Treatment of patients with alcoholic psychoses

Therapy should be comprehensive. Patients with acute severe psychoses are referred for treatment to specialized wards or intensive care units.
The tactics of treating alcohol delirium depend on the severity of its course. In mild and moderate severity, patients who first received treatment without a pronounced somatic pathology are prescribed sleeping pills, antipsychotics, and tranquilizers in medium doses, glucose, magnesium sulfate, vitamin and symptomatic drugs for 7-10 days (G.M. Entin, 1979) .It should be noted that alcohol delirium often acquires a severe protracted course and the indicated methods of treatment in such cases are ineffective. It has been established that antipsychotics are toxic in acute alcoholic psychoses, especially in case of alcoholic delirium, accompanied by severe liver dysfunction.
The pathogenetic principle of the treatment of acute alcoholic psychoses and encephalopathies is aimed at intensive detoxification of the body, restoration of the acid-base state, impaired metabolism, prevention of hypoxia, cerebral edema (L. V. Shtereva, 1980; N. G. Shumsky, 1983). The following chart describes therapeutic methods depending on the severity (stage) and clinical form of alcoholic psychoses.
The treatment of alcohol delirium and acute encephalopathy, as the most life-threatening conditions, provides for a systematic (for 1.5-2 days or longer) intravenous drip of a detoxification solution (L. V. Shtereva, 1980), sodium bicarbonate, reopoliglukin, hemodes, glucose and dehydration solutions – mannitol (mannitol), urea with their change according to the scheme: detoxification solution-sodium bicarbonate-reopoliglukin or hemodesnit mannitol (mannitol), with a total daily amount of injected fluid not more than 2500-3000 ml (N. G. Shumsky, 1983). During this period, catheterization of the bladder is constantly performed. When oliguria is prescribed an injection of furosemide, or lasix, however, L. V. Shtereva considers this impractical, since impaired renal function is possible. According to L.N. Zinchenko and A.N. Pashkova (1981), the use of hemodesis in combination with other medications improves the effectiveness of treatment of patients with delirium tremens. First, 200-300 ml of an isotonic sodium chloride solution with thiamine, cyanocobalamin, ascorbic acid, corglycon and diphenhydramine are infused dropwise first, followed by 200-300 ml of hemodesis heated to body temperature. After that, to stop the excitation of acute psychopathological symptoms, 5-10 mg of haloperidol are intramuscularly administered, after 4-5 hours – 50-75 mg of tizercin; with aventive-delirious excitation, instead of haloperidol and tizercin, 10-15 mg of seduxen or 100 mg of elenium are administered intramuscularly 2-3 times a day until the excitation is stopped. In the afternoon, sodium thiosulfate and unitiol, magnesium sulfate, cardiac drugs, thiamine 6 mg per day are administered, if necessary – antibiotics and antipyretic drugs. Hemodesis and isotonic sodium chloride solution are stopped pouring in a day after the patient leaves psychosis, haloperidol is canceled after the excitation is removed, tisercin is prescribed for 25 mg overnight for several days. At the same time, and the difference from patients who receive seduxen or antipsychotics without hemodezis, there is a way out of psychosis during the day, which L, N. Zinchenko and A. N. Pashkova explain by the normalizing effect of hemedesis on lipids and phospholipids in blood plasma, especially at the level of cell mebranes (prior to its introduction, the level of cholesterol, sphingomyelin, lecithin, and cephalin was significantly reduced). According to clinical indications, cardiac agents are used. The principles of treatment for acute alcoholic encephalopathy of Gaillot-Wernicke are the same as for severely occurring alcoholic delirium, but with the use of massive doses of vitamins for a long time . As the patient’s somatic and mental state improves, the intensity of detoxification and dehydration therapy decreases, that is, after 2-3 days he is prescribed single injections of the appropriate solutions. For stopping psychomotor agitation, diazepam (seduxen) and sodium oxybutyrate (GHB) are used predominantly. In severe alcohol delirium, haloperidol is ineffective, and chlorpromazine and tizercin in most cases worsen the condition of patients (T. N. Dudko, 1981). They can be used in small doses after removing the patient from a serious condition. According to our data (A. N. Bacherikov, 1981, 1983), craniocerebral hypothermia is a more effective and safe method of treating alcoholic delirium – cooling the brain to 28-30 ° C for 4-6 hours, carried out after medical blockade of thermoregulation and the onset of drug sleep. Patients emerge from a psychotic state after a single such procedure with less severe asthenia and an earlier and higher level of recovery of mental and mental processes. The treatment of patients with acute alcoholic hallucinosis and paranoid is based on the same principles, however, their more favorable somatoneurological condition allows limiting the volume and duration of the administration of detoxification and dehydration solutions, including sulfosine injections, insulin in hypoglycemic doses and antipsychotics (preferably intravenously). In the treatment of chronic alcoholic hallucinoses and paranoids, the main place is given to psychotropic drugs. However, the occurrence of these conditions as a result of chronic alcohol intoxication and their development as a result of toxic somatocerebral disorders, metabolic, neurodynamic and personality changes allows (in order to optimize therapy) to consider chronic alcohol psychoses primarily as intoxication. Therefore, at the first stage of their appearance, it is advisable to use detoxification solutions, including hemodesis, reopoliglyukin (400-500 ml intravenously drip for 7-10 days), sulfosino and insulin therapy (sequentially – if necessary) and vitamin preparations. Psychotropic drugs (tranquilizers, antipsychotics and antidepressants) must first be administered intravenously, part of the daily dose intramuscularly, and then taken orally. With Korsakov’s amnestic psychosis and alcoholic dementia, a detoxification solution with a double dose of vitamins is shown, as well as drugs that improve cerebral microcirculation (hemodesis, reopoliglyukin, cavinton) and metabolic processes (aminalon, piracetam, etc.). It is advisable to prescribe bioquinol, tonic and psycho-stimulating drugs, tranquilizers. Along with medical methods, psychotherapy should be used to treat alcoholic psychoses and encephalopathies and to involve them in labor processes. Active anti-alcohol therapy can be carried out only after the patient leaves psychosis and restorative treatment for 1-3 weeks. 

Social and labor rehabilitation of patients, examination and prevention of alcohol pathology

Social and labor rehabilitation of patients and examination (labor, military medical and judicial) in case of intoxication mental pathology are determined by the peculiarities of clinical symptoms, stage and severity of the pathological process. Patients with alcoholism, as a rule, are recognized as able-bodied, fit for military service and sane. The system of therapy and rehabilitation in addiction departments based on industrial enterprises contributes to the preservation of working capacity 

local_offerevent_note October 18, 2019

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