Alcohol gradually destroys the human psyche and leads to severe changes in consciousness. There are a number of alcoholic psychoses that occur both during binge drinking and during withdrawal symptoms. Each of them is characterized by its own symptoms and specific treatment. A fairly common form of mental disorder called alcoholic paranoid. Not everyone knows that this is a serious disease that requires hospitalization. People are more often afraid of conditions such as alcoholic schizophrenia or “delirium tremens,” but they haven’t heard much about paranoid. What symptoms appear in patients with this pathology? When does it occur and why is it dangerous?
Causes
The mechanism contributing to the development of alcoholic paranoid in alcoholic patients is not precisely known. Psychiatry is still full of mysteries and speculation. There are several proposed pathways through which ethanol exerts its negative effects on the brain. The main ones are alcohol poisoning with a severe overdose of alcohol and withdrawal syndrome. Most often, disorders occur in patients against the background of prolonged drunkenness. The blood supply to the brain is disrupted. As a result of malnutrition, cells die, which leads to serious consequences. In addition, ion exchange in brain neurons changes. All this leads to disruptions in the generation of impulses, and therefore to pathologies of higher nervous activity.
There are also numerous disruptions in the metabolism of biologically active substances that affect the central nervous system:
- enkephalins,
- endorphins,
- serotonin,
- dopamine
- vitamins (especially group B), etc.
In chronic alcoholism, all these factors take place, which means that the functioning of the brain in such a patient is impaired in any case in one way or another. What remains unclear is why in each specific situation a particular change develops and not another. For example, in some cases, schizophrenia and alcoholism become siblings, in others, dementia appears, and in others, seizures should be expected with alcoholism. However, the fact that alcohol destroys the psyche remains indisputable.
Description of the paranoid personality type
A person with a paranoid personality type is characterized by the following character traits :
- Unfounded suspicion of other people of exploitation, harm or deception.
- Distrust of people, explained by the possibility of using information for malicious purposes.
- Focus on insults, the impossibility of forgiving insults and consciously remembering them.
- Extremely painful perception of criticism addressed to oneself, even if it was justified.
- Doubts about the reliability of friends and the loyalty of a loved one.
The above qualities lead to the following behavioral characteristics of a person with a paranoid personality type :
- Avoiding other people in order to avoid possible criticism and responsibility for actions.
It is also typical for a paranoid personality type to be the first to terminate a relationship in order to avoid betrayal or being rejected. - An obsession with blaming someone who, in his opinion, is to blame for the current situation, rather than rationally searching for a way out of it.
- Bias in thinking is a preference to focus attention on those features that do not contradict his judgments, while simultaneously ignoring facts that do not correspond to his desires, views, and aspirations.
- Pessimism , the desire to consider the worst-case scenario in a given situation. Most often, someone else is accused of deliberately acting to worsen the situation in order to cause harm to him.
- Pronounced anger in a situation where it is impossible to solve the problem, avoidance of one’s own responsibility for the current circumstances.
- Categorical statements - the words “never”, “always”, “everything”, “nothing”, etc. are often used in speech.
- Endless conversations going in circles using cliched phrases and expressions .
- Denial of events that cause strong negative emotions, illusion and belief that they did not happen, dissociation from traumatic circumstances.
- The tendency of an adult to be strongly emotionally dependent on another person.
This also includes the dependence of health, well-being, and decision-making on another person. - Expressed discomfort in situations in which what happened does not fit into the framework of his beliefs .
A person with a paranoid personality type tends to show increased interest in how others evaluate his behavior.
If views on basic issues differ, he may go into isolation and avoid communication even with family and friends.
It is very difficult for a person of a paranoid type to endure a situation when a person on whom she is emotionally dependent prefers someone else to her.
The reaction to bad events that causes negative emotions is very painful, even to the point of hysteria . Also in this case, victimization is possible - positioning oneself as a victim of the actions of another person.
People of the paranoid type are very quick-tempered and touchy . A minor event can provoke a strong negative reaction that is inadequate to the circumstances.
Also, such people are susceptible to panic attacks, during which symptoms such as chills, trembling, rapid breathing and sweating appear.
Main types of disease
Alcoholic paranoid of any kind is characterized by the appearance of delusions in the patient, that is, ideas that do not correspond to reality, which become an obsession. In this case, they are associated with a feeling of fear. This may be something like “persecution mania,” when a person believes that they want to kill him, rob him, or injure him. He notes only this side in the behavior of others, pays attention only to the negativity on their part. In addition, the patient may have auditory hallucinations: an intrusive voice inside whispers about constant danger, utters threats.
Depending on the duration of the attack and the severity of the clinical picture, the following are distinguished:
- abortifacient alcoholic paranoid;
- acute alcoholic paranoid;
- prolonged alcoholic paranoid.
A condition close to this group is alcoholic delirium of jealousy, which is also characterized by an obsession, but not about a threat to life, but about the betrayal of a spouse.
Abortive and acute forms of alcoholic paranoid have similar manifestations in patients. The difference is that abortive paranoid occurs during severe intoxication or binge drinking and lasts several hours, while acute disorder is associated with withdrawal symptoms and lasts several days or weeks. Protracted paranoid develops against the background of acute paranoid, proceeds sluggishly and drags on for a month or more.
Differential diagnosis
Diagnosis and differentiation of alcoholic paranoid is a rather difficult task. It is differentiated from alcoholic paranoid schizophrenia.
The main difference between these disorders is the nature of the delusion: there is a specific, stable delusion of everyday everyday topics; in paranoid schizophrenia it is pretentious and intricate.
It is necessary to collect a complete medical history with the help of the patient’s relatives. The disease is diagnosed in cases where symptoms appear in a heavy alcoholic at the height of withdrawal symptoms or prolonged binge drinking. Paranoid schizophrenia is defined in people with the early stages of alcohol dependence or in cases where there is no clear clinical picture of alcoholism.
The behavior of patients is subject to a persistent delusional idea. Within its framework, he behaves logically. Schizophrenia is characterized by a false split personality. With paranoia, antisocial behavior and a tendency to create conflict situations are observed. With schizophrenia, most often the patient does not provoke open conflicts.
Alcoholic paranoid is characterized by a person’s activity: he hides from imaginary pursuers or attacks them, tries to bring others into the open. The behavior is often rude, and there may be manifestations of cruelty towards the “suspects” of surveillance. With paranoid schizophrenia, patients often behave quietly and distantly. As a rule, they show outward indifference and suspicion towards others.
The delusional idea of persecution is simple, concrete and logical. Visual and verbal hallucinations, illusions that are quite simple, are observed infrequently. In schizophrenia, they are changeable, pretentious, and defy logic. Hallucinations are constant and associated with changing delusions.
Clinical picture of the acute form
The disorder occurs suddenly and is characterized by the appearance of pronounced delusions of persecution. At first it is not formalized, but manifests itself as an unconscious feeling of fear and the appearance of motor restlessness, usually in the evening and night hours. Along with this, autonomic reactions appear, such as increased sweating, palpitations (this may be accompanied by chest pain), and tremors of the limbs. Characterized by sleep and appetite disturbances, general weakness, and depression.
Over time, these symptoms develop into something more: the patient has the idea that there is someone who wants to kill him. First, anxiety and absent-mindedness appear, and then panic fear. Mental disorders contribute to the appearance of auditory hallucinations. At first there are rustling sounds, knocking, creaking, coughing, etc. The person clearly senses their connection with the impending threat. Over time, voices may appear, which will only contribute to an increase in anxiety.
Acute alcoholic paranoid significantly affects the patient's behavior. Mental disorders make his behavior harsh and his actions intense. Very often a person in this state tries to protect himself from an imaginary danger: he tries to run away, he may even jump out of a vehicle and do other dangerous things, contact the police, or try to fight the “attackers.” A patient with this disorder poses a danger to himself and others. So that he does not harm anyone, he must be urgently admitted to the hospital.
Delusions of persecution
This form can occur against the background of chronic intoxication of the body. The patient believes that he is in mortal danger. Suspicions may arise regarding any person in his field of vision. He may perceive gestures, facial expressions and any actions of strangers as a threat. Delusions of persecution in an alcoholic can also affect his close people and family members.
In his head, he scrolls through different ways of reprisal against himself (which his enemies want to inflict), which is a consequence of inappropriate behavior. For example, an alcoholic attempts to escape or refuses food, suspecting that he may be poisoned. Often, under the influence of delusions of persecution, patients commit suicide. It is impossible to convince a person.
Symptoms:
- The patient regularly experiences panic attacks.
- Unreasonably feels threatened and aggressive by others.
- Increased anxiety.
- A closedness unusual for a person arises.
- Inappropriate behavior in society.
Diagnosis of this form of psychosis is carried out by a psychiatrist using psychological and laboratory tests.
Treatment is carried out medically using antipsychotic drugs. At the time of treatment, it is better to hospitalize the patient, as he poses a danger to others.
Protracted form of the disease
Acute paranoid often transforms into protracted paranoid. This transition is quite conditional and it is impossible to determine the exact boundary. The criterion is changes in the signs of the disorder: fear decreases, takes on a more specific form (a specific person or group of people whom the patient is afraid of appears, that is, the threat ceases to be vague in his eyes), hallucinations disappear. Delirium is no longer based on illusions; a certain logic can be traced in it.
It seems to relatives that the danger has passed and the disorder is gradually going away - they can breathe a sigh of relief. However, this is not the case. The patient looks more conscious, and this is true, but he still has mistrust, anxiety, and suspicion. He does not make contact well, especially with perceived ill-wishers, and is still capable of dangerous and aggressive actions.
The symptoms become more subdued, but do not completely disappear. Periodically they become aggravated again. A deterioration in mental state can be provoked, first of all, by taking another portion of alcohol. Leaving such a patient without treatment is no less dangerous than a person with an acute form of mental disorders. In this case, treatment in a hospital under 24-hour medical supervision is also required.
How to recognize the syndrome
Symptoms of pathological intoxication appear literally immediately, just 4-5 minutes after drinking.
This condition is accompanied by severe fear, paleness of the face, and anxiety. The personality is not able to adequately assess the surrounding reality. The inflamed brain turns all strangers into some kind of monsters that pose a potential threat to the intoxicated person. A person begins to behave and react inappropriately, trying to escape from an imaginary danger. There is a high threshold for hyperactivity. By the way, the patient, being in such a state, may not look intoxicated (against the background of extremely heightened excitement, signs of intoxication are relieved). That is, symptoms characteristic of drunkenness may be absent, such as:
- unsteady gait;
- specific facial expressions;
- problems with coordination;
- distortion of speech functions.
We can say that the patient is almost completely sober, but at the same time he has a complete lack of self-control and there is a loss of understanding and awareness of the offenses committed. The facial expression reflects a feeling of intense anxiety, fear or loss. The patient is able to perform some logical, purposeful actions. But he is in a state of insanity.
This disorder causes people to act on perceived delusions and hallucinations. Features of behavior in this case include:
- attempt to run away and hide;
- the desire to protect yourself from some invisible threat;
- aggressiveness directed at surrounding people.
Fortunately, this condition does not last long - the body uses up strength and energy too quickly. The period of acute arousal gives way to deep sleep. Having woken up, a person remembers absolutely nothing, or all his memories of what is happening at the moment of change in consciousness are fragmentary and incomprehensible. Doctors refer to this condition as “amnestic.”
Pathological jealousy
Very often, against the background of prolonged drinking, it is not the fear of imaginary murderers that develops, but the alcoholic delirium of jealousy. This pathology is rare in women; it is most common in men over forty years of age. The main manifestation of the disorder is pathological jealousy of the spouse, which arises out of nowhere without any apparent reason.
At first, it seems to the patient that his wife has somewhat cooled towards him. She does not pay as much attention to him as before, is somewhat aloof, and is reluctant to engage in sexual contact. Perhaps there is some truth in these arguments. What kind of woman would experience strong warm feelings for her constantly drunk husband? Some withdrawal is a normal reaction on her part. However, in the eyes of the sick husband, everything looks completely different. It begins to seem to him that his wife is not only alienated, but also takes better care of herself, leaves home more often, and shows signs of secrecy.
Threats, reproaches, scandals begin. After each such showdown, the patient becomes even more excited and angry. He becomes rude and aggressive. In his opinion, his wife is behaving worse and worse every day. Vague doubts develop into constant confidence. As a rule, the patient begins to suspect his wife of having an affair with one of their mutual acquaintances, and every day he finds more and more confirmation of his guesses. No evidence to the contrary works.
The disease progresses, and hallucinations appear, which prove the wife's guilt. The person begins to think that he hears her telephone conversations with her lover or even sees the betrayal itself. Naturally, aggression on his part is only growing. He definitely wants to put an end to this state of affairs.
Often patients begin to “educate” their wives by beating them or even rushing at them with a knife. Such a mental state of the husband may well result in serious consequences, including the murder of his wife. It is the presence of an obsession and danger to others that delusions of jealousy are similar to paranoid. Psychiatrists distinguish between these two conditions, but in all textbooks they are mentioned next to each other, since they have much in common.
Types of pathology
1. Acute alcoholic paranoid. This disorder causes depression, sleep disturbances, delusions and auditory hallucinations. The patient suffers from frequent panic attacks and develops a feeling of persecution.
2. Alcoholic pseudoparalysis. It develops against the background of prolonged alcoholism and is characterized by a clear mental disorder with accompanying symptoms such as memory impairment and inability to remember life events. The patient may stop recognizing others, control his behavior, and lose acquired skills.
3. Abortive delirium. May occur in short periods. It manifests itself as delusional fears and experiences that are not related to real events in life. Accompanied by amnesia and loss of orientation in time.
4. Prolonged alcoholic psychosis lasts from 2 months to several years. The development of this disorder occurs in the initial stage as acute psychosis, but then acquires a stable anxiety state.
Treatment of alcoholic paranoid
You should not try to help such a patient at home; it is better to immediately admit him to the hospital. There are two arguments in favor of this decision: the need for professional consultation with a doctor and the danger of a person with a mental disorder for himself and others. Under no circumstances should the problem be dismissed or not given due importance. This condition is not a whim of the patient, not his bad character, but a real serious illness. To ignore it is to allow it to progress. Only in a hospital setting can a patient receive competent treatment, as well as round-the-clock monitoring and proper care.
The basis of therapy is antipsychotics. The most commonly used drug is haloperidol. In addition, an important place in treatment is given to benzodiazepines (a typical representative is diazepam), vitamins, and neurometabolites. Most drugs have serious side effects on the patient’s body, so only a doctor can select the correct dose. In a hospital setting, it is possible to monitor the dynamics of the condition, which means timely adjustment of medications and their dosage.
Along with the relief of psychosis, measures are taken to combat other symptoms that have developed due to prolonged drinking. Treatment of alcoholism itself begins. You shouldn't expect quick results. Several months may pass from the time a patient is admitted to the hospital until he is discharged. Paranoid requires long-term comprehensive therapy.
Crime and Punishment
By the way, if a person who has committed a serious crime is subsequently found to be pathologically intoxicated, criminal liability does not arise. This point is stipulated in Article 23 of the Criminal Code of the Russian Federation, which states that this syndrome is a short-term mental disorder. As a result, the person who committed the illegal act loses the ability to recognize and be responsible for his own actions.
Pathological intoxication, which belongs to a type of psychological disorder, excludes sanity and, accordingly, criminal liability. Also, due to the regular consumption of intoxicating compounds, a person may develop independent psychiatric disorders that do not relate to the syndrome in question:
- delirium tremens;
- alcoholic delirium;
- drug withdrawal.
These conditions also exclude (like pathological intoxication) the sanity of a given subject. But in such a situation, a thorough psychiatric examination and careful consideration of all available circumstances of the case (if a crime is committed) are required. And the persons who committed them can be punished to the fullest extent of the law.
Consequences for the patient
If the patient continues to use alcohol, relapses can be expected. However, according to statistics, there is no direct relationship between drunkenness and repeated attacks. There is a fifty-fifty chance that the paranoid will return. There are many additional factors that determine it:
- severity of brain damage,
- general condition of the body,
- the presence of additional hazards,
- degree of alcoholism,
- heredity, etc.
As a rule, if the patient continues to consume alcohol, a relapse should be expected one to two years after the first attack. In the future, the interval between relapses will become shorter and shorter. As a rule, the clinical picture almost completely repeats the previous exacerbation that the patient had, but the symptoms may worsen or alleviate.
If the patient completely refuses to drink alcohol, the disease may lose its position forever, and the attack will remain isolated. However, even in this case, relapses sometimes occur, but their likelihood is much lower. One should not hope for a complete recovery. There will be some consequences anyway. Those cells that have already been damaged by alcoholic drinks will no longer be able to function. Consequently, headaches, memory impairment, attention problems, weakened vision or hearing are possible. As a rule, these symptoms are relatively mild and have virtually no effect on the patient’s future quality of life.
It is important to remember that he will require long-term rehabilitation. Memories of fears will remain and will seem realistic. A significant period of time is necessary for the patient to realize the falsity of past experiences and finally abandon them.
Female alcoholism has a number of features.
Alcoholism in women develops at a more accelerated pace and is more severe in its clinical manifestations than in men.
However, there are also opposing data indicating (in the absence of aggravating factors) a milder course of alcoholism, which does not allow female alcoholism to be assessed as malignant.
Unlike men, pathological attraction to alcohol
In women, alcohol abuse develops in the first 1-2 years, and during the same time, physical dependence on alcoholic beverages is revealed, i.e., withdrawal syndrome.
Alcohol-induced personality changes in women are revealed at a faster rate, accompanied by sexual promiscuity and social degradation.
