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Psycology » Psychiatry and psychotherapy » Alcoholism » Etiology and treatment of alcoholism

  1. Alcoholism
  2. Stages and symptoms of alcoholism
  3. Alcoholic psychosis symptoms
  4. Etiology and treatment of alcoholism

If evidence of an etiologic factor, as is the alcohol, its toxic effect, there is no doubt, that the disease itself (alcoholism), most researchers considered multifactorial. Alcoholism affects not all people who use ethanol. This is due to a hereditary predisposition, and, indeed, "family" alcoholism has long been known. A. Trout therefore wrote that children drunks expressed tendency to abuse alcohol. At the same time alcohol is not entirely genetically determenirovannym disease such as Down's syndrome. Hereditary predisposition becomes fertile ground for the development of disease in the presence of other external (environmental) factors. What are the interactions internal (endogenous) factors predisposing and external (exogenous) influence, hitherto not fully understood, so that the essence of alcoholism pathogenesis is not fully understood.

Development of organic psihosindroma in the long course of the disease, of course, contribute to vascular changes in the cerebral blood flow and liver disease, developing as a result of the toxic effect of alcohol degradation products. Liver disease affects the change of intracellular metabolism. Vascular and metabolic aspects of the pathogenesis of alcoholism, being combined, contribute to increasing the degenerative processes in neuronal structures and progression of alcoholism as exogenous-toxic process. This causes a variety of clinical pictures at different stages of the disease.

Withdrawal syndrome: treatment

To arrest the withdrawal syndrome, the treatment is carried out using means for detoxification and tranquilizers. Patients are assigned to intravenous drip gemodeza, reopoligmokina, 5% glucose solution.

Sedatives (seduksen, relium, phenazepam, bromazepam, etc.) Assign the first five or six days of treatment administration (every four hours) or parenterally 2-3 times a day. Doses are selected individually.

Specially appointed vitamins (B1 B6, B12, B15). It is believed that in the pathogenesis of psychiatric disorders in alcoholic psychosis and alcohol formation encephalopathy is vitamin B12 deficiency and pp.

Upon detection of hyperactivity of the sympathetic nervous system (sympathicotonia) shows the use of clonidine, pirroksan, beta-blockers (atenolol). It has been observed that the combination of beta-blockers, benzodiazepines can not only arrest the autonomic disorders, but also suppresses the craving for alcohol. In severe aac shown intramuscular magnesium sulfate.

As a rule, such a combination therapy suppresses alcohol withdrawal sindprom to the fourth-fifth day of treatment.

Successfully used as non-drug treatments withdrawal sondroma (ingestion sorbents SCM auvm, ACF), which shortens the aac one or two days. Sometimes use hyperbaric oxygenation (NM Yepifanova, 1989).

In the next stage of treatment there is formation of remission. The main therapeutic guidelines here is psychopathology. In the presence of depressive symptoms appointed antidepressants (mianserin lerivon, Paxil - SSRI). In the presence of psychogenic conditions prescribed teralen, neuleptil. Protracted asthenic conditions require the appointment of nootropics.

Delirium tremens: treatment

In Currently pathogenetic therapy of delirium (delirium tremens) provides for compliance with certain standards.

Necessary to monitor the value of a fluid and urine output; mandatory common blood and urine tests, blood chemistry (protein, sugar, residual nitrogen, urea, potassium, sodium, calcium, magnesium), hematocrit, ph blood, blood gases, ECG, medical consultation, ophthalmologist, neurologist.

Detoxification is performed with the use of drugs Trisol, hlosol isotonic glucose solution, Ringer's solution intravenously (drip) or sodium thiosulfate, calcium chloride, unitiola - 5.10 mL intramuscularly. Conducted and non-drug detoxification (enema, plasmapheresis, chelators). Mandatory appointment of B vitamins, ascorbic acid, nicotinic acid. Used nootropics, glucocorticoids (hydrocortisone, prednisone), anticonvulsants. For relief of excitation using intravenous administration reliya, seduksena 20-40 mg 2-3 times a day. Sodium hydroxybutyrate can be applied to achieve sedation, it is administered at 4.2 g was dissolved into 20 ml of 5% glucose solution, orally 3-4 times per day. Intravenously injected officinal 20% aqueous solution of 20-40 mL drip (slowly). Given the role etiopatogenicheskoy discontinuation of alcohol in the occurrence of delirium is also used for the purpose of arresting delirium popova mixture containing phenobarbital, wine alcohol - at night (200 mL).

When the patient's delirium tremens, neuroleptic treatment should be administered very carefully (haloperidol 0.5% - solution for intramuscular 2.0-3.0).

Recently, a method is proposed ksenonoterapii (tf. Khritinin b. Tsigankov etc., p. Well. Shamov, 2008) by giving xenon anesthesia that quickly relieves phenomena aac, primary and prevents the development of delirium Korsakov's psychosis, alcoholic encephalopathy.

Treatment of pathological craving.

The basis of this therapy is to develop an aversion to alcohol, securing the gag reflex to the smell, taste, appearance of alcoholic beverages. In addition, the aim is develop the reflex of fear before drinking alcohol.

Conditioned reflex therapy (urt) is used from the beginning of xx century (H.. Kantorovich, 1929). In the early stages of administration to patients suggested urt sniff spirits, this was combined with the impact of a weak electric current (electric shock in the arm). More effective was the method of alcohol intake on the background of emetics (apomorphine, emetine, Baranets broth, etc.). After several trials of this kind can be formed on the gag reflex kind of vodka, its smell, taste.

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