Alcohol paranoid is a mental disorder that requires immediate treatment. Treatment of the disease and further prognosis

Alcoholic paranoid (delusion of persecution) is one of the types of alcoholic delusional psychosis, along with alcoholic paranoia (delusion of jealousy). Delusional psychoses are observed quite often in people with severe alcoholism and occupy third place in the structure of metal-alcohol psychoses after delirium tremens (delirium) and alcoholic hallucinosis.

From the name it is clear that the main reason for the development of such mental disorders is systematic abuse of alcoholic beverages. In the second and third stages of alcoholism, after prolonged exposure to ethanol on the brain, serious mental changes occur. Due to impaired blood supply, neurons die en masse. Also, under the influence of ethyl alcohol, metabolic processes in cerebral cells change. As a result, higher nervous activity is disrupted.

Mental disorders in the clinical sense do not develop in every alcoholic.

Alcoholic psychoses are most often diagnosed in people predisposed to such disorders for some reason. These include:

• a history of traumatic brain injury;
• various infectious and inflammatory pathologies affecting the brain and its membranes;
• the influence of various hazards (toxic, radiation and other negative effects) during the period intrauterine development and in early childhood;
• flexible psyche, personality and character traits that are not a deviation from the norm (tendency to demonstrative behavior, hysteria);
• a history of mental disorders diagnosed before development alcohol addiction.

Various things can provoke a mental disorder in an alcohol-dependent person. life difficulties, feelings of fear, guilt, anxiety.

Most often, alcoholic paranoid and other psychoses develop at the peak of withdrawal symptoms or after long-term, continuous binge drinking.

Types of alcoholic paranoid

Alcoholic paranoid is classified according to the duration of its manifestations. There are three types of flow:

• abortifacient;
• spicy;
• lingering.

Abortive and acute alcoholic paranoid have similar clinical signs, but different durations.

In the first case, a mental disorder, as a rule, manifests itself at the peak of binge drinking and lasts for several hours. The acute form often develops at the height of withdrawal syndrome and lasts from several days to several weeks. In the abortive form, paranoid begins with the emergence of an affect of negative emotion (most often fear), which then takes shape in the delusional idea of ​​persecution.

In the prodrome of the acute form, characteristic signs are observed: depression, apathy, anxiety, sleep disturbances, lack of appetite, tremor, tachycardia.

Anxiety grows and transforms into a delusional idea, the patient begins to hallucinate or act within the delusion.

A protracted course of alcoholic paranoid is observed if it is not possible to stop the manifestations of the disease in acute form. The delusional idea takes on concrete shape, is systematized, and hallucinations disappear. The patient is in an anxious depressed state. He distrusts those around him, tries to hide from perceived enemies, and does not want to make contact with those who, in his opinion, are watching him. When drinking alcohol, paranoia worsens, and hallucinations may appear.

Clinical picture

Signs of alcoholic paranoid appear already in the prodromal period. The patient is in a depressed-anxious state and may experience feelings of fear or guilt.

When a nervous system stimulant (alcohol) is withdrawn, the addicted person develops anxiety, melancholy, and apathy. Due to sleep disturbances and negative emotions The idea of ​​persecution begins to form. It seems to him that they are watching him, they want to kill or kidnap him. Depending on the nature of the delirium, the patient may be afraid to go outside, as he assumes that he may be attacked there. Some refuse food for fear of deliberate poisoning.

He is wary of those around him, suspects them of spying on him and trying to kill him.

A person is afraid of both acquaintances and strangers, those with whom he previously had conflicts are especially suspicious.

In some people, paranoia is accompanied by hallucinations or illusions. IN the latter case the patient can regard any behavior, conversations and gestures of others within the framework of his idea. It seems to him that some metal object in the wrong hands is a knife, pistol or other weapon. Gestures or movements are perceived as a readiness to attack or an attempt to attack. He takes the conversations of people passing by or nearby at his own expense, and at the same time understands them incorrectly. Sometimes auditory hallucinations of threatening content are present.

The patient's behavior is quite logical within the framework of his delusional idea. It is consistent with character, habits and life experience. More often they try to hide from “pursuers”, “enemies”, to hide. They can turn to the police asking for protection. They attack and show aggression relatively rarely.

Visual hallucinations are usually simple and determined by the content of the delusion. The patient may defend himself or attack imaginary pursuers, or try to escape from them. His behavior is impulsive, his actions are dictated by a feeling of fear.

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. When paranoid there is a social behavior, tendency to create conflict situations. 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.

Treatment

Therapy for alcoholic paranoid is carried out in a hospital setting. After relief of acute symptoms of binge drinking or withdrawal symptoms, the patient may be discharged to continue treatment on an outpatient basis.

Mental disorders associated with alcoholism, including alcoholic paranoid, are treated with the use of antipsychotics (neuroleptics). Positive dynamics are observed after Haloperidol, Aminazine, Valium, Elenium.

Together with psychotropic drugs therapy is carried out for the consequences of alcohol abuse, infusion of glucose solution, thiamine, ascorbic acid, magnesium sulfate.

If the patient has a depressed mood, antidepressant medications may be prescribed.

For prolonged or severe acute paranoid treatment, sleep treatment is recommended. The patient is immersed in a long sleep using sleeping pills (Barbamil, Bromural) and neurotropic drugs. The dose is calculated so that the patient is in a state of sleep about 20 hours a day for 7-10 days. After the delirium passes, maintenance treatment is carried out with anxiolytics - drugs to suppress anxiety and fear.

To prevent the development of alcoholic paranoid in people prone to mental disorders, it is necessary to treat the root cause of alcoholic psychosis, that is, alcohol dependence.

The difficulty in treating alcohol addiction is convincing the alcoholic that he is sick. This is the task of loved ones: they must clearly understand that this is a serious chronic disease. It is useless to be offended by a patient because he drinks, and this must be accepted. Already at the second stage, it is difficult for a person to stop drinking alcohol on his own.

It is necessary to understand that treatment is a long process that requires patience and enormous expenditure of emotional energy. Such patients really need support from family and friends.

Treatment for alcohol addiction today is carried out using a variety of methods. To determine the complex required in a particular case, you need to contact an experienced narcologist who will develop an individual treatment program. To overcome the psychological causes of addiction, a course of psychotherapy is conducted. Medications are used to relieve physical cravings for alcohol. Possible various options coding, sewing in implants with medications.

After correct treatment, alcoholic paranoid, as a rule, goes away without consequences. No changes in the psyche are observed. If a person does not undergo treatment and continues to drink, then the likelihood of a relapse of a mental disorder increases. At the same time, in the future, mental disorders will be more severe: prolonged and chronic psychoses, alcoholic hallucinosis, encephalopathy.

For a long time, paranoid was not considered an independent disease. But today it is recognized as a serious disorder that requires immediate hospitalization and long-term rehabilitation therapy.

Alcoholic paranoid - causes and clinical picture

Alcoholic paranoid is one of the varieties of alcoholic psychosis, the main symptom of which is severe delusions of persecution.

The only cause of such psychosis is alcohol abuse. The disorder usually occurs in people only in the second or third stages of alcoholism; the majority of patients are people who have been constantly drinking alcohol for more than 7-8 years.

There are also several risk groups - paranoid is more often diagnosed in alcoholics who have suffered a head injury, who have severe heredity, and in patients with epileptoid psychopathy.

The clinic of alcoholic paranoid consists of 3 main phenomena. This affective disorders(sharp mood swings), sensory (figurative) delusions and inappropriate behavior.

Varieties

Alcohol paranoid is diagnosed exclusively in “experienced” alcoholics. It develops either in a state of intoxication, after a long binge, or during severe withdrawal syndrome. The second case occurs most often - usually delusions of persecution begin precisely during the period of a painful hangover.

The duration of the disease and its course largely depend on the form of psychosis. Scientists identify 3 main types of alcoholic delirium.

Abortive

Lasts from 3 hours to a day, begins mainly in a state of alcohol intoxication. First, affective disorders appear (bad mood, feelings of anxiety, then fear), which sharply develop into delusions of persecution.

Spicy

Lasts from 2 to 25 days and is most often diagnosed. This form of psychosis develops only during a hangover. First, prodromal phenomena appear that last for several days. These are classic withdrawal symptoms - depressed mood, problems with sleep and appetite, arrhythmia, trembling of limbs, feelings of anxiety, confusion, etc. Soon confusion develops into severe fear, delirium begins, and sometimes hallucinations.

Protracted

Such psychosis can drag on from 1.5-2 months to several years. It begins as a typical acute alcoholic paranoid, but over time the feeling of fear weakens and is replaced by a stable low-anxious mood. The specifics of delirium change - the alcoholic’s motives and suspicions become more logical and selective. This form of alcohol use disorder often occurs in periodic relapses that last for several months.

Some narcologists and psychiatrists divide prolonged alcoholic paranoid into subacute (lasts up to 6 months) and chronic (from 6 months to several years).

Symptoms and signs

The signs of alcoholic paranoid are similar for all types of the disease, the only difference is their extension over time. A very long binge or a sharp increase in the dose of alcohol can provoke the first attack of paranoid in an alcoholic.

The very first stage of psychosis is withdrawal symptoms (somatovegetative signs, insomnia and nightmares, bad mood). Then affective disorders take over. A painful melancholy, unreasonable anxiety, fear appears, which quickly develops into panic.

Alcoholic delirium soon develops, which can take different forms:

• delusions of persecution (the most common form);
• delusions of relationship;
• delirium of jealousy;
• delusions of self-blame;
• delirium of poisoning, etc.

At the first stage of psychosis, hallucinations may begin - auditory and visual, they last no longer than 1-2 days. The main sign of alcoholic paranoid always remains delusion, which is based on a single thought - that the patient is in danger of physical harm.

The alcoholic is convinced that they want to kill him, and completely in a specific way- poison, stab, hang, shoot, quarter, torture, etc. Sometimes the patient believes that his family members are also in danger.

If the delusion of relationships is involved, then it seems to the person that all people treat him with contempt or hatred in advance, and deliberately arrange various nasty things.

The course of alcoholic delirium is traditionally accompanied by a strong feeling of fear. The patient constantly performs impulsive actions: tries to run away, grabs people by the hands, asks for help, screams loudly, hides in the apartment, in attics, in sewer hatches, etc.

Differential diagnosis

One of the most difficult moments in the treatment of alcoholic paranoid occurs at the diagnostic stage. It is often difficult to distinguish between alcoholic psychosis and paranoid schizophrenia complicated by alcoholism. The most severe cases are when the patient suffers from schizotypal disorder due to alcoholism, in which personality changes are quite minor.

To make a correct diagnosis, it is necessary to collect a complete history of the disease. If a person’s psychosis is not associated with binge drinking, a hangover, or appears on early stage alcoholism, we're talking about about paranoid schizophrenia.

There are several other signs that can clearly distinguish between the two disorders:

Paranoid schizophrenia associated with alcoholism

Alcoholic psychoses: paronoid and delusions of jealousy

In this article we will look at some of the most frequent psychoses with alcohol dependence, namely paranoid and delusions of jealousy. The first is the patient’s obsession that someone is pursuing him, they want to harm him or even kill him. The second is the belief that the wife or girlfriend is cheating, which is accompanied by all sorts of humiliation of a loved one, unfounded accusations, etc.

Alcohol paranoid

Among all psychoses of alcoholic origin, alcoholic paranoid is in the top three. This diagnosis is made to every sixth patient who enters the clinic for the treatment of alcoholic psychosis. For a long time, alcoholic paranoia was not considered an independent illness.

But at present, acute alcoholic paranoid in men and women is recognized by experts as one of the most serious disorders, which requires urgent hospitalization and long-term rehabilitation.

The main symptom of this disease is intense delusions of persecution. There are several types of pathology, each of them has different symptoms.

Proper diagnosis is important for effective treatment, as the symptoms of paranoia are similar to those of other alcohol-related disorders (eg, delirium tremens).

Provoking factors

The only reason for the development of the disease in question is excessive consumption of alcoholic beverages. This disorder begins to develop in alcoholics in the third stage of addiction.

A larger percentage of patients are people who have been drinking alcohol regularly for more than seven years. The greatest likelihood of the disorder occurring is in those who drink more than half a liter of vodka every day.

There are also certain risk groups, which include alcoholics who have suffered a brain injury, who have severe heredity or epileptoid psychopathy.

Symptoms

The main symptoms of the pathology:

• affect;
• figurative delirium;
• inappropriate behavior.

Regardless of the form of development of the disease, its symptoms are similar to each other. The only difference is the duration. The manifestation of the first attack is possible with prolonged heavy drinking or with an excessively sharp increase in the dose of alcohol.

On initial stage Alcohol psychosis is manifested by withdrawal syndromes:

• insomnia;
• nightmares;
• sudden changes in psycho-emotional background.

A person feels intense melancholy, groundless anxiety, fear, developing into real panic. Then delirium begins to develop, taking various forms:

• persecution mania;
• relationship mania;
• delirium of jealousy;
• self-accusation;
• poisoning and other disorders.

The first stage is also supplemented by the appearance of auditory and visual hallucinations, their duration is no more than two days. A person is constantly convinced that physical violence awaits him. He thinks that someone wants to kill him, and he even knows the method - he says that they are trying to poison him, stab him, hang him or shoot him.

Sometimes an alcoholic is sure that his family members are also in danger. Usually, during an attack of delirium, an intensely expressed feeling of fear appears. A person acts impulsively - he wants to run away somewhere, calls for help, starts hiding and screaming loudly.

Diagnostics

It is often difficult for specialists to deliver correct diagnosis. Paranoid is difficult to differentiate from paranoid schizophrenia, which occurs due to alcohol intake.

To make a correct diagnosis, it is very important to collect complete anamnestic data. If the psychosis is not provoked by a prolonged binge or a hangover, a diagnosis of paranoid schizophrenia is made.

Treatment

Paranoid therapy should be carried out only in a specialized medical institution. If the form of psychosis is mild, the first symptoms are relieved, after which the patient can continue therapy on an outpatient basis. If the form of psychosis is severe, the patient remains in the clinic for at least a week.

Several groups of drugs are used for drug treatment:

After the patient is hospitalized, he is administered drugs to get rid of fear and paranoia (haloperidol).

If there are signs such as mood swings, antidepressants are used. The patient can be sent home only after the symptoms of delirium and aggression completely disappear.

Usually this disease does not cause serious consequences and does not negatively affect consciousness. But this is only if the patient undergoes drug therapy in full and the person no longer touches alcohol.

If the patient begins to lead his previous lifestyle and drinks alcohol again, hallucinosis and prolonged psychosis may occur against the background of previously suffered paranoia.

What is alcoholic delirium of jealousy?

Alcoholic delirium of jealousy is a disorder that occurs against the background of prolonged abuse of alcoholic beverages. Symptoms develop gradually. The main characteristic of this condition is the predominance of the idea of ​​​​infidelity on the part of the wife or husband.

A delusional idea appears, gradually it draws the person in more and more, and soon he loses touch with the real world. The alcoholic spies on his wife, makes unreasonable demands, forces him to confess to cheating, and even shows sadistic tendencies in addressing his wife.

Even after a person stops drinking alcohol, alcoholic delusions of jealousy can continue to bother you for a long time.

Symptoms

This disorder most often develops in the second or third stages of alcohol dependence. The average age category of patients is over 45 years old. This kind of psychosis is different high degree progression, the violations are aggravated, the level of aggressiveness increases, social behavior changes for the worse.

The patient begins not only to be jealous, he shows cruelty and aggression towards his wife or girlfriend, he can beat or even kill. If alcoholic delusions of jealousy develop, treatment should be carried out as early as possible. Moreover, it must take place in combination, with the use of drugs prescribed by a narcologist and a psychiatrist.

Delusions of jealousy usually develop gradually. Appear first episodic seizures mistrust or unfounded claims, often in severe alcoholic intoxication. Over time, real events in the mind of an alcoholic are mixed with fictitious ones; he loses touch with reality even when sober.

As it progresses, delusional ideas of constant infidelity and lovers arise; the patient believes in what he himself came up with (for example, that he saw an act of infidelity with his own eyes).

Causes

The main reason for the development of this disorder is prolonged abuse of ethanol-containing products. More often, this diagnosis is made to people who, even before the disease, have the following character traits:

• self-centeredness;
• distrust;
• excessive suspicion;
• constant demands on others.

In most patients, alcohol dependence continues for at least 10 years. There are signs of personality degradation.

Previously, such patients had repeatedly suffered delirium tremens or other types of alcoholic psychoses.

Diagnostics

It is not difficult to distinguish this disorder from other disorders. Typically, the diagnosis is made based on the clinical picture and after collecting the patient's anamnestic data.

Treatment

A patient with such psychosis is dangerous to others. At the same time, he can skillfully disguise aggression. Treatment of alcoholic delusions of jealousy is usually long-term and should be carried out only in a specialized medical institution. At the beginning, detoxification of the body, taking vitamin substances, and antipsychotics are prescribed.

It is important to combine drug treatment with the influence of psychotherapy, alcohol addiction is simultaneously treated.

Mental disorder - paranoia

In this article we will talk about a mental disorder such as paranoia, which causes many serious problems for those who are susceptible to it. We will look in detail at the causes of paranoia and talk about what methods exist that can help overcome paranoia.

Symptoms and signs of the disease

First, let's define what is called paranoia and what are the symptoms of paranoia disease.

Paranoia is a mental disorder that is accompanied by the gradual development in the patient of delusional ideas, to which the patient himself attaches extremely valuable importance. This disease can be very difficult to notice from the outside, because the patient’s thinking and behavior may seem quite normal and meaningful to others. At the same time, the patient may have an extremely critical attitude towards the world around him, although patients with paranoia absolutely do not perceive criticism addressed to them and do not attach importance to any comments from others. Moreover, the patient may aggressively perceive all those who do not share his beliefs.

Paranoia is, first of all, a violation of the normal perception of the world around us. Therefore, it can be expressed by the fact that the patient ceases to adequately respond to what is happening around him. Some events that worried him before may simply cease to interest him, and some moments that did not previously evoke special emotions may be tolerated negatively by the patient. Attacks of paranoia are characterized by the fact that the patient loses connections in his thinking, which leads to the fact that the patient ceases to be able to normally cope with any problems in life. The patient has a feeling in his head a large number of confused thoughts that prevent him from concentrating and making the right decision. One of the symptoms of paranoia is the appearance of delusions in the patient, which occurs during the most acute attacks of the disease.

As for the patient’s perception of the world, the hearing is primarily affected. The patient may hear various non-existent sounds, and this can continue for quite a long time.

Signs of paranoia can also be if a person suddenly stops trusting people and becomes too secretive and suspicious. Paranoia can also manifest itself in pronounced jealousy, resentment, or even delusions of grandeur. Such phenomena occur because the patient becomes unable to compare himself with society and begins to see in everyone a certain threat or an irritating factor. But of course, all these symptoms of paranoia in women and men may not be very pronounced; a person may look the same from the outside as before, but at this time paranoia may already begin to gradually develop. Over time, the more the disease develops, the more noticeable its manifestations become - the patient loses less and less control over himself, which is why his actions more and more openly demonstrate that he is susceptible to someone else’s mental disorder.

Causes

The causes of paranoia, and many other mental disorders, have not been thoroughly studied, and therefore it is not always possible to say exactly what exactly led to the emergence of paranoia in a particular case. We can only list the reasons that can contribute to the appearance and development of this disease:

• Head injuries;
• Hereditary tendency;
• Pathological conditions in the brain;
• Drug or alcohol addiction;
• Frequent stressful situations;
• Social isolation;
• Violation metabolic processes related to the process of protein synthesis;
• Age-related changes in the brain;
• Psychological trauma received in childhood;
• Long-term use of medications;
• Some chronic diseases;
• Previous brain diseases;
• Dissatisfaction with life.

Speaking about the causes of paranoia, it makes sense to identify groups of people who are more prone to developing this disease:

• Genetically predisposed people;
• People with drug or alcohol addiction;
• Elderly people;
• Men over twenty years old;
• People who are initially prone to depression or other mental disorders.

Varieties

Psychotherapists identify several types of paranoia, which differ in their manifestations:

• Alcohol paranoia– this is a delusional chronic psychosis that develops in those who suffer from alcoholism;
• Involutional paranoia is a psychosis in which the patient periodically begins to systematically rave. Older women are often susceptible to this phenomenon. Such a disease, as a rule, begins to manifest itself quite sharply and can last for a long period of time;
• Fighting paranoia is a rather outdated term that applies to paranoia that occurs with a high level of activity and fanaticism. Such manifestations may be aimed at defending supposedly violated rights;
• Acute paranoia is a type of psychosis characterized by stuporous and hallucinatory-delusional manifestations;
• Persecutory paranoia is different in that with it a person constantly thinks that someone is following him and watching him;
• Paranoia of conscience manifests itself in the fact that the patient begins to constantly blame himself for something. This condition can often occur during depression;
• Paranoia of sensitivity has the character of delusions on the topic of relationships. This phenomenon often occurs in people who have suffered brain damage. In this case, the patient is characterized by vulnerability and sensitivity. In addition, the patient is quite conflict-oriented towards the people around him;
• Senile paranoia occurs in people at involutionary age (from 45 to 60 years). With his chronic course, such paranoia does not lead to dementia.

There are also mixed types of paranoia, in which the patient is susceptible to several types of paranoia at the same time.

Diagnosis of the disease

If you have discovered any manifestations in your behavior that may indicate that you are developing paranoia or have noticed any symptoms of paranoia in children or in other loved ones, then you should definitely visit an appointment with a psychotherapist. Now there are various clinics, and you can make an appointment with a doctor directly by phone or using the Internet. To diagnose this disease, unfortunately, there are no most accurate laboratory or diagnostic methods. But, despite this, if the doctor detects any alarming signs, he will prescribe a series of examinations that can confirm the diagnosis of paranoia.

Doctors also conduct special tests for paranoia, surveys and conversations with the patient, which also help to more accurately identify signs of paranoia in men or women.

Treatment

The main condition proper treatment paranoia is taking medication

In medicine, paranoia is not classified as psychosis, but a patient with paranoia has certain difficulties interacting with other people, which can cause a lot of inconvenience to both those around him and the patient himself. If a patient is diagnosed with paranoia, doctors prescribe him treatment, which consists of undergoing a course of psychological correction.

A complicating factor in the treatment of paranoia is that the patient may experience distrust of everyone around him, including doctors. Or, due to criticality towards the entire world around him, the patient may refuse to admit the fact that he has a disease such as paranoia.

Therefore, the main task for a doctor is to establish good and trusting contact with the patient. As a rule, this is difficult to do, and it may take a lot of time for the doctor to win over the patient and begin to effectively fight the disease.

For the success of treating paranoia, how timely the disease was diagnosed is very important.

Thanks to psychotherapy, the patient begins to control the symptoms of the disease, feels the approach of an exacerbation and takes certain actions to alleviate or prevent it. There are several types of therapy that can help cope with paranoia. For example, thanks to cognitive behavioral therapy, the patient will be able to change his behavior pattern at the right time in order to prevent relapse.

As for the question - “how is paranoia treated?”, then everything is quite twofold - some patients who have just begun to show some symptoms of paranoia cope with this problem forever. But there are also a large number of patients in whom attacks of paranoia alternate with a certain remission. As already mentioned, a lot depends on at what stage of development of paranoia this disease was discovered. Due to an overly critical perception of the surrounding world, the patient himself may not notice the manifestations of paranoia, even with its strong development. For this reason, many patients end up seeing a doctor by the time the disease has already reached strong development and in this case it will be much more difficult to help the patient. In addition, the doctor knows well how paranoia differs from schizophrenia, and is able to help the patient detect this more dangerous disease at an early stage.

As a rule, the doctor draws up a complex that includes the following treatment methods:

• Taking neuroleptics, antipsychotropic drugs;
• Taking sedatives;
• Family psychotherapy;
• Tranquilizers;
• Individual psychotherapy;
• Antidepressants;
• Psychotherapy, which includes the use of cognitive behavioral methods.

Prevention

Walking on fresh air and positive emotions can protect the nervous system

Like any disease, it is easier to prevent paranoia than to later ask the question “how to cure paranoia?” In matters of mental health, prevention should be to minimize various stresses, depression and generally maintain good body tone. In our modern world, which presents a huge number of stressful situations, you need to be able to properly rest and restore your strength, not only physical, but also mental. Walking in the fresh air or some kind of recreation in the wild helps with this.

Prevention of paranoia also includes the fight against bad habits. A huge percentage of people susceptible to paranoia and many other mental illnesses are people with alcohol or drug addiction.

Alcohol paranoia (delusions of jealousy)

This is a relatively rare mental disorder that occurs in men with paranoid or epileptoid character accentuation in the premorbid state. Delirium develops gradually. First, when intoxicated or during abstinence, patients begin to accuse their wife or partner of infidelity. Initially, these accusations may seem plausible to others. Then the reproaches become more and more ridiculous. Patients gradually begin to spy on their wife, subject her to shameful tests, force her to confess, and present flimsy evidence of “infidelity.” From outsiders they may get ideas of jealousy

skillfully hide. Usually they do not show any aggression towards imaginary rivals - they blame their wife for everything.

In the pathogenesis of delirium, a decrease in

sexual potency, common in stage II-III alcoholism, as well as conflictual relationships and alienation between spouses due to the patient’s drunkenness.

Treatment, in addition to anti-alcohol treatment, is aimed at dis-actualizing delusions through antipsychotic neuroleptics (triftazine, mazeptil).

15.3.4. Alcohol paranoid

Delusions of persecution were described by I.V. Strelchuk in 1949. Against the background of insomnia, anxiety and fear, the patient begins to feel that he is going to be killed - shot, stabbed to death in the entrance of a house, run over on the street. They are afraid of all strangers and unfamiliar people, as well as those with whom they previously had conflictual relationships. Illusions are associated with delirium: in the bulging pocket of someone you meet, you can discern the outline of a pistol, in the flash of some metal object in someone’s hands - a knife. The words of others, spoken among themselves, are attributed to themselves and misinterpreted. Sometimes they hear threats. Behavior is determined by delusion. They lock themselves at home, seek refuge in going to unknown places (“delusional drift”), hide, or turn to the police for protection. But aggression towards imaginary pursuers is rarely shown.

Psychosis lasts from several days to 2-3 weeks. If the delirium drags on for months, then delusional suspicions become selective: they focus on persons with whom they were previously on bad terms and in whose evil intentions they find certain reasons.

Alcoholic paranoid is distinguished from a paranoid attack of schizophrenia provoked by alcohol in that delusions of persecution are not accompanied by other types of delusions (impact, staging, etc.).

Treatment is the same as for alcohol paranoia. For fear and anxiety, injections of sibazon (Seduxen, Relanium) are indicated.

15.3.5. Alcoholic encephalopathic psychoses

These psychoses are accompanied by severe neurological and somatic disorders. Occurs in stages II-III of alcoholism. Often they directly

preceded by delirium. Sometimes delirium has been experienced previously, and more than once.

Acute alcoholic encephalopathy Gaye - Wernicke. This encephalopathy usually follows delirium delirium. The patient's condition becomes extremely serious. Body temperature during the day fluctuates from subfeb-Rilmoy to 40 ° C and above, dehydration, tachycardia, shortness of breath increase, blood pressure drops, and collapse is possible. Stunning, manifested in the fact that the patient has difficulty understanding speech addressed to him, reacts sluggishly and with a delay to his surroundings, and gradually passes into an unconscious state. A variety of neurological disorders are characteristic: symptoms oral automatism(sucking and proboscis reflexes), grasping reflexes, spontaneous nystagmus, hyperkinesis. In the following days, bedsores appear. In some cases, death occurs after 10-15 days, in others the somatic condition improves, but stunning is replaced by Korsakov psychosis.

Korsakov psychosis. This psychosis is named after the outstanding Moscow psychiatrist S.S. Korsakov, who described this mental disorder. This psychosis is usually preceded by delirium tremens or Gaye-Wernicke encephalopathy. A triad of symptoms is typical: fixation amnesia, confabulations and amnestic disorientation. Fixation amnesia is manifested by the inability to remember current events with preservation of memory for the past, especially the distant one. You can repeat your name to the patient many times, but after a few phrases he forgets it. A person whom I met more than once in last days, perceives it as if seen for the first time. Confabulations (fictions that cover up the described memory impairments) especially appear when asking the patient about where he was just or yesterday, who he met, etc. (“Yesterday I went to the dacha and picked flowers,” the patient declares in the middle of winter, has not left the hospital for several months). Due to fixation amnesia, patients are disoriented in place and time: they cannot understand where they are (“In some hospital,” the patient answers, looking around the surroundings and seeing the staff in white coats), unable to name today’s date, month, day of the week, say whether they had lunch today or not, etc. But old skills are well preserved, old acquaintances are recognized immediately.

Psychosis occurs chronically - many months and even years. Under the influence of treatment and time, improvement gradually occurs.

When diagnosing Korsakov's alcoholic psychosis, one should keep in mind that a similar syndrome can develop as a result of poisoning carbon monoxide, after hanging, in those who suffered clinical death and those who were resuscitated.

The pathogenesis of encephalopathic psychoses is considered similar to the pathogenesis of severe delirium. Particular importance is attached to a deficiency of B vitamins. Gaye-Wernicke encephalopathy is characterized by many pinpoint hemorrhages in the brain stem, especially in the mastoid bodies.

Treatment for acute encephalopathy comes down to detoxification, measures to maintain homeostasis, cardiac activity, and respiration. Intramuscular administration of large doses of B vitamins is recommended. The same vitamins, as well as nootropic drugs, are indicated for Korsakoff psychosis.

With Korsakov's psychosis, chronic alcoholic hallucinosis and chronic paranoid, the ability to work is lost and there is a need to determine disability.

In all psychoses, at the moment of committing a public dangerous actions patients are recognized as insane and in need of compulsory treatment. When assessing individuals with a history of delirium, the possibility of intentionally reproducing previous symptoms (metasimulation) should be considered.

DRUGS AND TOXIC ABUSES

16.1. Basic terms

The concepts of “drug addiction”, “drug” or “ narcotic or substance” have become not so much medical as legal.

A drug - a narcotic drug and a narcotic substance - is included in the official state list

juice due to social danger due to the ability, with a single use, to cause an attractive mental state, and with systematic use, mental or “physical dependence” on it. If a substance or product has similar “properties, but from a state point of view does not pose a great social danger, then it is not recognized as a drug (an example would be alcohol). The same drug"

In different years, it may or may not be considered a drug, or included among them. For example, the sleeping pill barbamyl has been classified as a drug only since the mid-80s, although it can cause both mental and physical dependence. This legal understanding is due to the fact that, according to the Criminal Code, the illegal manufacture, acquisition, storage, transportation and transfer of drugs is classified and punished as a crime.

Drug addiction is a disease caused by the systematic use of drugs included in the state list of drugs, and manifested by mental and sometimes physical dependence on them. All drugs can cause strong mental dependence, but physical dependence on some is pronounced (opium drugs), on others it remains unclear and doubtful (marijuana), and on others it is completely absent (cocaine).

Psychoactive toxic substances have the same properties as a drug (they cause an attractive mental state and addiction), but they are not included in the official list. An example is some tranquilizers (sibazon) or gasoline, acetone, etc. used in the form of inhalations.

Substance abuse is a disease manifested by mental (and sometimes physical) dependence on a substance not included in the official list of drugs.

Abuse of drugs or other toxic substances without dependence is not considered drug addiction or substance abuse. For these cases, many different names: drug addiction, substance abuse behavior, episodic abuse, etc. last years The term “addictive behavior” (from English, addiction - a harmful habit, a vicious inclination) is becoming increasingly widespread, which indicates that this is a behavioral disorder and measures are required more educational than medical.

Mental dependence is manifested by an increasingly overwhelming desire to continue using a given substance, obtaining it by any means and neglecting the unpleasant and even dangerous consequences. A break in use causes tension and anxiety and a sharp increase in craving for this substance. This attraction is sometimes inaccurately called obsessive (obsessive), although, unlike neurotic obsessions, one is not at all burdened by such an attraction and is not considered painful. External manifestation Psychological dependence is caused by a constant desire for contact with other persons who abuse this substance, the beginning of using a drug or other substance alone, and the search for substitutes in its absence. Group mental dependence, especially pronounced in addictive behavior in adolescents and young adults, should be distinguished from true, individual mental dependence. Attraction in these “cases* arises only when “their own company” gathers, constantly abusing some substance together. Outside of it, attraction does not manifest itself, and when separated from it, it disappears.

Physical dependence develops when a substance that has been abused becomes constantly necessary to maintain the normal functioning of the body. A break in its regular intake into the body causes a painful condition (withdrawal syndrome), manifested not only by mental, but also by pronounced somatic and neurological disorders, which disappear after the administration of the next dose of the usual substance.

Withdrawal syndrome (from the Latin abstincntia - abstinence) is the main manifestation of physical dependence. It usually develops a few hours after the body has not received another dose of a drug or other toxic substance. The symptoms that arise are, to a large extent, the antipodes of those signs that are characteristic of intoxication with this substance. Instead of euphoria, depression sets in, instead of lazy contentment - restlessness and anxiety, instead of increased activity - apathy, instead of miosis - mydriasis, etc. Somatic and neurological disorders can even prevail over mental ones.

Compulsive attraction (from English, compulsion - coercion) differs from the previously mentioned as follows:

called obsessional irresistibility, the inability to suppress it. The patient is not able to hide or somehow mask this attraction.

Tolerance (resistance) to a drug or other toxic substance is determined by the minimum dose that can cause the usual effect or eliminate withdrawal symptoms. As some types of drug addictions develop toleoantostj^a^^^ysg^n_^n^significantly(opiates), with others it appears only with prolonged abuse (hashish), with others it does not increase at all (cocaine).

Anosognosia - reluctance and inability to recognize the presence of a disease, in particular depending on a psychoactive substance, is characteristic of drug addiction and substance abuse. The exception is the development of severe physical dependence with severe withdrawal syndrome.

Polydrug addiction and polytoxicomania as terms are sometimes unreasonably used to refer to all cases when the patient has experienced the effects of two or more drugs and other toxic substances. The diagnosis of polydrug addiction is legitimate only when there is a simultaneous dependence on two or more drugs; the diagnosis of polydrug addiction is on two or more non-narcotic substances. If simultaneous dependence on one narcotic and another non-narcotic substance is established, then these cases are proposed to be called “complicated drug addiction.” Abuse of two or more drugs or other psychoactive substances without dependence on them is neither polydrug addiction nor poly-drug addiction, as well as a sequential transition from one drug to another.

16.2. Classification of drugs and other toxic substances

Medical classifications are based on the characteristics of the action of substances (euphorizers, tranquilizers, psychostimulants, hallucinogens, etc.). However, the same substance, depending on the dose and route of administration, can have different effects. The most common taxonomies reflect practical needs.

International Classification of Diseases (10th Revision) among Drugs and psychoactive substances highlight

includes: 1) opium preparations, 2) sleeping pills and sedatives, 3) cocaine, 4) Indian hemp preparations (cannabinoids), 5) psychostimulants, 6) hallucinogens.

16.3. Clinical manifestations 16.3.1. Drug addiction

16.3.1.1. Opium addiction

Drugs used. Among pharmaceutical drugs they use morphine, omnopon, promedol, dionine, codeine, etc. Heroin and methadone are prepared in clandestine laboratories in our country. Various poppy extracts are made in an artisanal manner. The raw material is the milky sap from the heads of an immature plant or dried and crushed heads and stems (“poppy straw”). The hypnotic poppy Papaver somniferum is richest in opium, but oilseed poppy and even ornamental garden poppy also contain it.

A picture of intoxication. Most often, pharmaceutical ampoules or homemade liquids are administered intravenously. Immediately after the infusion, the face turns red, a hot wave is felt passing through the body, a feeling of tingling with needles, itching of the skin of the face. Often there is a short feeling of lightheadedness. Fainting may occur.

After 10-15 minutes, all unpleasant sensations disappear. Euphoria develops - an elevated mood with a feeling of extraordinary mental and physical comfort. However, this euphoria is usually not combined with either increased activity or the need for communication. People tend to enjoy a pleasant state (“high”) alone or away from others. They sit silently, indulging in tempting dreams, memories or desired thoughts, but there are no vivid visual fantasies. Consciousness remains clear. Only in case of an overdose does stupor, stupor, and coma develop. The pupils are like dots and do not dilate in the dark. Experienced drug addicts, if desired, can dissimulate opium intoxication; only narrow pupils give it away, so to camouflage they wear dark glasses even indoors in the evening or drop atropine into their eyes. Intoxication lasts several hours and is replaced by lethargy and drowsiness.

In case of overdose, drowsiness quickly sets in and may

a life-threatening comatose state may arise for the patient: consciousness is completely lost, he has the appearance of a deeply sleeping person who cannot be awakened. Narrow pupils do not respond to light. Breathing disturbance increases, which becomes periodic (two or three deep breaths alternate with delays), difficult, and snoring. Death occurs from respiratory paralysis.

Much less often, patients inject opium preparations subcutaneously or eat gruel from poppy straw. Then the initial vegetative reaction is absent, and euphoria occurs after 20-30 minutes.

Abuse without addiction. The first infusions are usually done in the company of drug addicts and with their help. About 60% immediately quit these infusions, and 40% become drug addicts. The motivation for starting abuse is similar to that for alcoholism. Among young people, boredom, inability to keep oneself busy, and satiety with entertainment are common motivations. Main role Delinquent and criminal groups and companies of drug addicts play a role in introducing young people to drugs. Among the “informal” movements, there are both “narcophile” movements, where drugs are easily distributed (hippies, punks, some fans), and “drug-phobic” ones, which actively reject drugs (breakers, bodybuilders, etc.). Nowadays, drug addictions that have developed as a result of the elimination of chronic severe pain with drugs are rare.

Addiction. The first stage of drug addiction develops quite quickly: it is enough to repeat the infusions 5-10 times for mental dependence on the drug to arise. Attraction to him becomes the main thing in life. Drug addicts themselves learn to give themselves intravenous infusions and prepare homemade drugs. They try not to break away from the company of drug addicts as a source of obtaining drugs. Somatic changes are still moderately expressed: appetite is reduced, constipation appears, weight loss begins. Due to constant miosis, vision deteriorates.

With a forced break in taking the drug, withdrawal symptoms are erased. The craving for the drug increases sharply. The mood becomes depressive-dysphoric: depression is combined with irritation, hysterics with sobs, and demands for money from loved ones to purchase drugs.

Autonomic withdrawal symptoms can be provoked by injection of a drug antagonist (naloxone, nalor-

I Finnish). After their infusion, the pupils sharply dilate, which does not happen in healthy people.

The erased abstinence persists for several days, but the strong craving for the drug persists for several months. However, in the future, in stressful situations or when meeting drug addicts, the attraction may resume.

At the first stage, tolerance begins to grow: to induce euphoria, the dose has to be increased 2-3 times. From frequent injections, the veins of the forearms and elbows become sclerotic, and nodules form at the site of needle punctures.

The second stage of drug addiction is characterized by severe physical dependence on the drug, which usually occurs after several weeks or even months of regular abuse. Abstinence begins 12-24 hours after the break and is severe. Severe muscle pain, muscle convulsions, abdominal cramps, often vomiting and diarrhea, pain in the heart area appear. The pupils become wide, the pulse increases. Tearing and drooling and incessant sneezing often begin. Chills alternate with heavy sweat. Chronic somatic diseases are getting worse. Cases of death from myocardial infarction during abstinence have been described.

A severe condition lasts several days, and vegetative disorders last 1-2 weeks. However, mental dependence and strong craving for the drug can last for several months. Under the influence of psychogenic stress or acute somatic diseases(for example, influenza), transient states of “pseudo-abstinence” may develop - a repetition of the described autonomic disorders in a weakened form.

The increase in tolerance at the second stage is sharply expressed. Cases have been described when tolerance reached several dozen lethal doses per day for an intact organism. After abstinence, tolerance drops sharply, and the previous, habitual dose can lead to death.

The picture of intoxication changes. The previous “buzz” disappears. The drug becomes a necessary doping to restore performance, sociability, vigor, and appetite. Its effect lasts only a few hours, which requires repeated infusions throughout the day.

Somatic disorders are pronounced and constant. The skin peels, the hair splits, the nails break, the teeth crumble. Characterized by unusual pallor, constipation, anemia. Lost appetite. Narrow (“pinpoint”) pupils interfere with accommodation. Sexual desire fades, impotence occurs in men, and amenorrhea occurs in women. Sexual activity can manifest itself in a passive form, including homosexual activity, in the form of prostitution in order to obtain money for drugs.

Complications include viral hepatitis, AIDS, thrombophlebitis and thromboembolism as a result of constant internal infusions without observing the rules of asepsis. The mortality rate among drug addicts is 20 times higher than in the general population. The reasons are drug overdose, suicide, and the mentioned somatic complications.

The third stage of drug addiction occurs infrequently, since not all drug addicts survive to it. Extreme exhaustion, asthenia and apathy make the patient unable to work. Interest retained only in the drug. Tolerance to it decreases. Previous high doses may cause painful conditions. However, a slightly smaller dose is required at all times to prevent withdrawal symptoms. Activation under the influence of a drug is reduced only to eating on your own and basicly serving yourself. Drug addicts spend most of their time in bed. Collapses are often observed. Death occurs from intercurrent diseases.

Treatment. In case of overdose with the development of soporous and comatose states and respiratory disorders, intravenous infusions of nalorphine (nallin), an antagonist of opiate drugs, are used. In its absence, you can use an infusion of bemegride, a barbiturate antagonist and respiratory stimulant. Detoxification is carried out using generally accepted methods. Caffeine is added to the drugs administered by drip into a vein (up to 10 ml of a 10% solution per day).

Relief of withdrawal symptoms is necessary in the case of immediate drug withdrawal, which is accepted in our country. Abroad, methadone is often used, a synthetic drug similar to morphine that eliminates the painful symptoms of withdrawal. During treatment, its dose is gradually reduced. However, in large doses, methadone can cause euphoria, and with prolonged use -

addiction and addiction. In our country, such treatment is considered unacceptable, since it can replace a more severe opium addiction with a milder methadone addiction. A gradual reduction in the dose of the drug, preventing severe withdrawal, is allowed only if drug addiction is combined with organic heart disease, severe hypertension and a previous heart attack.

To eliminate vegetative disorders, pir-roxan (alpha-blocker), atropine, and baralgin are indicated. Muscle pain is reduced under the influence of analgin, as well as acupuncture. Amitriptyline is used for depression and anxiety. Individual psychotherapy is necessary: ​​empathy facilitates informal contact, allows you to find out the sincerity of the intention to be treated or push for such a decision.

Suppressing drug cravings is a difficult task due to the lack of effective means. Neuroleptics (Neuleptil, Sonapax) weaken desire only as long as they are used. Naltrexone, an antagonist of morphine that blocks its action and makes opiate drugs unable to cause euphoria, is quickly inactivated in the body, and desire is resumed. If the patient wishes to recover from drug addiction, they resort to intensive and long-term psychotherapy, including group and family therapy. Attempts are being made to develop aversion therapy (to develop an aversion to drug intoxication through a conditioned negative reflex). To do this, during drug intoxication, corazol, which causes acute fear, or ditilin, which causes a short-term cessation of breathing, is administered intravenously.

16.3.1.2. Cannabinoid addiction (hashishism)

Drugs used. In our country, the most commonly smoked hashish (hemp, “plan”) is a dried and compressed resinous substance that protrudes on the surface of the flowering tops of female cannabis plants. The active principle is tetrahydrocannabinol. Most of it is found in Indian hemp, but it is also found in its other types and not only in the flowering tops, but also in the stems and leaves. In America and Europe, ma-

rijuana - dried and crushed leaves and upper parts of the stems of the cannabis plant (“weed”). Effect of marijuana weaker hashish approximately 10 times. Synthetic tetrahydrocannabinol, which is 20 times more active than hashish, has appeared on the black market. Marijuana and especially hashish are often smoked mixed with tobacco, usually in groups. It is much less often added to sweets or alcoholic drinks.

A picture of intoxication. Smoking hashish for the first time in your life usually does not cause any sensations. To experience the “high” you need to smoke 2-3 times. A large dose with food or alcohol can cause nausea, headache, chest tightness, and difficulty breathing.

The picture of intoxication depends on the dose received and the sensitivity of the body.

Psychosensory disorders appear: colors become unusually bright, sounds become saturated. There is a feeling of heightened hearing - it seems that every rustle and rustle is caught. In fact, the hearing threshold does not decrease. The estimation of distance is distorted - objects move away. If drunk people take the wheel in such a state, then due to incorrect assessment of distances they end up in accidents and catastrophes. There is a feeling of unusual lightness of the body and movements (“weightlessness”). In a company, a peculiar narrowing of consciousness is revealed (a symptom of I. N. Pyatnitskaya): its participants perceive only what is happening in their circle, and do not notice outsiders. Sometimes it seems that they see themselves from the outside.

Autonomic disorders boil down to dilated pupils, shiny eyes, and dry mouth.

Intoxication lasts up to several hours. When sobering up appears severe hunger. A diagnostic sign can be a peculiar sweetish smell from the clothes of someone who smoked hashish, which lasts for a long time.

Severe psychotic intoxication It is rare and occurs as a result of overdose or hypersensitivity. Oneiroid usually develops: those who are detached from the environment are immersed in a world of dream-like fantasies or re-experience previous emotionally intense events (“scenes of love and hate”). At the same time, it is not possible to make contact, and the facial expression changes from bliss to horror and anger. With delirium, hallucinations can be frightening. They can flee from them or show aggression towards those who accidentally catch their eye. In a state of confusion, they look around in confusion, do not recognize those around them or the situation, and it is difficult to make contact. The duration of acute intoxication psychoses caused by hashish ranges from several hours to several days.

Abuse without addiction. Usually it happens sporadically, when “your own company” gathers. Such abuse, even for 2-3 years, may not lead to drug addiction. But with almost daily smoking, its signs appear after 1-2 months. When smoking marijuana (“weed”), addiction develops much more slowly than when using hashish.

Addiction. The first stage is characterized by mental dependence and is manifested by the need to smoke 2-3 times a day. They smoke alone and are constantly and persistently looking for where to get hashish. With a forced break, the picture of abstinence is erased: asthenia, drowsiness, depressed or irritable mood, headache, unpleasant sensations in the heart area - all this immediately disappears after smoking hashish.

The second stage develops with regular smoking of hashish for 2-3 years and is characterized by a change in the pattern of intoxication, psychopathization, and sometimes signs of physical dependence. When smoking weaker marijuana, physical dependence usually does not occur. Hashish becomes a constantly necessary doping. Without it, all performance is lost. After smoking they become active, lively, collected, and sociable. But you have to smoke several times a day.

In case of physical dependence, a break from smoking for a day causes a pronounced withdrawal syndrome, for -

lasting about a week. Severe asthenia and depression are combined with extremely unpleasant sensations in different parts body (senestopathy), compressive pain in the head and heart, nausea, abdominal cramps. There may be chills, heavy sweats, muscle tremors, and hypertensive crises. Later, asthenia gives way to dysphoria - an angry and melancholy mood.

Psychopathization in some is manifested by increasing apathy towards everything except hashish, in others - by explosiveness (outbursts of irritation, anger and aggression). General exhaustion increases, impotence occurs in men, and anemorrhea occurs in women. There is evidence of suppression of immune reactions.

Chronic psychoses in hashish addiction. Chronic psychosis occurs in approximately 15% of long-term hashish smokers. The picture is usually similar to paranoid schizophrenia: delusions of persecution and influence are combined with apathy, lack of will, inactivity, and less often with auditory hallucinations. It is assumed that these psychoses occur only in those who are predisposed to schizophrenia, and hashish is a provocateur. Sometimes in such persons, hashish intoxication proceeds atypically from the very beginning - with anxiety, a suspicious attitude towards others, they accuse their own friends of malicious intent, the effect of hashish is mistaken for deliberate poisoning.

Treatment. Mild subpsychotic intoxication does not require treatment. Sobering up is accelerated by eating a lot of food, especially sweets. Intravenous glucose infusion can be used. In case of severe psychotic intoxication, Relanium (Sibazon, Seduxen) or chlorpromazine is administered intramuscularly. For withdrawal symptoms, detoxification is carried out, for asthenia, sydnocarb is used, for depression - amitriptyline, for dysphoria - carbamazepine (Finlepsin).

Abuse without dependence does not require drug treatment. It is necessary to explain to the patient the harm and danger of hashish. In case of drug addiction, they try to suppress the desire with long-term use of psychotropic drugs (Sonapax, Neuleptil). The most effective is aversion therapy according to V. S. Bitensky: at the beginning of hashish intoxication, corazol (metrazol) is injected intravenously, causing severe fear. Several combinations produce a fairly persistent negative conditioned reflex- hashish is disgusting.

16.3.1.3. Ephedrone and pervitin addiction

Drugs used. Ephedra is produced in clandestine laboratories from medications containing ephedrine (eye drops, ointments for the common cold, containing ephedrine for the treatment of bronchial asthma). A derivative of pervitin (iodpervitin hydrochloride) is included in the homemade drug, called “shirk” in drug addict slang.

Ephedrone and pervitin intoxication. Homemade drugs are administered intravenously. First, chills, a tingling sensation in the arms and legs, moving hair on the head, and palpitations appear. Then a state resembling hypomania develops. The mood is elevated, a sense of elation is felt, confidence appears in one’s unusual abilities and talents, and in the execution of tempting but unrealistic plans. In contrast to opium euphoria, activity increases and the desire for communication and adventure increases. They talk incessantly, quickly, jumping from one topic to another, animatedly gesturing. They note lightness in the body (“weightlessness”). The situation around becomes unusually interesting. A feeling of boundless love for all people appears. Sexual desire sharply increases, prolonged sexual arousal occurs. Aggression is uncharacteristic, but can be provoked by attempts to limit activity or an unfriendly appearance and tone. Autonomic disorders are reduced to increased blood pressure, tachycardia, extrasystoles. Eyes shine, lips dry.

Intoxication lasts several hours and is replaced by lethargy, fatigue, and poor health. In this post-intoxication period, a strong craving for the drug arises.

Formation of drug addiction. More than half of those who once tried to inject ephedra or pervitin into their veins begin to repeat infusions. Sometimes 2-3 infusions are enough for addiction to arise - an uncontrollable desire to experience such intoxication again.

Severe physical dependence may occur within a few weeks. Withdrawal is manifested by dysphoria - a gloomy and angry mood towards others. Drowsiness is combined with the inability to fall asleep, those who have fallen asleep awaken from nightmares

dreams. Autonomic disturbances during abstinence are pronounced: muscle tremors, alternating chills and heavy sweating, compressive pain in the heart, painful urinary retention, hyperacusis and photophobia last for several days and are replaced by severe asthenia.

The cyclical nature of anesthesia is characteristic of these types of drug addiction and is due to the fact that withdrawal symptoms begin in the post-intoxication period - already 2-4 hours after the drug infusion there is a desire to repeat it. As a result, infusions are given several times a day. Conditions reminiscent of alcoholic binges arise. The daily dose increases by 20-30 times compared to the original. A single dose increases no more than 2-3 times due to strong heartbeats during an overdose. Those who take the drug endure such intoxication for 2-5 days: they do not sleep, hardly eat, and bring themselves to the point of complete exhaustion. Then the craving for the drug temporarily weakens. Patients take sleeping pills or tranquilizers (usually in large doses), sleep, eat, and after a few days the craving for the drug flares up with renewed vigor. As drug addiction develops, the intervals between cycles decrease.

Over time, exhaustion increases, myocardial dystrophy, chronic gastritis and spastic enterocolitis develop, in men - impotence, in women - amenorrhea. In the homemade production of ephedrone, potassium permanganate is used, and as a result, long-term abuse results in symptoms of chronic manganese poisoning: choreiform hyperkinesis, paresis soft palate, tongue, facial muscles.

Alcoholic paranoid is an acute, subacute or chronic alcoholic psychosis, the main symptoms of which are delusions (closer to primary delusions), delusional interpretation of the environment, anxiety, fear and psychomotor restlessness, expressed only in the acute period of the disease.

Before we described the clinical picture of this disease and identified it as an independent alcoholic psychosis (1949), there were only isolated references in the literature to the possibility of delusional psychoses due to alcohol abuse. Depending on the clinical views of the author, they were given one or another interpretation.

Bleuler explained the occurrence of delusions in alcoholics that are not associated with hallucinatory phenomena by the purely endogenous nature of this psychosis. American authors attributed the delusional syndrome that occurs in alcoholics to schizophrenic and paranoid reactions. In modern domestic and foreign manuals on psychiatry, alcoholic paranoid is not identified as independent disease(O. V. Kerbikov, N. I. Ozeretsky, E. A. Popov, K. Snezhnevsky, 1958; I. F. Sluchevsky, 1961; A. A. Portnov and D. D. Fedotov, 1965). After the publication of our work, a detailed study by A. G. Goffman (1961) appeared, which confirmed and developed the concept of nosological independence of alcoholic paranoid, as well as studies by X. Gasanov (1956, 1964), V. E. Rozhnov (1964), L. I. Kolosov (1962), V.V. Anuchin (1963), who recognized the legitimacy of identifying alcoholic paranoid as an independent nosological unit. Certain issues related to alcoholic paranoid are treated in the works of A. N. Molokhov and I. I. Rakhalsky, E. Lukomsky, P. F. Malkin, B. D. Soltan, G. I. Plesso and I. F. Myagkova. Along with this description

We have atypical cases of alcoholic paranoid with mental automatism syndrome (G.S. Vorontsova, A.N. Pokrovsky), a road variant of alcoholic paranoid (A.S. Bobrov, I.B. Talant and I.V. Khramin, T. Ya. Iosefovich, etc.).

Alcoholic paranoid usually occurs after prolonged alcohol intoxication, although there are exceptions to this rule. Let's give some data

0 patients we observed with alcoholic paranoid.

Of the 390 patients, there were 10 patients aged 21-25 years, 70 patients aged 26-30 years, 220 patients aged 31-40 years, 80 patients aged 41-50 years, and 10 patients aged 61 years and older. 70 patients had suffered some form of alcoholic psychosis in the past. 26 patients abused alcohol for at least a year, from

1 year to 2 years - 34, 3-5 years - 59, 6-8 years - 66, 9-10 years - 108, I-15 years - 92, 16-20 years - 5 patients.

Consequently, the overwhelming number of patients abused alcohol for over 7 years. Most of them drank from 0.5 to 1.5 liters of vodka per day, only a few patients said that they drank 200-300 liters of vodka per day. The overwhelming number of patients (340) were tolerant to alcohol, and only 50 were intolerant to it. In 330 patients, alcoholic paranoid developed during the abstinence period after pronounced alcoholic excesses. Over 16% of our patients had a history of head trauma; the remaining patients had no other pathology other than alcohol intoxication. A history of head trauma in patients with alcoholic paranoia was noted by a number of other authors (I. B. Talant, G. I. Plesso, A. G. Gofman, B. M. Berlin, I. F. Myagkov, etc.). In particular, X. A. Gasanov found it in 37.2%, M. A. Rosenblat - in 36.6% of patients with alcoholic paranoid, and P. F. Malkin noted organic complications in 43.4% of patients with prolonged alcoholic paranoid and only in 6 .5% of patients with acute disease. Compounded heredity was observed only in a relatively small number of patients (50 patients, or 15%). The disease developed in individuals of various constitutional groups without the prevalence of any of them.

Currently, among alcoholic psychoses, alcoholic paranoid occupies, according to our observations, the third place in frequency, the first two places belong to delirium tremens and alcoholic hallucinosis. Some authors also indicate a significant frequency of this disease, accounting for 10 to 25% of admissions with alcoholic psychoses in psychiatric hospitals(P. F. Malkin and A. E. Yankovsky, P. A. Dolenko, B. E. Gracheva and B. E. Tulmankova, L. I. Kolosova, etc.).

People who are accustomed to always referring to statistical data know very well that about 25% of alcoholics suffer from this mental disorder like an alcoholic paranoid. The disease is often confused with schizophrenia, but the two concepts have significant differences. The problem is slightly less common than delirium tremens, but also requires long-term hospital treatment. Therapy must necessarily be comprehensive, because otherwise it will be almost impossible to solve a problem of this type.

The disease is divided into several varieties, each of which manifests itself with some individual symptoms. In order not to miss such a problem in your loved ones and begin to treat it in a timely manner, people whose loved ones like to abuse vodka should learn more about this type of problem.

General characteristics of the disease

Alcoholic prolonged or short-term paranoid should be called a fairly common and extremely unpleasant phenomenon. The disease has a number of symptoms that help diagnose it when examining the patient. The general characteristics of this purely psychological problem look like this:

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• the patient begins to become very delirious, either in a hangover;
• coordination of movements, speech impairment, significant deterioration in brain activity are observed;
• a person feels a very strong fear, the culprits of which he often considers a specific person or group of people;
• Both visual and auditory hallucinations may occur.

More often, this problem affects addicts who drink about 1.5 liters of vodka per day. Because ethyl alcohol breaks down in the body and releases toxic substances into the blood. The circulatory and nervous systems are in limbo, which is why complete delirium begins. Prolonged alcoholic paranoia can manifest itself for more than two months, which creates additional discomfort both for the addict himself and for his loved ones.

The problem is indeed very serious, but statistics confidently indicate that after such a disorder, a person has the opportunity to completely restore his mental state, which cannot be observed after schizophrenia.

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Main symptoms of the disease

Patients with alcoholic paranoia cannot soberly assess the situation that has arisen around them. People begin to become obsessed with a specific thought, and it’s definitely not possible to convince them otherwise. When a person suffering from alcoholism begins to experience this particular mental illness, he will have to deal with the following, not very pleasant symptoms:

• sudden mood swings;
• inappropriate behavior that is not characteristic of a sober person;
• the appearance of delusional thoughts and actions;
• deterioration of health, the presence of the same symptoms as in case of poisoning;
• harshness and rudeness of the patient’s behavior;
• the presence of short-term auditory and visual hallucinations;
• the emergence of the problem of dual personality.

The presence of a serious psychological disorder forces a person to also feel purely physical discomfort. The patient thinks that he was seriously poisoned, overworked, or received some kind of injury. The likelihood of developing this particular problem increases in those alcoholics who have ever experienced actual head injuries.

The most common types of delirium

Psychology is a rather complex science, because it studies what cannot be seen in any physical forms. Experienced specialists in this field, observing people with alcohol addiction, found that most often patients suffer from these types of delusions:

• stalking is the most common type, a person thinks that someone is constantly watching him, trying to cause physical harm;
• jealousy - the patient is sure that a loved one is cheating on him;
• relationships - the alcoholic thinks that everyone around him treats him very badly, wants to cause harm and because of this he does not let anyone close to him;
• poisoning - a psychological problem sharply develops into physical discomfort, but in fact the problem is only in the head, although alcohol also poisons the body quite strongly.

The first type of psychological disorder is the most common; its occurrence is observed in almost 70% of cases of the appearance of alcoholic paranoid. Getting rid of this at home is almost impossible, especially if the problem is protracted.

How long does the disorder last?

Studying the features of this disease, medical specialists came to the conclusion that the period of its course is not the same for every patient. There are people who get out of this state quite quickly, and some cannot get rid of it for months. Referring to the findings of qualified doctors and psychoanalysts, in terms of duration, paranoid manifests itself as follows:

• abortive paranoid - begins during the onset of alcohol intoxication, lasts no more than three hours, may pass a little faster, in extreme cases observed throughout the day;
• acute – has a duration that ranges from 2 to 25 days, the patient’s condition during this period does not change for the better;
• protracted - lasts at least a month and a half, can cause harm for about three months, most often occurs precisely at the stage of a hangover, when the body fights with toxins left over from the breakdown of alcohol.

Regardless of how long a psychological disorder lasts, it must be treated in a hospital setting. A qualified medical specialist will select individual therapeutic measures for each patient, which will be the key to his faster recovery.

Drug treatment of the problem

Often psychological problems become more serious than any physical ailment. This is confirmed by the experience of millions of doctors and patients around the world. This unpleasant practice also awaits those who have had to deal with alcoholic paranoid. The doctor, after communicating with the patient and performing certain diagnostic measures, will most likely offer the patient to remain in a hospital setting. No one excludes the possibility of outpatient treatment, but this does not happen very often.

The patient who remains in the hospital will undergo a long psychological rehabilitation, doctors will offer him medications from the following pharmacological groups:

• neuroleptics and similar drugs;
• tranquilizers;
• strong antidepressants;
• vitamins and complexes of drugs that contain many useful substances.

Alcoholic paranoid is often treated with antidepressants, and vitamins help restore the normal functioning of the human body. At the same time, we should not forget that if the problem drags on, psychological therapy should still be considered the main therapeutic measure.

Treating the problem through psychology

There are people who have virtually no psychological problems or blocks, but not everyone is so lucky. Many people have been visiting psychoanalysts for years to overcome their own complexes and fears. When a person abuses alcohol, he develops psychological problems gradually and this cannot be avoided. Over time, such ailments become so serious that they are clearly visible to the patient’s loved ones and even to outsiders.

When an alcohol-dependent person develops alcoholic paranoia, he should think about the need to go to a psychoanalyst. A person in such a state, of course, will not be able to think soberly, but his relatives must take him for treatment. In a hospital setting, very serious psychological work is carried out with patients, the main goals of which should be called:

• clarification in the near future the real reason occurrence of a delusional state;
• a person’s belief that all his problems are hidden exclusively in his head, and real life does not presuppose them;
• convincing the patient that he is very important for society and is needed by his loved ones.

The combination of psychological work and standard pharmacological medications are the factors that will allow an addicted person to throw his mania into the background. After the work done by doctors, relatives and friends should understand that the rate of preservation of this positive effect depends solely on their actions.

People suffering from mental disorders constantly require emotional support from the family. A good atmosphere in the house will become a trigger for the fact that over time a person will completely stop drinking vodka and only then will he be able to completely forget about such a psychological disorder as alcoholic paranoid. Relatives should soberly assess the situation, which will help them understand and support their loved one.

Every person who has communicated with a person suffering from psychological disorders knows that this phenomenon is not very pleasant. That's why even healthy people need advice qualified specialists so that when faced with such patients they know how to behave correctly.

If someone has had to deal with the problem of alcoholic paranoid, which is present in a loved one, then there is no need to panic, you just need to know how to behave correctly in this situation. People whose relatives suffer from similar mental disorders need to learn to put the following tips into practice:

1. calm down yourself, without showing your anxiety in front of the patient;
2. avoid nervous conversations in a raised voice, any quarrels and other conflict situations, which can significantly worsen the patient’s condition;
3. try to calm a person who is suffering from delirium a little, doing it very gently and carefully, without unnecessary intrusiveness;
4. try to convince the person that he needs to see a medical specialist and take him to the hospital;
5. during inpatient treatment, support the victim in every possible way;
6. After therapy, you go to the hospital, take the person home and try to surround him with care in every possible way so that he does not drink and a similar condition does not recur.

Psychological problems are much more difficult to deal with than any physical ailments. Anyone who has similar patients at home should remember this. You should not demand instant results from your loved one, but it is better to be patient and try in every possible way to do better.

Eliminating the source of the disease

A psychological disorder cannot arise on its own. The main reason for this problem is that the patient systematically drinks alcohol in a very large quantities. A lethal dose for a person is considered to be 8 liters of vodka per day, but there are people who need half that amount to face mortal danger. Everything depends solely on individual characteristics body, but one way or another, the problem needs to be properly disposed of.

It is almost impossible to completely overcome alcoholism at home, but qualified doctors will always be able to help an addicted person with this. Treatment of alcoholism should consist of several very important stages, which can be described as follows:

• finding out the reason why a person began to abuse alcohol - therapy with an experienced psychoanalyst is required;
• psychological therapy aimed at achieving an effect purely at the subconscious level;
• drug treatment of an unpleasant condition - droppers, tablets or capsules, sewing in ampoules with medications.

Now there are a lot of pharmacological drugs that cause a fairly strong aversion to alcohol. In addition, the patient needs to independently want to overcome the problem, because, otherwise, even the most best medicines will provide only a short-term effect. Treatment should be comprehensive, the home environment should be calm. If possible, the patient should be protected from communicating with people who previously drank with him.

Alcoholism may be the beginning sad consequences. Terrible dependence turns a person into an antisocial plant, incapable of life. It is very important to see the problem in time and begin to solve it. What you need to know about this pathology in order to avoid many problems is discussed in this article.

Occurrence of diagnosis

In 1949, alcoholic delirium was first diagnosed as a type of psychosis in its own form. During periods of prolonged drinking, people may experience acute delirium, illusions, a state of hostility, aggression and groundless suspicion of the actions of others, which is recorded in medical histories. The psychiatry of alcoholic paranoid began with research into this addiction. Now this condition is determined by many factors and varieties.

Explanation of the term

Alcoholic paranoid is a type of mental disorder characterized by a severe condition, false ideas, delusions and beliefs, as well as persecutory delusions against the background of prolonged alcohol use.

Men with this disease tend to dramatize everyday events, which is accompanied by strange reasoning. This can be expressed in jealous behavior, misinterpretation of one’s feelings, fighting non-existent enemies, inadequate assessment environment, sad mood.

The female body becomes a victim of alcoholic paranoid at a faster pace. Mental problems due to abuse can develop in just 1.5-2 years. Mental disorders are expressed in the form of hallucinations, which are observed much more often in women than in men. In addition, women are susceptible to the rapid development of amnestic syndrome, which reveals severe intellectual impairment and memory loss.

Patients obsessed with alcoholic paranoia often spy on loved ones, neighbors, friends, and just acquaintances. This is explained by the fact that they see all extraneous actions as a threat to their lives. Closed doors, kitchen appliances left in sight, and facial expressions and gestures of others can be interpreted as a targeted threat. A person who drinks a liter of vodka a day is at risk. The first signs of pathology may occur when consuming 200-300 ml per day.

Stages of alcoholism

Alcohol abuse develops into mental disorders in the second. The development of disorders can occur at an increased rate, for example, in people who have suffered a head injury, infectious diseases with problems with the central nervous system or poor heredity.

1. At the initial stage of alcoholism, a person already requires urgent treatment. His behavior is characterized by some features:

• The dose of alcohol increases sharply.
• Lack of basic reflexes of the body trying to get rid of excess alcohol (for example, vomiting).
• Problems with internal organs. Often their liver and stomach suffer. The first stage of hepatitis may occur. A person does not limit himself to drinking alcohol until he loses consciousness.
• Manifestation of signs of alcoholic paranoid, delusions of persecution and jealousy.

2. Inability to give up any type of alcoholic beverages. The patient often goes on long-term binges, suffers from acute psychosis for several years, and experiences extremely unsatisfactory health. Special psychiatric hospitals can save you from this condition.

3. The period when the condition develops into the stage of acute dependence. Prolonged intoxication occurs after 150 ml of vodka. Such people are unable to spend even one day without alcohol. Degradation and an asocial lifestyle sets in.

Types of pathology

1. Acute alcoholic paranoid. With this disorder there is depressive state, sleep disturbances, delusions and auditory hallucinations. The patient suffers from frequent panic attacks and develops a feeling of persecution.

2. Alcoholic pseudoparalysis. Develops against the background of prolonged alcoholism, is characterized by a clear mental disorder with such associated symptoms, as a memory impairment, 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 anxious state.

Forms of manifestation

Alcohol psychosis can manifest itself in several forms:

• Acute psychosis. Not characterized by a clear description of symptoms. The reasons for the manifestation may vary, from hereditary predisposition before changes in external factors (change of residence, everyday stressful situations). In this state, people's consciousness is impaired and mental activity, disorientation in time or space occurs, and hallucinations may occur.
• Alcohol paranoid. In this state, a person feels increased anxiety and fear. Manifests itself in the stage of withdrawal syndrome with regular alcohol consumption. A person may be prone to violence, aggression, and demonstrate antisocial behavior in society.
• Delirium of persecution. The patient is sure that everyone around him is plotting against him and feels a threat to his life for no apparent reason.
• Nonsense of self-blame. The disorder is expressed in moral self-destruction. The patient begins to come up with ways of self-punishment and cause physical damage to his health.
• Delirium of jealousy. It develops with prolonged use of alcoholic beverages and can manifest itself at the 2-3rd stage of alcoholism. Manifested by unfounded suspicions of adultery.
• Delirium of poisoning. The patient may suspect others of trying to poison him.

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.

He's replaying in his head different ways 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 is regularly exposed panic attacks.
• Unreasonably feels threatened and aggressive by others.
• Increased anxiety.
• An unusual isolation for humans 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.

Alcoholic Jealousy

Delusion of jealousy is an alcoholic paranoid in which a person begins to make scandals about adultery.

Delusions of jealousy manifest themselves gradually, in bursts. When the condition worsens, the alcoholic may pass it off as the truth. false memories. In this case, the alcoholic poses a serious danger to loved ones.

Symptoms:

• Firm belief in adultery without reason.
• (disorder mental activity, lack of semantic connection in logical reasoning).
• Lack of awareness of the painful condition.

Treatment should not only relieve the patient from alcohol dependence, but also alleviate emotional condition. Carrying out complex therapy helps return the patient to normal life. However, this disorder cannot always be cured. During therapy, tranquilizers, neuroleptics, hepatoprotectors, vitamin complexes and others are used pharmacological preparations.

How does alcoholic paranoid manifest itself?

The main symptoms of alcoholic paranoid:

• Sudden mood swings.
• Hallucinations or delusions.
• Inappropriate speech and strange actions.
• Antisocial behavior.

Under the influence of strong alcohol intoxication, a person can be rude towards loved ones, regularly provoke quarrels and fights, and show cruelty against a background of jealousy.

The very initial signs can be expressed in insomnia, regular headaches, bad mood, and prolonged binge drinking. Then the person falls into a panic state.

In the following stages, the patient is overcome by fear of danger. He can claim that they want to deal with him, and he sincerely believes in this.

Diagnostic measures

It is not always possible to diagnose alcoholic paranoid, since the patient may carefully hide his condition.

For an accurate diagnosis, it is necessary to collect all the information about the behavior of such a person. The disorder can be identified by several main signs:

1. Rough aggressive behavior.

2. Delusional ideas based on fear or jealousy.

3. Hallucinations.

4. Antisocial behavior.

Treatment

Treatment of alcoholic paranoid is carried out only in medical institution under the supervision of specialists. The patient is hospitalized in a psychiatric hospital for long-term treatment.

The first task of doctors is to eliminate the patient’s paranoid behavior, to relieve a false sense of fear and other negative sensations. During treatment, tranquilizers, nootropics, antipsychotics and other drugs are prescribed. In some cases, antidepressants are necessary. Used to relieve symptoms vitamin complex, psychotherapy, social assistance in Alcoholism Anonymous groups.

The patient returns to home only after the symptoms of the pathology are eliminated.