How to recognize delirium tremens and begin treatment

Delirium tremens occurs in chronic alcoholics after approximately 7-10 years of regular drinking. A person with delirium tremens experiences hallucinations and increased anxiety . He may lose consciousness frequently and for a long time. This is a serious and very life-threatening condition that requires immediate assistance from specialists. Attacks may recur if a person continues to drink alcohol. Alcoholic delirium can lead to death or irreversible mental changes, so you shouldn’t let the situation get worse.

About the condition

Long-term alcohol consumption leads to mental disorders: the patient’s personality degrades, mental abilities decrease, and character changes. acute mental disorder can also occur .
What delirium is, how it manifests itself and whether the addict really sees “little green men” can be found out by looking at delirium tremens syndrome in more detail. Delirium tremens is one of the names for alcoholic delirium, along with “squirrel” and metal-alcohol psychosis.

It has several important features:

• develops only in alcoholics;
• is not a symptom of a primary mental illness;
• does not occur in a state of intoxication, but as one sobers up.

In the development of fever, abstinence plays an important role - withdrawal syndrome. Every time a person consumes ethanol, a person suffers from intoxication: some feel it clearly, while others, whose liver produces more specific enzymes, experience almost no discomfort. However, in both cases, alcohol in the blood breaks down into the poison acetaldehyde, which can disrupt the functioning of internal organs.

If such poisonings occur regularly , the body protects itself from chronic intoxication by gradually integrating ethanol into metabolism. This happens at the second stage of addiction: from this moment on, the person is faced with a hangover syndrome - withdrawal symptoms that force him to take a new dose of alcohol.

If a person in a state of withdrawal abruptly stops drinking alcohol, his health worsens. He experiences various unpleasant symptoms:

• weakness and drowsiness;
• nausea, vomiting, diarrhea;
• tremor, dizziness, etc.

Acute mental disorders are one of the possible complications. According to statistics, it occurs at least once in half of alcoholics. The risk of its development increases if the patient:

• has sleep disorders;
• is on a binge for more than 4-5 days;
• suffers from dehydration or acidosis;
• previously suffered traumatic brain injuries and severe stress.

The mechanism of delirium development remains open. Typically, doctors identify metabolic changes in the brain of an addict, in which the function of the GABA and N-methyl-D-aspartate systems, as well as the metabolism of serotonin, dopamine, acetylcholine and endorphin, are disrupted.

In the list of diseases in ICD-10, delirium delirium is coded F10.4. Depending on the symptoms accompanying the condition, several subtypes of delirium tremens are distinguished.

Can delirium be treated at home?

Delirium tremens usually develops over several days. The first symptoms appear 2-3 days after the end of the binge and intensify. Relatives may suspect something is wrong and call an ambulance . This is the best thing that can be done for the patient. You can’t waste time and wait for the condition to normalize on its own.

The first thing to remember is that it is impossible to get rid of delirium at home without medical help. However, you can alleviate the patient's condition before the doctor arrives. You can use the following recommendations :

• Don't make the patient angry. There is no need to try to prove to him that he is having a seizure or schizophrenia; he is not able to adequately perceive someone else's speech. Slapping him in the face, pouring water on him, and screaming will not help him come to his senses, but will only worsen the situation.
• Do not let the patient leave the house. It is better to hold him until the doctors arrive. If the patient goes outside, he may get lost, freeze, or get hit by a car.
• Do not give him unknown drugs and dubious folk remedies. Be careful with painkillers, sedatives, and sleeping pills. It is advisable to wait for the specialists to arrive. If you decide to give the patient the drug, do not exceed the dosage.
• Never give alcohol. Although delirium occurs due to abrupt withdrawal, alcohol should not be given to the patient. This will not help him wake up, but will only increase intoxication and complicate the work of doctors.

Folk remedies cannot completely restore the damaged nervous system and psyche. Sometimes it is recommended to give a decoction of yarrow, wormwood, and bay leaf. You can add honey to the broth; it speeds up the process of removing toxins. However, you need to know for sure that the patient is not allergic to herbs or bee products.

The sooner you recognize delirium and call a doctor, the more likely it is that the patient's mental state will recover. One of the severe consequences of delirium tremens is Wernicke-Korsakoff syndrome. A person may permanently lose their memory. Changes in the brain become irreversible due to damage to the hypothalamus.

Classic shape

Fever is accompanied by a triad of symptoms by which the disease can be easily differentiated from others:

• confusion;
• hallucinations, delusions;
• tremor (shivering).

The disorder usually develops in the evening and begins with a feeling of restlessness, causeless anxiety. If the patient can sleep, he has nightmares.

Only an experienced psychiatrist can recognize alcohol psychosis by identifying the signs characteristic of an altered state.

1. At the first stage, the patient’s mood quickly changes: from a cheerful state he moves to a depressed one, from lethargy and relaxation to euphoria. He faces depersonalization and often cannot navigate in space. According to the scheme described by doctors back in 1866, the patient’s emotional reactions accelerate, and facial expressions become richer. Bright light seems unpleasant to him, and loud noises make him flinch.
2. At the second stage, visual hallucinations appear. A person can see images that are made up of shadows on a wall or in a wallpaper pattern, and also see distinct visual images immediately after waking up or at the moment of falling asleep. Dream and reality mix, a person begins to see pictures reminiscent of dreams, not only in sleep, but also when closing his eyes. After waking up, addicts cannot understand what was a dream and what was reality.
3. At the third stage, a person physically cannot fall asleep even for a short time. He experiences auditory, visual, tactile, gustatory and other hallucinations. If you give the patient a blank sheet of paper, he will see an image or text on it, and instead of silence in the telephone receiver, he will hear speech.

Most people associate delirium with aggressive behavior. But this impression is wrong : a person can be in high spirits, communicate with other people, tell funny stories that are partly incoherent and full of illogical details. Also, the patient often expresses tenderness and love for others and the world, but after a few minutes he withdraws into himself, becomes gloomy and thoughtful.

The exit from the state usually occurs after a deep and long sleep. After waking up, the person partially remembers what happened to him during the attack. Sometimes he continues to hallucinate when focusing on shiny objects.

In 80% of cases the syndrome does not last long. However, in some patients, fever occurs in waves, with alternating deterioration and improvement of well-being. The prognosis depends on the specific form.

Development of withdrawal syndrome

Withdrawal syndrome may appear within a few hours after the last drink. The main stages and possible complications are listed below. Please keep in mind that these are general cases and there may be exceptions.

Withdrawal symptoms can be deadly.

The first stage of withdrawal involves the onset of minor symptoms, usually subsiding in less than 12 hours after the last drink. These include anxiety, insomnia, nausea, headaches, loss of appetite, sweating, and fast or irregular heartbeat.

12 to 24 hours

During this period of time, tactile, auditory, or visual hallucinations may occur . Visual hallucinations are the most common. For example, a person may see something dangerous outside the window, break the glass and cut himself. The patient may experience a burning sensation, itching or numbness that has no physical cause.

24 to 48 hours

Severe withdrawal attacks most often occur during this period. This can be very dangerous as life-threatening complications can occur. Typically, most symptoms resolve within a maximum of five days , but full recovery may take weeks.

Reduced forms

In some patients, the clinical picture of delirium tremens is not fully revealed. This group includes forms where some of the symptoms are absent.

• Hypnagogic

The form of delirium tremens, in which a person experiences predominant visual hallucinations associated with falling asleep, is called hypnagogic. The main sign of pathology is the vivid and realistic scenes that appear when falling asleep.

Most patients with alcoholism in a state of delirium see zoological visions - that is, images of small animals that quickly move around the room. It was this feature that became the reason for the appearance of the popular name for alcoholic delirium - “squirrel” or “squirrel”. However, some people have more detailed pictures, for example, military battles or space travel.

It is important to understand that in a state of acute mental disorder, a person is not able to understand that what he saw or heard is a pathological symptom. He will be sure that the squirrel sitting in front of him on the table is absolutely real, even if its size is hundreds of times larger than normal, or it will talk, play musical instruments, etc. Also, a person cannot ignore the visions: he will be completely immersed in a hallucination and react emotionally: get scared, delighted, run away or fight.

• Hypnagogic onirism

This form is distinguished by hallucinations of fantastic content. Vivid scenes can occur not only in sleep, but also when closing your eyes. In this case, the vision is interrupted when the person opens his eyes, and then the patient again plunges into a hallucination.

• Without delirium

The syndrome may not cause hallucinations or delusions, and may be limited to neurological symptoms only. In this case, the patient suffers from tremors, anxiety, and severe depression.

• Abortive form

The easiest variant of the course of alcoholic tremens is the form without a prodromal (preceding the main) stage, with single short auditory (less often visual) hallucinations.

Symptoms of delirium delirium

To help a person, you need to know the signs of alcoholic delirium and recognize them in time. In a patient with delirium tremens, all chronic diseases become aggravated, the mood changes sharply from euphoria to depression, and then hallucinations .

There are several symptoms of extreme delirium:

• Physical weakness. The patient cannot stand on his feet and has difficulty moving.
• Severe shortness of breath, fever. The patient's temperature rises greatly (up to 40 degrees), chills appear, it is difficult to breathe or breathing becomes shallow.
• Problems with coordination. Your arms and legs are trembling, it is difficult to maintain a firm gait.
• Lack of normal perception of reality. A person cannot soberly assess the situation, express his thoughts and perceive someone else’s speech.
• Excitation. A person with delirium has difficulty concentrating and paying attention to anything.
• Increasing symptoms. Without treatment, every hour a person’s condition becomes more unstable and severe.

It is advisable to call an ambulance at the initial stage. The sooner you can help the patient, the lower the likelihood of irreversible consequences.

Severe forms

The most dangerous types of delirium for alcoholics are:

• Professional

The patient experiences mental disorders not in the evening, as in most patients with withdrawal syndrome, but during the day. The person is silent, despite internal excitement, or speaks in rare spontaneous phrases.

The concept of “professional” is associated with monotonous movements , which are usually associated with his daily activities. He will monotonously repeat the movements that he often made before, washing dishes, driving a car, working on a computer.

After normalization of health, complete amnesia occurs.

• Mussitating

Occupational delirium is often replaced by the “muttering” form. Hallucinations are usually absent, but there is marked confusion of consciousness. The patient lies in bed, so attacks of excitement are limited to his position: he can make grasping movements and pronounce short syllables.

After regaining consciousness, the patient also does not remember what happened to him.

Severe forms can cause death, so the patient needs immediate medical attention.

First aid

The disease tends to last from 3 to 7 days (in some cases longer). At the first occurrence of an open attack of delirium tremens, the patient must be given proper assistance. You should not immediately try to treat it; before doing so, it is necessary to remove the patient from an excited state.

First aid for an attack of delirium tremens consists of the following actions : the alcohol addict is put to bed, stopping all attempts to get up. If the clouding is severe, that is, the patient’s behavior is violent, and he poses a threat to himself and others, then it is worth resorting to tying up. It is necessary to urgently call a doctor. Trying to deal with a squirrel yourself without proper experience is extremely undesirable.

The further state of health is determined by the treatment of this clouding itself. The patient needs a lot of fluids and coolness. If it is not possible to put it under a cold shower, you can limit yourself to wiping it with a wet cloth. Sedatives (for example, piracetam, diphenhydramine) will be beneficial. In this condition, the patient must first of all be reassured.

Calm can also come through kind words. There is no need to quarrel with the squirrel's victim: this will definitely not help him. Treat him with understanding: everything he says or does happens unconsciously.

Clarity

Delirium in alcoholism causes a change (switching off) of consciousness of varying severity. This term may not be clear to people outside of medicine, so each stage of the condition needs to be considered separately.

1. Obnubilation is a “veil on consciousness” when the patient is a little inhibited and inattentive. He answers questions out of place and cannot concentrate.
2. Stunning is a significant decrease in clarity of consciousness when a person ignores most questions and can only answer the simplest of them. Often he does not perceive remarks addressed to him the first time, speaks with difficulty, repeating the words of his interlocutor.
3. Stupor and coma are two severe forms of loss of consciousness, when a person reacts only to pronounced stimuli (strong screaming, rough touches) or does not react at all.

All forms of altered consciousness are present in the patient, but stunning is considered the most common.

Consequences

After normalization of the condition, patients retain residual neurological, asthenic and somatic symptoms for some time.

They reveal:

• Rhythmic tremor, especially of the hands with periodic amplitude shocks.
• Unpleasant smell of sweat.
• Skin hyperemia.
• Muscle hypotonia and atrophy.
• Hyperreflexia.
• Tachycardia and changes in blood pressure.
• Pain in the right hypochondrium, enlarged liver, yellowness of the sclera.
• Low-grade fever up to 37.5.
• Convulsive seizures.

Laboratory blood tests reveal an increase in ESR, leukocytosis with a shift to the left, bilirubinemia, and azotemia.

Treatment

There is no way to bring a person to his senses on his own. Only drug treatment will make therapy effective and safe.

1. The protective regime will eliminate external catalysts for deterioration of well-being and provide the necessary peace. For round-the-clock medical observation, the patient is indicated for hospitalization in a hospital. At the clinic, the patient undergoes detoxification, which will remove traces of alcohol from the blood.
2. Pathogenetic and symptomatic therapy restores water-salt and acid-base balance, blood pressure, metabolic processes, brain function and other organs.
3. The use of psychotropic drugs reduces cravings for alcohol and facilitates recovery from withdrawal symptoms.

Additional methods that help to quickly get out of a difficult physical and mental condition are: electrophoresis, darsonvalization, electrosleep. During the treatment of alcoholism, patients are interviewed by a psychotherapist who helps them cope with emotional discomfort and motivates them to stop drinking alcohol forever.

Content:

1. Delirium tremens: when and how it occurs
2. Delirium tremens: symptoms
3. Classification
4. Alcohol delirium: consequences
5. “Squirrel”: what treatment

Alcoholism
is a serious disease that affects all human organs and systems, including the nervous system. Long-term intoxication with ethyl alcohol often leads to the formation of severe mental disorders. One of them is delirium tremens or delirium tremens.

Sources

1. Gofman A.G., Slyusar A.I., Dyagileva V.P., Begunov V.I. On differentiated treatment of patients with delirium tremens. In the book: Third All-Russian Congress of Neuropathologists and Psychiatrists. Abstracts of reports. Responsible editor: V.M. Banshchikov. 1974. pp. 145-147;
2. Gofman A.G., Begunov V.I. The role of various factors in the occurrence and course of delirium tremens. In the collection: Questions of the clinic, pathogenesis and treatment of alcoholism. works of the Moscow Research Institute of Psychiatry. Moscow, 1980. P. 61-71.;
3. Gofman A.G., Aleksandrova N.V., Nizhnichenko T.I. Clinic and treatment of severe delirium tremens. In the book: Issues of social and clinical psychiatry and narcology. Abstracts of reports of the Moscow Regional Scientific and Practical Conference of Psychiatrists and Narcologists. Edited by Doctor of Medical Sciences, Professor V.B. Belova. 1989. pp. 293-296;
4. Sivolap Yu.P., Damulin I.V., Mendelevich S.V., Savchenkov V.A., Yanushkevich M.V. Mental disorders in the postpsychotic period of alcoholic delirium tremens. Journal of Neurology and Psychiatry. CC Korsakov. 2011. T. 111. No. 11-2. pp. 28-29;
5. Damulin I.V., Shmidt T.E. Neurological disorders in alcoholism. Neurological Journal. 2004. T. 9. No. 2. P. 4.

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Delirium tremens: when and how it occurs

It is noteworthy that, as a rule, it occurs during the withdrawal phase of use, and not during drinking. Imagine that a person has been drinking alcohol for months and years. And suddenly the body stops receiving its usual daily dose of alcohol. Changes in metabolic processes begin to form. The mechanisms responsible for excitability and inhibition grow in the central nervous system. Mental disorders appear that aggravate the withdrawal syndrome.

Many narcologists note the dependence of the frequency of delirium on the length of use, neurological and vegetative status. The longer a person drinks, the more likely it is that delirium tremens will develop. The chances of a “squirrel” appearing also increase when the elimination of withdrawal symptoms is started too late. Delirium often occurs after coming out of a long binge, characterized by massive alcohol intoxication. Sometimes, but extremely rarely, the “trigger” for it is a large dose of alcohol taken once.