In accordance with the ICD of the 9th revision, alcoholic psychoses include acute and prolonged hallucinatory and delusional psychoses that arise in connection with the use of alcoholic beverages, and alcoholic encephalopathies, accompanied by gross disorders of mental and intellectual functions, as well as pathological intoxication. Some psychotic conditions, mainly acute, have a meta-alcoholic nature, that is, they develop as a result of changes in somatocerebral functions that occur under the influence of chronic alcohol intoxication, when you stop taking or reducing the dose of alcohol and temporarily stop it.
Classification of alcoholic psychoses and encephalopathies
I. Pathological intoxication (code 291.4).
II. Acute alcoholic psychoses:
1. Delirium tremens, or alcoholic delirium (291.0).
2. Alcoholic hallucinosis (291.31-32).
3. Alcoholic paranoid (291.51).
III. Chronic alcoholic psychoses:
1. Chronic alcoholic hallucinosis (291.33).
2. Chronic alcoholic paranoid (291.52).
IV. Alcoholic encephalopathies (291.1):
1. Korsakovsky alcoholic psychosis (291.11).
2. Alcoholic encephalopathy of Gaye-Wernicke (291.12).
3. Alcoholic dementia (291.2).
Pathological intoxication
It arises as a result of a single intake of alcohol in a small or medium dose in individuals who do not abuse alcohol. Pathological intoxication is very rare. This indicates the essential role of the premorbnd state of the body, a predisposition to the psychotic type of response to alcohol. The nature of this predisposition is poorly understood, although it is known that pathological intoxication is usually observed in people with the consequences of organic brain lesions (injuries, infections), with psychopathic and psychopathic personality changes in explosive, epileptoid and paranoid types, previously asthenized with somatogenic and psychogenic factors (AND V. Strelchuk, 1970; A. G. Hoffman, A. K. Kachaev, 1974; N. G. Shumsky, 1983).
According to the literature and our own examinations (for 35 years of clinical and expert work we diagnosed pathological intoxication only 3 times), pathological intoxication is characterized by a sudden, occurring 10-30 minutes after taking 100-150 ml of vodka or cognac psychotic change in consciousness with illusory, hallucinatory and delusional experiences, flight, automated destructive and aggressive actions. The state of consciousness can be qualified as twilight, accompanied by pronounced affects of anxiety, fear. Speech production is either absent or fragmentary, indicating hallucinatory perception, delusional understanding of the environment.
Epileptiform and hallucinatory-paranoid variants of pathological intoxication are distinguished. Duration – no more than a few hours. The way out of psychosis is critical (or after sleep), the experience in psychosis may be complete or partial amnesia. Medical assistance, as a rule, is not provided due to the short duration of psychosis. During a psychotic state, intramuscular injections of antipsychotics can be prescribed: chlorpromazine, haloperidol, tisercin.