observed: deterioration in motor skills, articulation, changes in behavior depending on environmental conditions, and intact orientation.

The most severe in terms of clinical manifestations and social consequences are such altered forms of simple alcohol intoxication as epileptoid and paranoid. Their very name emphasizes the well-known similarity with the main types of pathological intoxication.

Epileptoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is determined by rapidly increasing motor excitation with the effects of irritation or anger towards others. The state deepens under the influence of opposition and is complicated by aggressive violent acts. Initially, aggression is usually selective and directed at persons directly related to the behavior of the intoxicated. As motor excitation intensifies, aggressive actions spread to everyone who is nearby. The disturbances of coordination of the movement observed earlier usually decrease or absolutely disappear. At the height of arousal, movement disorders and statements may become stereotyped, but a semantic connection with the situation of the initial period of intoxication is always preserved. Moreover, the intensity of speech-motor excitation and the aggressive actions associated with it is subject to certain fluctuations, depending on the verbal reactions of others. At the height of the episode, there is no complete separation of the intoxicated from the real situation. Mental disorders disappear critically, followed by drowsiness or sleep. Quite often there is amnesia of the period of pronounced excitement.

3. Pathological intoxication

Pathological intoxication is a hyperacute transient psychosis caused by alcohol intake. After taking a relatively small amount of alcohol, twilight confusion suddenly develops. There is a detachment from the environment, accompanied by disorientation of all kinds, but the usual automated actions remain, in particular the ability to move on foot or in transport. As a rule, the episode is completely amnesic. Psychiatrists usually come to the attention of those cases of pathological intoxication in which twilight stupefaction is accompanied by productive disorders - figurative delirium, motor agitation, affective disorders (fear, rage, frenzy), visual hallucinations of a frightening nature, i.e. there is a "psychotic" form of twilight clouding of consciousness. In this state, socially dangerous acts are often committed. The actions of patients are entirely determined by the psychotic disorders that have arisen, the real situation does not matter for their actions. In the behavior of persons in a state of pathological intoxication, two main tendencies are usually revealed: defense with the desire to destroy the source of danger and flight from a life-threatening situation. Often these two tendencies coexist. With a certain degree of conventionality, two main forms of pathological intoxication are distinguished - epileptoid and paranoid, or hallucinatory-paranoid (more common).

In the epileptoid form of pathological intoxication, intense motor excitation predominates, usually in the form of meaningless and chaotic, aggressive actions of a stereotypical nature. The affect of frenzied anger and rage predominates, speech production is very poor, sometimes motor excitation is mute. Hallucinatory-delusional disorders are usually rudimentary.

In the paranoid (hallucinatory-paranoid) form of pathological intoxication, figurative delusions predominate, the content of which is usually situations that threaten the life of the intoxicated person. The environment is perceived in an altered (illusory-delusional) plan. In a state of motor excitation, the ability to perform sequential and complex actions that outwardly look purposeful is often retained. Both motor and speech reactions are caused by psychopathological disorders, primarily delirium and altered affect. Much less often, frightening visual hallucinations predominate in the clinical picture; as a rule, these are isolated rather than scene-like phenomena. Oppressive, haunting, relatively simple visual hallucinations predominate.

alcohol intoxication pathological simple

Approximately in 2/3 of cases, pathological intoxication is replaced by deep sleep, and in the rest - by a sharp psychophysical exhaustion. A very common symptom of pathological intoxication is amnesia of a psychotic episode (almost 90%), with more than half having complete, and the rest partial.

There is evidence that in 10% of cases there are repeated states of pathological intoxication.

Pathological intoxication can occur in practically healthy individuals, but much more often a psychotic episode develops against the background of permanent and temporary additional hazards. The former include residual effects of transferred organic (TBI, neuroinfections) diseases. Of the temporary additional hazards, overwork, lack of sleep, high or low temperature are more common. environment, sudden temperature changes, intercurrent somatic and infectious diseases, as well as previous psychogenies.

Forensic psychiatric examination qualifies pathological intoxication as a state of insanity, in connection with which persons who have committed socially dangerous acts in this state are exempted from criminal liability.

4. Treatment of acute alcohol intoxication

With mild and moderate degrees, general and local warming is recommended, inside 10-15 drops of ammonia in 100 ml of water.

In moderate and severe: gastric lavage, subcutaneous injection of 0.25-0.5 ml of apomorphine hydrochloride solution (to induce vomiting), bladder catheterization in case of urinary retention. In a coma - the introduction of cardiac drugs, intravenously, 100 mg of pyridoxine (vitamin B6), up to 1 liter of saline with 15-20 ml of 40% glucose. With strong motor excitement, vitamin B12 is recommended at a dose of 50-100 mg. The introduction of barbiturates is contraindicated!

In cases of severe coma - venipuncture with the withdrawal of up to 200 ml of blood, subcutaneous saline - 800-1000 ml. With asphyxia - inhalation of oxygen, artificial respiration, cytiton (1 ml of a 0.15% solution in / in), lobelin (1 ml of a 1% solution of s / c), inhalation of a mixture of 90% oxygen and 10% carbon dioxide.

A medical examination to determine the state of intoxication is a complex event that fulfills the social order of society, including the fulfillment of legal, medical, metrological, moral and ethical requirements.

Since the survey is carried out in accordance with the requirements of applicable laws and other normative documents, its consequences can lead to serious consequences for the examinee.

A feature of the medical examination is that not only specialists involved in this particular activity are involved in the examination, but also non-specialists in the field of medical examination - a wide range of doctors of other specialties and paramedics for whom the medical examination is an additional burden. As a rule, they are not sufficiently familiar with the legal basis of the examination, the procedure for its conduct and the criteria for substantiating the conclusion.

The basis of the medical opinion regarding the conditions associated with the consumption of alcohol is the data of a comprehensive medical examination. After its completion, the exhaled air is taken to examine it for the presence of alcohol. Blood for alcohol testing is taken in exceptional cases: for medical reasons (for example, severe injuries, poisoning, etc.), as well as in cases where, due to the severity of the condition of the person being examined, signs of intoxication cannot be detected.

The conclusion about intoxication is made on the basis of identifying clinical signs of intoxication and positive results of the study of exhaled air for the presence of alcohol. The degree of intoxication is not indicated, since there is no such requirement in legislative acts.

Conclusion

Alcohol intoxication is an acute intoxication caused by the psychotropic effect of drinks containing ethyl alcohol (alcohol), causing inhibition of the central nervous system. In mild cases, it proceeds with ideomotor agitation and vegetative symptoms, in severe cases, with a further deepening of inhibition, the development of neurological disorders and a sharp depression of mental functions, up to coma.

The severity of alcohol intoxication and its clinical features depend not only on the amount of alcohol taken, the rate of intake, air temperature and even its concentration in the blood. It also depends on the individual biological, mental characteristics of the individual - the type of nervous system, personality traits, as well as on his functional state at the moment. For example, the sensitivity to alcohol is sharply increased in psychopathic individuals, in persons with the consequences of craniocerebral trauma, who have had infectious and somatic diseases or central nervous system depletion in the past, and even just overwork immediately before drinking alcohol.

Clinical manifestations of alcohol intoxication are divided into the following main types:

A) simple alcohol intoxication;

B) modified forms of simple alcohol intoxication;

C) pathological intoxication.

Bibliographic list

1. Balabanova L.M. Forensic pathopsychology (issues of determining the norm and deviations). - D.: Stalker, 1998.

2. Dunaevsky V.V., Styazhkin V.D. Drug addiction and substance abuse. - L .: Medicine, 1990.

3. Kirpichenko A.A. Psychiatry: Proc. for honey. in-tov, - Mn .: Vysh. school, 1996.

4. Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M.: "Expert Bureau - M", 1997.

5. Forensic psychiatry. / Ed. G.V. Morozov. - M.: Yur. Lit., 1978.

6. Forensic psychiatry: Textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.

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