These include verbal hallucinosis, lasting more than 6 months. Acute hallucinosis is possible at first, more often repeated, in combination with depressive-paranoid symptoms.
According to I.V. Strelchuk (1970), chronic verbal hallucinosis without delirium most often occurs. With this hallucinosis, constant verbal hallucinations are observed – “voices” discuss all the actions and desires of the patient, condemn him or protect him , threaten him. There is no criticism during the period of intense hallucination, patients enter into active “discussions” with “voices”, experience indignation, fear, and mood depression. Discontinuation of alcoholic beverages and active treatment lead to the reduction of hallucinations, a critical attitude towards them. In cases of “encapsulation” of verbal hallucinations, patients not only evaluate them as a painful phenomenon, but often lead an orderly lifestyle, engage in production activities. Chronic verbal hallucinosis with delusions is characterized by a delusional interpretation of hallucinatory experiences – the presence of hallucinatory delusions of persecution, exposure. In chronic verbal hallucinosis with mental automatisms and paraphrenic changes in delirium, the picture of true verbal hallucinosis with symptoms of mental automatism, auditory pseudo-hallucinations, and fantastic megalomanic delusions that do not have a stable systemization become more complicated. An increasing organic decline in the level of personality is noted.
A protracted alcoholic paranoid is manifested by a delirium of attitude and persecution, intense passion, and restriction of communication with others. Delirium has a tendency to systematize, intensifies after drinking alcohol. A protracted alcoholic paranoid usually occurs with periods of exacerbation, when there are verbal hallucinations, delusions of jealousy, poisoning and exposure, accompanied by anxiety, fear, evil affect. The object of delusional experiences are often people with whom the patient previously had a conflict. Sometimes psychosis resembles a picture of depressive-paranoid syndrome.
Some authors believe that alcoholic delirium of jealousy is a special kind of protracted alcoholic paranoid. Its main content is the systematized ideas of adultery, infidelity – alcoholic paranoia of jealousy (E. I. Terentyev, 1982).
EI Terentyev (1982) identifies the most pronounced signs of alcoholic delirium of jealousy, namely: the emergence of ideas of jealousy against the background of decreased sexual potency, the absence of their correction, the struggle for conviction in the depravity of a wife (husband), accusations of treason with many men, with brother, own son, public “exposure”, complaints to various authorities, “detective” behavior (examinations of the wife’s underwear, genital organs, surveillance of her), lack of “shame emotions”, delusional sadistic-masochistic behavior with the eliciting of “confessions” of treason e and aggressive behavior, aggravated when intoxicated, the presence of the plot of “direct sexual rivalry”, motives of material and moral damage. The delirium of jealousy is complemented by secondary ideas of persecution, corruption, witchcraft. Gradually, delusional evidence is becoming more stereotypical, ridiculous, which serves as an indicator of an increase in organic changes in the brain. Psychosis can continue for years if treatment is not carried out, or relapse, usually with the resumption of drinking.
When making a diagnosis, one has to differentiate the alcoholic delirium of jealousy and ordinary jealousy, overvalued ideas of jealousy among alcoholics. The correct solution to this issue is important for forensic psychiatric examination.
Normal jealousy is common to many healthy people. It is determined by the instincts of procreation (sexual) and self-preservation, social morality, group and family traditions, a certain level of claims and self-esteem, internal need for maintaining one’s social position, and the continuation of one’s biological and social self in posterity. Internal and external manifestations of jealousy depend on the characteristics of temperament, intelligence, affective stability, psychological attitude, actual life situation, and, in addition, on the characteristics of upbringing, personal sexual experience, therefore they are individual, diverse and variable. Jealousy may be more pronounced in some people, but manifests itself in the presence of a real reason: clear evidence of treason, reliable or slanderous messages, open flirting. She does not advertise, explanations on this subject, as a rule, are in private. Leading in the experience is the topic of moral damage, wounded pride, insult to honor and dignity. In the state of effect, aggression is possible in relation to the wife (husband) and sexual rival (rival), followed by a feeling of remorse and shame, a critical assessment of their behavior.
In patients with alcoholism, it is more difficult to differentiate overvalued ideas of jealousy and delirium of jealousy, since the real reason is either insignificant or lost their relevance due to the long prescription. A decrease in sexual potency with high claims, a cold attitude of a wife to a drunken husband, a refusal of sexual claims cause a feeling of anger with the intensification of overvalued jealous experiences. Drinking buddies and ill-wishers support them with jokes and obscene hints, but in a calm state, patients evaluate their experiences and behavior critically, do not advertise jealousy, speak on this topic only among friends and family. When explaining with his wife, as calming down, super-valuable ideas fade for a while, then reappear. Usually, patients do not resort to spying on their wife, examining linen, public evidence and written complaints with allegations of debauchery; they do not blame cohabitation with their immediate family, persons of inappropriate age, and many men. The patient’s everyday behavior does not go beyond the usual, but at the height of affect, overvalued ideas of jealousy can cause violent actions, up to murder, often provoked by a daring (from despair) response or a statement about the betrayal of the wife accused of this. After a decrease in affective tension, a feeling of remorse for the deed, a critical attitude towards him, is noted.
In clinical and expert practice, it is often necessary to distinguish psychoses of alcoholic genesis from other diseases, since patients with organic brain diseases, epilepsy, schizophrenia, and manic-depressive psychosis can abuse alcohol. In the differential diagnosis, it is necessary to take into account the alcohol history, the features of the clinical picture and the course of the disease, as indicated by I. V. Strelchuk (1956), S. G. Zhislin (1965), V. M. Banshchikov and C. P. Korolenko (1968) , A, A. Portnov and I.N. Pyatnitskaya (1973), A. G. Hoffman and A. K. Kachaev (1974), N. G. Shumsky (1983). Long-term alcohol abuse, anti-alcohol treatment, and a history of alcoholic psychoses give rise to the assumption of the alcoholic genesis of the observed mental illness. Doubts about the alcoholic nature of the psychotic state usually arise when there are symptoms of psychic automatism in its structure (feelings of openness, lack of freedom of thought, emotions, motor acts), visual and auditory pseudo-hallucinations, catatonic neurotic symptoms, delusions of hypnotic effects, depressive and manic episodes. The episodicity, fragmentation, imagery of these manifestations, the emotional richness of experiences and their connection with the alcoholic past speak in favor of the diagnosis of alcoholic psychosis.
In endogenous diseases, in most cases, alcoholization and related disorders are secondary, in the premorbid period and in the clinical picture, changes characteristic of endogenous psychosis come to the fore.
If the course of alcoholic psychosis is atypical and its genesis is complex (with the participation of other factors), two main diagnostic errors are possible: 1) the definition of alcoholic psychosis where alcoholization arose as a way of psychological or psychopathological compensation against the background of a developing mental illness of a different origin; 2) the diagnosis of schizophrenia (mainly), epilepsy or another disease with complication or atypization of the clinical picture of alcoholic psychosis, especially with its repeated relapses. Clinical symptoms of acute Gaie-Wernicke alcoholic encephalopathy have many common symptoms with mussitizing and febrile (deadly) variants of alcoholic delirium. It is characterized by a pronounced impairment of consciousness according to the delirious-aventive type, stupor or doubtfulness with transition to stupor and coma, incoherence of speech with lack of speech contact, agitation within the bed, disturbances in muscle tone, complex hyperkinesis, stiff neck muscles, nystagmus, fever up to 40-41 ° C. This psychosis is often complicated by pneumonia and impaired cardiovascular activity, which complicates the prognosis. In such cases, patients often die. The course of acute encephalopathy can be “lightning fast”: occurring against the background of pronounced autonomic neurological disorders, the process quickly acquires a severe course with the development of stupor, stupor and coma. With a favorable outcome, acute alcoholic encephalopathies result in psycho-organic, Korsakovsky or pseudoparalytic syndrome. S. S. Korsakov (cited by N. G. Shumsky, 1983) described mitigating acute encephalopathy in the form of asthenia with impaired memory, delnrious disorders, and anxiety-dysphoric depression. Korsakovsky alcoholic psychosis refers to chronic alcoholic encephalopathies, with it toxicoencephalopathic and toxic neuric symptoms, gross organic memory impairments (fixative and reproductive amnesias) with pseudo-reminiscences, confabulations and amnestic disorientation are noted. The course is long, with a tendency to regredience, in elderly people upon exit from psychosis, as a rule, there is a persistent defect in memory and thought processes. Alcoholic dementia is characterized by symptoms of decreased intellectual-mnestic and emotional-volitional personality traits. Previous interests, creative and professional opportunities, differentiation of emotional reactions and a sense of empathy disappear, limited and primitive desires, assessments of one’s position and the environment appear. Rude, cynical alcoholic humor, loss of shame and self-esteem, responsibility for one’s actions are characteristic. The main motive for the behavior is the acquisition and use of alcohol, its surrogates. Allocate a pseudo-paralytic form of alcoholic dementia when psychopathological symptoms resemble a dementia or expansive form of progressive paralysis. There is a loss of previously acquired knowledge, dullness and apathy or euphoria with an overestimation of their capabilities, up to ideas of greatness, as well as inconsideracy, cynicism, and lack of criticism. Neurological organic symptoms appear. N. G. Shumsky (1983) indicates that this form is characteristic mainly of men of mature and old age, however, we have observed such a form of alcoholic dementia in women. According to V. V. Syreishchikov (1981), chronic psychopathological conditions (paranoid syndrome with overvalued and delusional ideas of jealousy, chronic verbal hallucinosis) began to occur much less often, but the number of acute exogenous reactions increased, mainly due to acute verbal hallucinosis and a statistically unreliable increase frequency of acute paranoid.