According to N. G. Shuisky, delirium tremens accounts for 25-50% of all “meta-alcoholic” psychoses. It is observed in chronic alcoholism lasting 5-10 years or more, usually in the II or II-III stages of the disease, 2-4 days after stopping alcohol intake or (less often) when the dose is reduced, that is, against the background of withdrawal syndrome. Delirium tremens are often preceded by somatic diseases or their exacerbation, head injuries, acute infections, surgical intervention as provoking factors.
In the prodromal period, headache, sleep and appetite disturbances, chills, heart pain and a gradual increase in the psychopathological signs of withdrawal symptoms – anxiety, anxiety, distracted attention, lack of thinking, emotional lability are usually observed. Illusory and fragmentary hallucinatory disturbances of perception appear, and a critical assessment of one’s condition decreases. Some authors call this period pre-lirious. Delirium is sometimes preceded by single convulsive seizures.
The main clinical signs of alcohol delirium are confusion of varying degrees without disturbing autopsychic orientation, fragmentation of the perception of the environment, true visual and tactile, auditory, olfactory and taste hallucinations, delusional interpretation of the environment (delirium of attitude, persecution, physical impact), affect of fear, psychomotor agitation. The intensity of psychopathological symptoms usually increases in the evening and at night. The duration of psychosis during treatment in a hospital is 1-4 days, repeated delirium is longer.
L. V. Shtereva (1980) divides alcohol delirium downstream into four stages: 1) precursors of psychosis (a psychotic version of withdrawal syndrome); 2) delirious stupefaction with a large amount of visual and auditory hallucinations, an affect of fear and psychomotor agitation, an increase in somatoneurological disorders; 3) dizziness on an amentic or soporous type, an increase in body temperature to 40-41 ° C, a decrease in blood pressure, adynamia, pronounced somatoneurological disorders, cerebral edema, dehydration (mussing delirium); 4) akinetic coma (terminal stage). Recently, the pathomorphism of alcoholic delirium has been observed: the number of cases with an altered structure of the psychopathological syndrome, the transformation of delirium into delirious-amentic, hallucinatory-paranoid pictures, with episodes of the twilight state of consciousness, severe somatic complications has increased. N. G. Shumsky (1983) describes the following variants of alcoholic delirium: 1) delirium without delirium (fussy excitement with severe tremor and sweating, transient disorientation in the environment); 2) abortive delirium (single visual illusions and micropsic hallucinations, acoasms and phonemes, affect of anxiety or fear, distrust, suspicion with delusional behavior and attacks of motor excitement); 3) systematic delirium (multiple scene-like visual hallucinations and illusions, disorientation in the environment, experiencing scenes of persecution, chasing and flight, false recognition, fear, delusional ideas that reflect hallucinatory experiences); 4) hypnagogic delirium (vivid scene-like dreams or visual hallucinations when falling asleep and closing eyes with a critical or semi-critical attitude to them); 5) hypnagogic delirium of fantastic content, or hypnagogic onyrism (plentiful sensually-bright visual scene-like hallucinations of fantastic content that disappear when you open your eyes, disorientation and the surrounding, the affect of surprise); 6) delirium with fantastic content, or alcoholic oiroid (initially multiple photopsies or elementary visual hallucinations, afternoon episodes of figurative delirium, attacks of psychomotor agitation; after 2-3 days – scene-like visual and verbal hallucinations, symptom of a positive double, motor excitement; after 1- 2 days – episodes of immobility with changing facial expressions, hallucinatory experiences of paintings of battles, world cataclysms, space flights, celebrations, festivities with a sense of flight, movement, impact rays; the patient does not participate in these events, but only passively observes them); 7) delirium with onyric disorders (first hypnagogic onyrism, then ideomotor inhibition with oriented onyrism – with experiencing scenes of fantastic content intertwined with surrounding events, then completely filling the mind, with a feeling of moving, flying, falling); 8) delirium with professional delirium (transformation of a typical delirium into a state with stereotyped everyday and professional motor acts that reflect the experiences of the corresponding scenes); 9) delirium with pronounced verbal hallucinations (along with visual ones, there are verbal hallucinations that come to the fore; figurative delusions of dramatization, a symptom of a positive double, affect of fear); 10) delirium with mental automatisms (transient symptoms of ideator, sensory or motor automatism, visual pseudo-hallucinations, delusional ideas of physical and mental effects are noted); 11) prolonged, or chronic, delirium (a prolonged course of delirium with mental automatisms and oneiric disorders, in the structure of which there are visual, tactile and auditory hallucinations, anxiety, paranoidness while maintaining orientation, asthenia, a critical attitude during the day); 12) delirium mussitizing, or “mumbling” (deep dizziness, lack of speech contact, involuntary muttering of individual words and interjections, rudimentary motor anxiety within the bed, choreiform hyperkinesis and myoclonic twitching, hyperthermia, hypotension); 13) fatal delirium (severe delirium with hyperthermia, epileptic seizures, expressed somatoneurological disorders leading to death, is observed in almost 2% of cases). All variants of alcoholic delirium are characterized by a change in consciousness with predominantly visual hallucinations. In some cases, impaired consciousness can be qualified as stupor, an amentic or twilight state, that is, as a change in exogenous type with a corresponding change of syndromes (twilight state, delirious, oneiric, amentic syndromes). In some atypical deliriums, the clinical picture shows a combination of visual hallucinations with auditory (mixed or transitional forms from delirium to hallucinosis, from delirium to parancid), pseudo-hallucinations, symptoms of mental automatism, unsystematized and systematized delirium with a shallow disturbance of consciousness (L.K. Khokhlov, 1972; K. G. Danielyan, 1980).