The four types of psychoses associated with the abuse of alcohol
This is an acute reaction that occurs in individuals whose tolerance to alcohol is chronically very low, especially epileptics or those of an unstable personality makeup, or in normal people whose tolerance to alcohol is temporarily lessened by exhaustion, emotional stress or other conditions. Moderate consumption may even cause these individuals to suddenly become disorientated and may exhibit homicidal rage and may at times commit violent crimes.
This extraordinary state is usually followed by a period of deep sleep followed by complete amnesia.
These acute reactions would usually last only for a short time and confusion, excitement and delirium will be manifested. They are termed alcoholic psychoses as they are identified by a temporary loss of contact with reality.
This alcoholic psychotic reaction is common among those who drink excessively for a long time, appear during a period of abstinence, be associated with a head injury or infection or occur upon the withdrawal of alcohol after prolonged drinking.
A period of restlessness and insomnia may prelude the delirium and the person may generally feel uneasy and apprehensive. Apparently slight noises or sudden moving objects may cause considerable excitement and agitation.
Full-blown symptoms may include:
- Disorientation for time and place in which a person may mistake the hospital for a church or jail, friends are no longer recognized and hospital attendants may be identified as old acquaintances.
- Vivid hallucinations usually of small, fast moving animals like snakes, rats and cockroaches.
- Acute fear of those animals which may change in form, size or colour in terrifying ways.
- Extreme suggestibility as the person can be made to see almost any form of animal if its presence is merely suggested.
- Notable tremours of the hands, tongue and lips.
- Perspiration, fever, a rapid and week heartbeat, a coated tongue and foul breath.
The delirium lasts from three to six days and is followed by a deep sleep. Once the person awakes there are few evident symptoms but would frequently be badly scared and may not resume drinking for several weeks or months.
There would unfortunately be an eventual resumption of the abuse of alcohol, followed by a return to the hospital with a new attack. Death could be caused by convulsions, heart failure and other complications and which should be initially treated with the chlordiazepoxide drug.
Psychoses and alcoholism
Acute alcoholic hallucinosis
The main symptoms are auditory hallucinations as the individual hears a voice making certain simple statements. These hallucinations usually extend to the voices of several people and they tend to be critical and reproachful. Private weaknesses are usually itemized and discussed and various horrible punishments are then proposed. Typical sounds would be the clanking of chains, the sharpening of knives, the sound of pistol shots, or footsteps approaching in a threatening manner. The individual may eventually scream for help or attempt suicide. These bizarre occurrences may continue for several days or even weeks while the person is depressed but relatively well oriented and coherent, apart from the hallucinations.
Originally described by the Russian psychiatrist Korsakoff in 1887, this symptom is a memory defect which is concealed by falsification. These individuals may not recognize pictures, faces, rooms and objects that they have just seen, although they may feel that these people or objects are familiar. They tend to fill in the gaps with reminiscences and fanciful tales that lead to unconnected and distorted associations. They may appear to be delirious, hallucinated and disorientated but their behavior is closely related to their attempts to fill in memory gaps. This reaction usually occurs in older alcoholics after many years of excessive drinking.
The symptoms may be due to vitamin B deficiency and other dietary deficiencies as a diet rich in vitamins and minerals would restore the patient to more normal physical and mental health.
Some personality deterioration may remain in the form of memory impairment, blunting of intellectual capacity and lowering of moral and ethical standards.