Alcoholic hallucinosis is a mental disorder caused by constant drinking. What is alcoholic hallucinosis and how to deal with it

Are you always sure that you see the true development of events? People can believe that objects and phenomena are presented to them in their true light. However, in psychology there is such a thing as hallucinosis. It comes in organic, alcoholic and spicy. Everyone has their own symptoms, causes and methods of treatment.

Hallucinosis involves hallucinations that a person sees and believes to be real. However, their difference is the presence of delirium. If hallucinations are an incorrect perception of the surrounding reality, then delusions are thoughts that can arise in a person based on what he perceives.

Alcoholic hallucinosis is common, since it is in people that they can hear sounds, see pictures, and experience sensations that are not really there. This is an abnormality that can progress if left untreated.

What is hallucinosis?

Speaking about hallucinosis, we should consider the question of what it is. Hallucinosis is a psychotic disorder that is accompanied by hallucinations and delusions. Hallucinatory syndrome is facilitated by fears, anxieties and worries. Visual hallucinations are common, although all others are not excluded.

A common cause of hallucinosis is alcoholism. It ranks second after delirium. Hallucinosis develops in the 10th year after the onset of alcoholism. More common in women than in men. It appears at night or in the evening, as well as when falling asleep.

A distinctive feature of hallucinatory syndrome is that a person sees, feels or hears non-existent phenomena while maintaining consciousness. That is why it seems to him that everything that happens is real and normal. Only other people can tell him that he is hallucinating.

The preservation of consciousness distinguishes hallucinosis from amentia, delirium and other darkened states in which hallucinations can also be observed.

Hallucinosis occurs in three forms:

Spicy. She is the brightest and most emotional.
Chronic. It is monotonous. A person may not pay attention to it.
Protracted.

Hallucinations and delusions can be combined, or they can be separate from each other. Hallucinations can cause delusions. However, not every delusion can be explained by the presence of hallucinations.

Alcoholic hallucinosis

The appearance of alcoholic hallucinosis is associated with long-term alcoholism. The average age of patients is 40-43 years. It can be acute, protracted and chronic. Often resembles alcoholic psychosis.

Symptoms of delirium delirium develop first. The appearance of hallucinations begins with the fact that a person hears voices. As long as they are not addressed to him, he may not pay attention to them. However, persecution by voices makes a person curious, dissatisfied, indignant, surprised, perplexed, and desire to find those who produce these voices. Then the state is replaced by fear, anxiety, expectations, melancholy and despair.

Alcoholic hallucinosis is usually accompanied by auditory hallucinations, which can be of a different nature. They may be accompanied by visual or tactile hallucinations, while being vivid and involving the person in themselves. The voices that the patient hears can comment on him, condemn him, threaten him, or order him to do something. Great importance is attached to human actions, which are commented on by voices. Especially if a person starts drinking, voices begin to condemn him.

On the other hand, voices may be heard justifying and defending the patient. All this forces him to take some action, for example, seek help from the police, doctors, or engage in self-defense. The patient may resort to suicide as a means of salvation. In rare cases, he becomes dangerous to others.

In hallucinatory syndrome, a person can talk to himself. He can be completely detached, and also be in such despair that he is thrown into a stupor. Often the consciousness becomes clouded, attention is upset, and partial pain occurs.

Organic hallucinosis

Sometimes hallucinosis is caused by damage to the brain. A person suffers not because of mental problems, but because of organic ones. In this case, hallucinations manifest themselves in a state of wakefulness, which helps to differentiate organic hallucinosis.

Factors that influence the occurrence of this type of hallucinatory syndrome are:

Alcohol. Often observed in alcoholics.
Drugs.
Medicines, such as hallucinogens.
Diseases of the heart and blood vessels.
Migraine.
Brain damage (aneurysm, abscess, neoplasm).
Diseases of the sensory organs (glaucoma, cataracts, etc.).

Auditory hallucinations are common in organic hallucinosis. However, visual and olfactory hallucinations cannot be ruled out. However, cognitive function is not impaired.

The duration of hallucinations depends on the reason for which they arose. If the diseases are curable, then they last no more than a few weeks. If the diseases are chronic, then hallucinations take on a similar character.

Treatment of organic hallucinosis occurs thanks to:

Taking medications: Triftazin, Haloperidol, Finlepsin, Carbamazepine, Depakine.
Carrying out therapeutic and diagnostic pneumoencephalography.
Carrying out resorption therapy.

Acute hallucinosis

Acute hallucinosis manifests itself in alcoholic hallucinatory delusions or insanity of drinkers. It is a consequence of hangover syndrome, anxiety, paranoia, and vegetative-somatic symptoms. It rarely appears in the last days of heavy drinking.

This condition can last from several weeks to one month. It manifests itself during falling asleep, as well as in the form of verbal hallucinations. After waking up, the hallucinations disappear immediately. The patient exhibits a low-anxious mood.

The following types of acute hallucinosis are distinguished separately:

Acute hallucinosis with delirium.
Acute abortive hallucinosis.
Acute hallucinosis combined with delirium.

This condition is considered reversible. It is preceded by fears, depression, anxiety, irritability.

Another form of hallucinosis is the chronic type. It is rare - lasts from a couple to tens of years. It rarely occurs with alcohol abuse. Chronic hallucinosis is preceded by isolated psychoses and hallucinations. If the visions do not go away after 6 months, then we are talking about a chronic form.

Chronic hallucinosis manifests itself primarily in verbal hallucinations. A person hears voices that conduct a meaningful dialogue and discuss the daily affairs, actions and thoughts of the patient. At first, a person may interfere in the conversation, trying to be indignant, challenge, or convince. But then addiction sets in, and the patient may even look quite healthy, not paying attention to the voices in his head.

Causes of hallucinosis

The main cause of hallucinosis is damage to parts (occipital, temporal, parietal) of the brain after suffering:

Injury
Encephalitis. Visual hallucinations are common
Epilepsy. Hallucinations occur before attacks in the form of bright, large-scale, mass pictures.
Malformations.
Vascular diseases of the central nervous system.
Schizophrenia. Typically, verbal hallucinations appear, which over time can be supplemented by visual and delusions. They are varied in structure.
Intoxication.
Symptomatic psychoses. Accompanied by delusions, verbal hallucinations and psychomotor activity.
Bipolar afferent disorder.
Problems with the thyroid gland.
Neurosyphilis.
Huntington's chorea.
Meningitis.

Alcoholic hallucinosis is a consequence of prolonged drinking. Drug abuse should also not be ruled out.

Symptoms of hallucinosis

Hallucinosis is determined by the symptoms that appear in one form or another. Organic hallucinosis is accompanied by auditory and visual hallucinations, in which clarity of consciousness is maintained. Tactile hallucinosis is accompanied by objectivity and localization. In epilepsy, hallucinosis is characterized by photopsia (geometric figures, circles), parosmia (unpleasant odors), acoasmas (humming, whistles).

First, the patient begins to hear sounds and noises, which gradually turn into voices. He does not evaluate them critically, but simply wants to find the source of their sound. Over time, the number of voices increases and they begin to condemn, threaten, and criticize the patient. All this manifests itself against a background of fear, confusion, and anxiety. Then voices may appear that defend the patient. An argument begins between them.

Usually the voices discuss the patient's past and present life, and also condemn him for drunkenness. They can speak both loudly and quietly, involving the patient in their dialogue. The patient experiences stupor, lethargy, and detachment. Delusional ideas begin (mania of persecution, accusations, physical destruction).

Symptoms worsen in the evening and at night. It is during this period that a person begins to be afraid of everyone, to be wary, and to accuse everyone of persecution. He can appeal to the prosecutor's office or engage in self-defense.

Treatment of hallucinosis

Hallucinosis has two directions in its treatment: basic and symptomatic. After identifying the cause of hallucinosis, doctors prescribe measures that will help in recovery. Usually it is enough to eliminate the cause of its occurrence so that the symptoms go away on their own.

Alcoholic hallucinosis is eliminated by giving up alcohol. When ethanol is removed from the human body, then its symptoms will go away on their own. As for organic hallucinosis, its elimination consists of treating the underlying disease.

Symptoms - anxiety and increased excitability - are removed by prescribing sedatives and antipsychotics (Azacyclonol). Acute hallucinosis usually resolves after one month. It is treated with ACTH (vitamins, insulin, adrenocorticotropic hormones, adrenal cortex extracts). Chronic hallucinosis is eliminated by conducting an insulin coma, taking antipsychotic drugs and electric shock.

The following are prescribed intravenously:

Seduxen.
Relanium.
Diazepam.
Aminazine intramuscularly.

An individual course of psychotherapy is prescribed.

Forecast

The prognosis for hallucinosis is good, although ambiguous. Some patients remain able to work, despite existing hallucinations and delusions.

You can't do without treatment. The condition is progressive, especially if the person continues to poison his body with psychotropic chemicals or gets sick. The causes should be eliminated so that the symptoms, which are hallucinations and delusions, go away on their own.

The outcome of the treatment is good - the person returns to normal life. The longer a patient does not receive help, the more difficult and lengthy his treatment becomes. This affects life expectancy. If it is not the disease that caused hallucinosis that leads to death, then the person himself can harm himself.

- a type of metal-alcohol psychosis that develops almost more often than delirium tremens.

The pathology is characterized by auditory hallucinations varying in intensity and degree of reality; as the condition worsens, delusions develop. Adequate perception of space and personality traits are preserved. There are independent attempts to end a life, and during an attack of aggression it is possible to cause harm to others.

Therapeutic measures are carried out only in a specialized clinic, under the supervision of doctors. The treatment regimen is selected individually, based on the patient’s physiological and mental indicators.

Diagnosis information

The ICD-10 code for alcoholic hallucinosis is F.10.5 - it is indicated in medical documents. Among metal-alcohol psychoses, this form is diagnosed most often - signs appear in 11% of people diagnosed with chronic alcoholism.

Good to know! The pathology manifests itself after forty years; in women, symptoms develop more often.

Features of the pathology:

lasts from two days to two years;
the main symptom is auditory hallucinations;
adequate perception of space and one’s own personality is preserved.

The main reason for the development of pathology– systematic, uncontrolled consumption of alcohol.

Often the disease develops acutely against the background of a hangover syndrome. The patient hears extraneous sounds, noise, knocking, and as the psychosis progresses, voices are added. Condemning statements, accusations, even threats are heard. Sometimes there are quiet voices of “lawyers”.

The patient constantly experiences fear, makes constant attempts to get rid of this condition - he travels long distances or contacts the police. In difficult situations, there are attempts to end a life prematurely. Alcoholic hallucinosis lasts for weeks and even months.

Important! The acute phase often recurs, and without qualified help it quickly transforms into a chronic phase. Characteristic signs - the patient regularly hears voices, clearly divides them into two groups - condemning and defending.

Causes

The disease in numbers:

many who suffer from alcoholism for more than ten years develop pathology;
pathology develops in 55% of people diagnosed with second stage alcohol dependence;
with alcohol dependence reaching the third stage, more than 45% of patients are at risk.

With this form of metal-alcohol psychosis, the patient exhibits low tolerance to alcohol. Research results confirm that pathology develops as a result of damage to brain tissue. At the same time, before hallucinosis, the patient experiences withdrawal symptoms more severely.

The main factor in the development of pathology– long-term and systematic use of alcoholic beverages. The intensity of the development of psychosis and its severity are determined by the following factors: the patient’s age, health status and lifestyle.

Conditions for the formation of alcoholic hallucinosis:

systematic use of alcohol for ten years or longer;
patients with the second and third stages of alcohol dependence are at risk;
constant withdrawal syndrome leads to damage to brain tissue, which in turn provokes the manifestation of hallucinosis;
tolerance (resistance) to alcohol - in order to feel the desired effect from drinking alcohol, a person has to constantly increase the dose, and accordingly, the likelihood of developing hallucinosis increases.

Classification

According to the form of the course, three forms of pathology are distinguished:

acute;
subacute;
chronic.

Each form has certain signs, symptoms and characteristics.

It appears suddenly, symptoms last from two days to several weeks. Provided timely treatment is provided to the patient, the signs of hallucinosis disappear and the condition improves.

Important! During the acute stage, the patient is confident that his feelings and thoughts are clear to everyone around him.

Hallucinosis in the acute stage has a certain classification:

classic shape– typical symptoms – auditory hallucinations, consciousness remains normal;
reduced form– extraneous voices are heard at the moment of falling asleep, at night, there is no delirium, a feeling of anxiety is characteristic;
atypical form- manifests itself in the form of fantastic images, the patient thinks he is doing something, saying something, but in reality the person is motionless, all thoughts and actions are perceived as hostile;
mixed form– in addition to auditory hallucinations, delirium is present, consciousness becomes confused, and orientation is disturbed.

Subacute form

There are these types:

with auditory hallucinations;
delusional disorder appears;
mood disturbance occurs.

Chronic alcoholic hallucinosis

Lasts from two months to two years. Develops in patients who:

do not receive adequate treatment;
continue to drink alcohol even during therapy.

Important! As a result of therapy, the patient's condition improves, but even a small dose of alcohol leads to relapse.

The chronic form is often accompanied by a delirious state. In this case, the patient worries about his life and the lives of his relatives; this behavior leads to emotional instability. The patient's mood changes dramatically at the slightest change in the usual environment. With this form of hallucinosis, the patient cannot adapt to new conditions.

Symptoms

The acute stage always begins abruptly, as a rule, a few days before the first signs of pathology the patient feels anxiety, tension, unreasonable fear. The disease is characterized by auditory hallucinations– voices scold, condemn, make threats. The patient hears voices from all objects in the house, surrounding people.

Sometimes there are optical illusions, but they are usually blurry, indistinct, but add unpleasant emotions to the patient. As a result of hallucinations, delusion develops; the person feels as if he is being persecuted, tortured, killed. The degree of anxiety during hallucinosis differs from the level of fear that the patient experiences in the event of a real threat.

Accordingly, a person tries in every possible way to protect himself from unpleasant feelings and emotions - he barricades himself indoors, leaves the city, hides away from home. In severe cases, there are suicide attempts, and during periods of aggression, injury to others is possible.

Often consciousness remains adequate and normal, a person behaves restrained and adequately, but the state changes dramatically and the reason may be the most insignificant.

Important! Relatives and friends are not able to influence the meaning of auditory and visual hallucinations and delusional states. Therefore, there is practically no chance of persuading the patient to seek medical help and undergo treatment.

At the chronic stage, there are no delusional states. Develop first vivid, real auditory and visual hallucinations, as the disease progresses, they become less intense and the person gets used to them. If a delusional state does appear, it can be corrected.

Treatment and prognosis

All therapeutic activities are carried out in a clinic (narcological dispensary) under the supervision of a narcologist.

Hospitalization is a prerequisite. Only in a specialized clinic can one restore the patient’s psyche and protect others from the patient’s aggression. The absolute indication for hospitalization is auditory hallucinations, which are of an orderly nature. A person is forcibly placed in a medical facility.

The patient is prescribed multi-stage treatment:

complete detoxification;
relief of symptoms of psychosis;
restoration of the functionality of internal organs;
preventing the manifestation of cognitive impairment.

The following drugs are used to cleanse the body:

"Reopoliglyukin";
"Hemodez";
saline;
saline solutions;
glucose solution.

A course of B vitamins, ascorbic acid, Inosine, and Cocarboxylase hydrochloride is prescribed to restore metabolism in brain cells. To protect brain tissue, Piracetam and Meldonium are prescribed.

To relieve the symptoms of this form of alcohol psychosis, a course of therapy is prescribed using the following drugs:

"Azacyclonol."
"Olanzapine."
"Haloperidol."
"Risperidone".

Medicines are administered parenterally, sometimes orally. The intensity of the positive dynamics depends on how long the hallucinosis has been developing.

Alcoholic hallucinosis is a verbal hallucinosis in persons with alcohol dependence, combined with delusional ideas of persecution.

What causes alcoholic hallucinosis?

Long-term course of the disease - alcoholic hallucinosis develops, as a rule, no earlier than 10-14 years of the existence of full-blown alcoholism; it is more often observed in women.
Long-term systematic alcohol intoxication.

Symptoms of alcoholic hallucinosis

Acute alcoholic hallucinosis manifests itself with affective disorders in the form of anxiety, restlessness, fear, and sleep disorders are often observed. Against this background, hallucinations appear in the form of individual sounds, noises, words and phrases. Usually, patients can clearly localize the source of sound (from the corridor, window, neighboring room, etc.). Hallucinations are accompanied by motor restlessness and an affect of bewilderment. Psychotic disorders often disappear after deep sleep, and affective disorders are also reduced.

With the further development of psychosis, multiple verbal hallucinations appear, and secondary delusions (relationships, influences, accusations, persecution or physical destruction) join them. Patients are extremely susceptible to attacks of fear and panic, and are extremely suspicious. Gradually, the patient begins to build delusions into a certain system - hallucinatory experiences are woven into real events (sometimes quite plausibly). After prescribing therapy, psychotic disorders, as a rule, are quickly reduced, criticism of the experience appears, but depressive and asthenic disorders may persist. At the same time, patients, as a rule, remember well their experiences and behavior in a state of psychosis.

Reduced acute alcoholic hallucinosis

Acute hypnagogic verbal hallucinosis

When falling asleep, acoasms or verbal hallucinations that are simple in form and neutral in content appear - individual words, singing, etc. After awakening, these disorders disappear. Affective disorders are represented by depressed-anxious mood. The duration of psychosis does not exceed several days. We should not forget: hypnagogic hallucinosis can be replaced by full-blown hallucinosis of a more complex structure.

Acute abortive hallucinosis

May be limited to simple verbal hallucinations of neutral content. As the psychopathological structure becomes more complex, hallucinations can become threatening, accusing, imperative, and addressed directly to the patient. Accordingly, a delusional concept is not formed, affective disorders arise in the form of anxiety, fear, behavior changes, motor arousal increases, and a critical attitude towards the experienced disorders disappears. The duration of such psychosis ranges from several hours to days. The output is critical. Sometimes abortive hallucinosis precedes full-blown hallucinatory psychoses.

Acute alcoholic hallucinosis (classic)

Acute alcoholic hallucinosis most often begins against the background of hangover disorders, accompanied by anxiety symptoms, paranoid mood, autonomic disorders, and in women - against the background of depressive disorders. However, sometimes hallucinosis develops after prolonged, daily drinking, accompanied by insomnia.

The symptom complex of acute alcoholic hallucinosis includes true auditory hallucinations, their delusional interpretation, and the affect of fear.

The onset of the disease is usually acute. For several weeks, there may be precursors in the form of restlessness, anxiety, depressed mood, dizziness, etc. Psychosis usually develops in the evening or at night. The patient is overcome by severe anxiety, he cannot sleep or wakes up in fear, sweating profusely after a short sleep. At first, auditory hallucinations are elementary - noise, ringing, crackling, rustling, whispering, screaming, individual simple words. Subsequently, they rapidly take on the character of a monologue, dialogue, and, in the final stage, polyvocal verbal hallucinosis in the form of successively replacing scenes connected by the unity of the theme. As a rule, the voices speak about the patient in the third person, but sometimes they directly address him. There are many voices, sometimes quiet, sometimes loud, reaching the point of roaring. They talk together, intertwining, arguing and swearing. The content of hallucinations is unpleasant for the patient. These are various threats, accusations, condemnation of the patient for past actions, especially for excessive drunkenness and the associated consequences. The voices consult, argue, discuss what to do with the patient and how to punish him. They can be not only accusatory, but also... protecting the patient. The patient, naturally, is a witness to such disputes, but sometimes becomes a participant in them. The topics discussed are always related to real events in the patient's present or past life. With an influx of hallucinatory experiences, short-term inhibition and detachment occurs, which can be classified as a phenomenon of hallucinatory substupor or stupor.

Delusional ideas are closely related in content to hallucinations, so they are fragmented, fragmentary and not systematized. With advanced hallucinosis, the affects of fear, anxiety, and despair prevail. The patient is always the master of events, his behavior corresponds to the content of hallucinations and delusions. In the first days, the patient, under the influence of delirium, does not see a way out of the situation, or when imperative voices prevail, we make suicidal attempts. Subsequently, when the affect of anxiety predominates, the patient begins to flee and develops motor agitation. Often patients in this state resort to desperate self-defense, barricading doors, boarding up windows, turning off communications, creating their own alarm system, etc. Such behavior of the patient is called “situation and one position.” Often in this state, patients begin to defend themselves, turning into aggressors, expecting invisible enemies, armed with sharp objects, bladed weapons or firearms. At the next stage, the patient turns from being pursued into a pursuer. This can lead to unforeseen consequences: he may attack random people in self-defense, since in this state he interprets everything around him in a threatening sense. The addition of delirious disorders (as a rule, at night, increases the frequency of various forms of abnormal behavior. However, in the future, the behavior of patients can become sufficiently ordered there, masking their ability to engage in socially dangerous actions.

Suggestibility in alcoholic hallucinosis, unlike delirium, is absent: it is impossible to convince the patient of his delusional interpretation of the situation or will instill in him other hallucinations.

Alcoholic hallucinosis occurs against the background of an unclouded consciousness, this is evidenced by an undisturbed orientation in one’s own personality and location; this significantly distinguishes it from delirium tremens. Only with a thorough clinical and psychopathological examination can one notice some stupor.

Patients retell the content of painful experiences quite accurately and in detail, external events are also not erased from their memory, patients reproduce them almost error-free consistently. Memory does not suffer in alcoholic hallucinosis. Confabulations are practically not observed.

Psychosis usually ends critically after prolonged deep sleep. With the lytic end of hallucinosis, the intensity of verbal hallucinations first decreases, then the affective charge disappears, and then delusional constructs fade. A critical attitude to the experience does not arise immediately; residual delusions are possible in men (depressive disorders occur more often in women). The duration of acute hallucinosis ranges from several days to 4 weeks.

Mixed acute alcoholic hallucinosis

Acute hallucinosis with severe delirium

The distinctive features of this psychosis are a combination of relatively poor, sparse verbal hallucinations of a predominantly threatening nature with pronounced delusions of persecution. Apart from the typical crazy statements. associated with the content of hallucinations, there are mediated delusional constructs that are not associated with hallucinatory disorders. Delusion in structure is sensual, figurative, this is evidenced by a symptom of confusion, an affect of intense anxiety and fear, an illusory perception of the environment, and isolated false recognitions. The reduction of mental disorders occurs gradually and consistently: affective disorders - “verbal hallucinations -” delusional disorders. Residual delirium is common.

Acute hallucinosis combined with delirium

Delirious disorders occur at any stage of the development of hallucinosis. They usually join at night. In the initial period and at the end of hallucinosis, these are isolated episodes, and at the height of the development of hallucinatory psychosis, full-blown symptoms of delirium can be observed. Rarely do patterns of delirium become predominant; more often, verbal hallucinosis remains the core disorder. Patients experience influxes of visual hallucinations, and tactile and thermal hallucinations may appear. The effect of fear alternates with euphoria. With such psychosis, fragmentary symptoms of occupational delirium may occur. Reduction of psychopathological disorders begins with the disappearance of symptoms of confusion, further development is similar to acute hallucinosis. The output is usually critical.

Atypical acute alcoholic hallucinosis

In the atypical course of acute alcoholic hallucinosis, the clinical picture shows a combination of the symptoms of hallucinosis itself with oneiric clouding of consciousness, mental automatisms or depressive symptoms.

Acute hallucinosis with oneiric stupefaction

Oneiric disorders in hallucinosis occur more often than in delirium, and are formed at the height of hallucinosis. The development of this form of psychosis is limited to the stage of oriented oneiroid. Compared to oneiric disorders that occur with delirium, patients report predominantly scenes of fantastic content, representing various world cataclysms, star wars, interplanetary flights, etc., however, these themes remain plot-incomplete, fragmented, as in a restless dream; often “fantasy” experiences are combined with scenes of drunkenness.

The onset of hallucinosis is classic, then polyvocal verbal scene-like hallucinosis joins: the patient has a pronounced affect of fear, he is in a substupor. Next, figurative delirium arises with an illusory perception of the environment; at night, visual pseudohallucinosis may develop, reflecting the content of verbal hallucinations. Reduction of psychosis begins with oneiric disorders, verbal hallucinosis disappears at the end.

Acute hallucinosis with stuporous disorders (alcoholic stupor)

The development of alcoholic stupor or substupor is indicated by motor disorders joining alcoholic hallucinosis. As a rule, at the height of hallucinosis, the patient’s immobility, his detachment from the world around him, and his workload are observed. There is no negativism. Retardation may be replaced by excitement or alternate with it. The duration of the above-described disorders ranges from several minutes to several hours.

Acute hallucinosis with mental automatisms

Similar to other, atypically occurring forms of psychosis, mental automatisms appear at the height of its development, with the formation of polyvocal hallucinosis. They always intensify and become more complex simultaneously with the intensification of verbal hallucinosis, mainly in the evening and at night. Most often, ideational automatisms are observed - a feeling of openness and anticipation of thought, forcibly arising thoughts, mentism. the phenomenon of external influence (“unwinding” of memories). It is noteworthy that the symptom of echo thoughts, as a rule, is not recorded. The development of mental automatisms in the structure of hallucinosis is always accompanied by an expansion of the content of delusional statements and the emergence of a tendency towards their systematization. With automatisms, delirious and oneiric disorders may occur. When recovering from psychosis, mental automatisms are the first to be reduced.

Subacute (protracted) alcoholic hallucinosis (F10.75)

Subacute include hallucinosis that lasts from 1 to 6 months. The most common duration of such psychosis is 2-3 months.

The onset of psychosis almost completely coincides with that of acute alcoholic hallucinosis; differences arise later and are usually associated with the addition of severe delusional or depressive disorders to hallucinations. There are frequent cases of verbal hallucinations that cannot be reduced and determine the further clinical picture. Based on the predominance of certain disorders in the clinical picture (verbal hallucinations, depressive disorders or delusions), affected alcoholic hallucinosis is conventionally divided into three variants.

Subacute alcoholic hallucinosis with predominance of verbal hallucinations

Seen relatively rarely. In the clinical picture, after the reduction of affective disorders and delusions, verbal hallucinations come to the fore. The behavior of patients is orderly, and the performance of daily and even professional duties is often preserved. As a rule, the patient is aware of the presence of the disease.

Subacute alcoholic hallucinosis with predominant depressive affect

At the height of the development of hallucinosis, a transformation of motor and affective disorders occurs. The clinical picture begins to be dominated by low mood, depression, and severe melancholy. The intensity of depressive disorders, including depressive delusions, is increasing. Ideas of self-accusation arise, gradually beginning to prevail over other delusional statements. The reduction of psychosis is gradual, starting with affective disorders.

Subacute alcoholic hallucinosis with predominant delirium

As a rule, at the height of development of verbal hallucinosis, a gradual reduction of sensory disorders occurs. Ideas of relation and persecution begin to dominate the clinical picture. The affect of anxiety and fear is constant and intense. Patients have a pronounced symptom of adaptation disorder, an increase in psychotic symptoms when the environment changes. Reduction of psychosis begins with the leveling of affective disorders, delirium disappears last.

Chronic alcoholic hallucinosis

Chronic alcoholic hallucinosis is a relatively rare disease. Psychosis can begin as acute alcoholic hallucinosis, less often as delirium delirium. However, according to some authors, chronic alcoholic hallucinosis immediately begins with the development of complex conditions, with the simultaneous presence of symptoms of delirium and hallucinosis, or hallucinosis is combined with depressive-paranoid disorders.

The acute stage of chronic hallucinosis is characterized by extraordinary brightness of visual and auditory hallucinations. The stage lasts 1-2 weeks.

Depending on the prevailing clinical picture, the following types of chronic alcoholic hallucinosis are distinguished.

Chronic verbal hallucinosis without delusions

The most common form of chronic alcoholic hallucinosis. In the prodromal stage, anxiety, severe restlessness, and sleep disturbance are significantly expressed. While falling asleep, patients hear that someone is creeping up on them, trying to grab them, etc., in fear they jump up and scream. Soon, abundant auditory hallucinations appear. Their content is unpleasant, threatening, and may include commentary or antagonistic hallucinations. In the acute period, auditory hallucinations are characterized by a bright emotional coloring, as a result of which patients perceive them as reality. In the background are visual hallucinations (insects, small animals, unreal creatures, various shadows, etc.). In the acute period, kinesthetic, tactile, and bodily hallucinations may occur. Against the background of hallucinatory disorders, delusions of persecution or relationship are formed. Consciousness, similar to other types of hallucinosis, is not impaired, but at the height of the development of psychosis it becomes not entirely clear. After 7-10 days, the fear in patients decreases; of the entire spectrum of disorders, only auditory hallucinations remain, which are less threatening than before. Subsequently, patients begin to get used to them. At the same time, external forms of behavior are normalized, patients can carry out everyday activities, and are able to engage in professional activities. No noticeable changes in memory for the past are noted; memory for current events suffers slightly. Over time, alcoholic hallucinosis loses intensity. Hallucinations can acquire the character of simple ones, sometimes they disappear completely, appearing only with external stimuli (so-called reflex hallucinations). Consciousness of the disease appears in the acute period and persists throughout the painful disorders. When alcohol consumption is resumed, the previous symptoms of hallucinosis reappear and worsen. This form of chronic hallucinosis is stationary and does not progress. Sometimes it lasts for many years without leading to dementia or decline in personality.

Chronic verbal alcoholic hallucinosis with delusions

In this case, a characteristic hallucinatory syndrome accompanies delusions of a peculiar nature. Unlike the usual one, it lends itself to a certain correction and is not of an absurd nature. More often, such patients are diagnosed with delusions of persecution, which are stereotypical in nature (the patient expresses delusional ideas in the same formulations); Delusional ideas do not become more complex over time. Under the influence of alcoholic excesses, naturally, periodic exacerbation of painful phenomena occurs. In terms of intellectual integrity, this form of chronic alcoholic hallucinosis does not differ from the first option.

Chronic verbal hallucinosis with mental automatisms and paraphrenic changes in delirium

It is considered the rarest form of chronic hallucinosis. Core disorder is true verbal hallucinosis. Over time, first episodic and then quite persistent phenomena of mental automatisms appear. As a rule, these are ideational automatisms in the form of auditory pseudohallucinations, openness of thoughts, anticipatory thoughts, mentism; highlight individual impact ideas. With the further course of psychosis, a change in the content of auditory hallucinations and pseudohallucinations is observed, and megalomanic delusions are formed. Patients talk about their unusual, special position, but not in the present, but in the future (he will be fabulously rich, will receive a high position, will be awarded for his services, etc.); very often the content of delirium has a tinge of puerilism and childishness. Labile affect predominates, euphoria is easily replaced by irritability. This variant of psychosis is characterized by sufficient intellectual preservation, but organic decline slowly increases.

In the treatment of acute alcoholic hallucinosis and delusional psychoses, psychopharmacotherapy occupies the main place. The drugs of choice are antipsychotics with a predominantly antipsychotic effect [for example, haloperidol 5-10 mg 2-3 times a day or risperidone (Rispolept) 4-6 mg/day], in case of severe affective disorders benzodiazepine drugs are additionally prescribed (0. 1% solution of phenazepam 2-4 ml intramuscularly or intravenously, lorazepam 2.5 mg, maximum dose - 15 mg/day). Nootropic drugs, vitamins are also used, and symptomatic treatment is carried out.

Treatment of acute hallucinosis and delusional psychoses


Acute alcoholic hallucinosis and delusional psychoses	Neuroleptics with a predominantly antipsychotic effect [for example, haloperidol 5-10 mg 2-3 times a day or risperidone (Rispolept) 4-6 mg/day]
	Therapy aimed at relieving affective disorders: 0.5% solution of diazepam (Relanium) 2-4 ml intramuscularly or intravenously drip up to 0.06 g/day; or 0.1% solution of phenazepam 1-4 ml intramuscularly or intravenously drip, up to 0.01 g/day
	Vitamin therapy: 5% solution of thiamine (vitamin B1) 4 ml intramuscularly; 5% solution of pyridoxine (vitamin B6) 4 ml intramuscularly; 1% solution of nicotinic acid (vitamin PP) 2 ml intramuscularly; 5% solution of ascorbic acid (vitamin C) 5 ml intravenously; 0.01% solution of cyanocobalamin (vitamin B12) 2 ml intramuscularly
	Neurometabolic therapy: picamilon 0.05 g 3 times a day; aminophenylbutyric acid (phenibut) 0.25 g 3 times a day
	Hepatoprotectors: ademetionine 400 mg 1-2 times a day, thioctic acid 600 mg 1 time a day Symptomatic treatment of somatic complications

Treatment of chronic alcoholic psychoses (F10.6*, F10.7**)

For prolonged and chronic hallucinosis and paranoid symptoms (F10.75*), antipsychotics are mainly used: haloperidol and other drugs of the butyrophenone, phenothiazine series or atypical antipsychotics (sometimes in combination). Prescribe haloperidol 10-20 mg/day, perphenazine 8-20 mg/day, risperidone 4-6 mg/day, quetiapine 300-600 mg/day, olanzapine 5-10 mg/day. If the patient has alcoholic delusions of jealousy, griftazine 5-15 mg/day or haloperidol 10-30 mg/day are indicated. Various neurometabolic agents (long courses), amino acid preparations and multivitamins are also used. For anxiety disorders, hydroxyzine is used but 25-75 mg/day.

For chronic encephalopathies (F10.73*) and Korsakon psychosis (F10.6*), long-term treatment with nootropic drugs, amino acids (methionine 2 g/day, glutamic acid 1.5 g/day, glycine 0.05 g) is necessary /day), drugs that improve metabolism and blood circulation in the brain (instenon, pentoxifylline, inosine, etc.), multivitamins.

Treatment of chronic alcoholic psychoses


Protracted and chronic alcoholic psychoses	For symptoms of psychosis, antipsychotics are prescribed; the drugs of choice for long-term therapy are atypical antipsychotics: quetiapine 150-600 mg/day; olanzapine 5-10 mg/day. If it is impossible to use these drugs or if they are ineffective, haloperidol 10-20 mg/day is indicated; perphenazine 8-20 mg/day; risperidone 4-6 mg/day; triftazine 5-15 mg/day
	For affective disorders of the anxiety circle, use hydroxyzine 25-75 mg/day
	Neurometabolic therapy: picamilon 0.05 g 3 times a day; aminophenylbutyric acid 0.25 g 3 times a day.
	Vascular agents: instenon 1 tablet 3 times a day; cinnarizine 25 mg 2-3 times a day
	Multivitamin preparations: Aerovit, Complivit, Glutamevit, Centrum 1 tablet/day
	Hyperbaric oxygen therapy course
	Symptomatic treatment of somatic and neurological diseases

Alcoholic hallucinosis must be understood as a disease that is characterized by mental disorders as a result of excessive consumption of alcoholic beverages on a regular basis. This pathological condition is considered one of the most common psychoses that manifest themselves against the background of alcoholism. Quite often, the symptoms of alcoholic hallucinosis begin to manifest themselves during a severe hangover, less often during a binge. The disease requires drug therapy, which will depend on the characteristics of the pathological condition.

As already noted, alcoholic hallucinosis is a psychosis that develops as a result of constant and long-term consumption of alcohol-containing drinks. Its main characterizing symptoms will be auditory hallucinations, while the patient will be conscious, understand who he is and orient himself in time and space.

In most cases, hallucinations are accompanied by feelings of persecution, fear, anxiety and panic attacks. When all these symptoms worsen, an alcoholic may try to commit suicide and injure others, thus protecting himself from an imaginary danger.

As for the causes of this disease, it is long-term and regular use of alcohol (after all, delirium, strange sounds and voices appear after about 12 years of drinking). According to observational data, cases of the disease are most often observed in women aged 40 to 43 years.

Alcoholic hallucinosis is classified according to two main criteria:

the course of the disease;
symptoms.

Depending on the course of hallucinosis, there are:

spicy;
subacute;
chronic.

Depending on the clinical picture, hallucinosis can be:

classic;
abbreviated;
mixed character;
atypical;
reduced acute.

Hallucinosis of this type is considered the mildest; its manifestations occur during a severe hangover. It manifests itself as confusion, groundless anxiety, which transforms into a feeling of fear, even horror.

The appearance of these sensations usually appears before going to bed or at night. First, the patient begins to hear simple noise (shots, roar, ringing); in rare cases, individual words, phrases and even songs can be heard.

In most cases, the patient understands the nature and cause of these sounds, but he is still haunted by a feeling of fear and surprise. To eliminate the manifestations of this pathological condition, it will be enough to get a good night's sleep.

Acute abortifacient

The first symptoms of this pathological condition will be mood disorders. The patient will be somewhat depressed, sad, and over time a feeling of fear and psychomotor agitation will develop.

These sensations are replaced by symptoms that manifest themselves in the form of auditory hallucinations. The alcoholic begins to hear sounds, but he does not pay attention to them. After this, he begins to hear voices, as if someone:

talks to him;
characterizes his actions;
blames for some problems;
threatens or demands something.

The duration of this pathological condition can be several days. It is necessary to take into account that in the absence of adequate treatment, the pathology can turn into alcoholic psychosis.

Classic hallucinosis is manifested by a hangover, which is accompanied by anxious thoughts and depression. The cause of psychosis can also be prolonged binge drinking in combination with insomnia. It begins with feelings of anxiety, sadness and panic, and over time they are joined by delusional thoughts and auditory hallucinations.

As for hearing deceptions, they most often manifest themselves in the evening or at night. At first they take the form of sounds, which alternate with monologues and dialogues (the voices can argue with each other).

After this, the alcoholic begins to be bothered by delusions of persecution and accusations. Moreover, all the patient’s delusions are associated with deception of hearing. It should be noted that such delirium does not bother the patient constantly, but from time to time. The duration of such an attack can last from several days to a month; its manifestations disappear after a healthy sleep.

Acute hallucinosis of mixed nature

Hallucinosis of a mixed nature, occurring in an acute form, is divided into:

Hallucinosis, which is accompanied by intense delirium. It is characterized by a combination of auditory deception and delusions of persecution. Its formation will be evidenced by the patient’s depression, anxiety and sense of fear.

Over time, the alcoholic will listen to sounds and voices that appear in parallel with obsessive delusional thoughts. In the typical course of this pathological condition, hallucinations and delusions are combined into a feeling of persecution.

Hallucinosis, which is associated with delirium. The manifestations of this type of psychosis are accompanied by symptoms of delirium tremens in the form of panic attacks, sleep disorders, autonomic disorders (tremors, rapid heartbeat, hypertension), hallucinations (in the form of sounds, pictures and even touches) and delusions. These manifestations can appear unexpectedly, at any stage of the disease and at any time of the day (but still more often at night). Please note that the main symptoms of this hallucinosis are auditory hallucinations.

This group includes hallucinosis with:

Oneiric eclipse of consciousness. They are characterized by a mental disorder, which is accompanied by a combination in the patient’s mind of real events and fabulous ones. A person loses orientation in time and space and feels like a hero of fabulous, imaginary events. The alcoholic mentally participates in saving the world, traveling between galaxies and fighting imaginary creatures.
Stuporous disorders. It should immediately be noted that this form of hallucinosis is rarely diagnosed. Manifestations of stupor do not appear immediately, but only at the peak of exacerbation of psychosis. An attack can occur at any time of the day and in any place. It is characterized by the fact that the patient freezes in place and does not react to surrounding people and events. In some cases, a combination of stupor with oneiric eclipse of consciousness may be observed. The duration of this state can vary from several minutes to several hours, and even longer.
Mental automatism. It is characterized by the patient’s feeling that his thoughts and experiences are controlled spontaneously by some unearthly forms of existence. It seems to an alcoholic that the people around him know about his thoughts and feelings. This syndrome appears at the peak of hallucinosis. It may be combined with delirium tremens and oneiroid. An increase in these pathological sensations is observed in the evening and at night.

Subacute hallucinosis

Subacute hallucinosis includes mental disorders lasting from 1 to 6 months. They are characterized by the typical onset of acute hallucinogenic psychosis and the subsequent addition of auditory hallucinations and other syndromes. Hallucinosis is distinguished:

With the addition of verbal hallucinations. The onset of the disease is accompanied by affective disorders with the addition of delirium and voices. A characteristic feature of this condition is that anxiety and delirium almost do not appear over time, only verbal deceptions of hearing remain. The patient is quite adequate, carries out his daily activities and even goes to work, while he is clearly aware of the presence of the disease.
With dominance of depression. In this condition, anxiety manifests itself quite intensely, the patient is in a depressed state, and is in a bad mood. Delusion appears in the form of self-accusation.
With dominance of manifestations of delirium. We can talk about this pathological condition if the patient, at the peak of hallucinogenesis, experiences a deterioration in mood, the appearance of delusional ideas and fear of physical violence against him. In most cases, delusions of persecution and relationships are observed. All of the listed symptoms are also accompanied by adaptation disorder, which manifests itself in the form of an inadequate reaction to the slightest change in the situation.

Chronic hallucinosis

Chronic hallucinosis is much less common than acute hallucinosis. Their onset is practically no different from a regular acute one, but the duration of such conditions can drag on for several years. Highlight:

Chronic alcoholic hallucinosis without manifestations of delirium. It is considered the most common and is characterized by oppression and unreasonable anxiety. Over time, the sensation of extraneous sounds and conversations begins to appear, which are expressed so clearly that the patient perceives them as reality. After this, visual hallucinations may also occur; the patient begins to see insects, animals and shadows that frighten him. Quite often this pathological condition is accompanied by persecution mania. After 7-14 days, all acute symptoms subside, only verbal hallucinations remain present. Over time, a person perceives them as normal and returns to his usual rhythm of life. Sounds and voices rarely bother him; their appearance is usually accompanied by external stimuli. But the first time you drink alcohol, all the symptoms of acute hallucinosis may return.
Chronic hallucinosis with delusions. This pathological condition is characterized by a standard clinical picture of hallucinogenic psychosis with the addition of persecutory mania. The patient says the same thing in different words. Over time, all the symptoms of the disease subside, so we can say that this pathology is quite similar to the previous one.

Treatment

For therapy to be effective, it is first necessary to establish the form of hallucinosis and make the correct diagnosis. Treatment is usually inpatient; in parallel with drug therapy, the patient is also prescribed treatment by a psychotherapist. This is explained by the fact that only in case of complete recovery from alcoholism will relapses of hallucinosis not appear.

In order to treat acute alcoholic hallucinosis, antipsychotics (Olanzapine, Quetiapine) and vitamins B, C and PP are used. At the same time, treatment of psychological and neurological disorders should be carried out.

To treat the chronic form of the disease, neuroleptic drugs that have an antipsychotic effect (Haloperidol, Risperidone) are used; in some cases, insulin therapy may be additionally administered.

Regardless of the form of the disease, the patient is prescribed:

drugs that help eliminate mood disorders (Diazepam, Phenazepam);
hepatoprotectors;
vascular agents (Cinnarizine);
drugs whose action is aimed at eliminating metabolic disorders (Phenibut, Picamilon).

– the second most common metal-alcohol psychosis after delirium tremens. It can occur acutely, subacutely or chronically. Auditory hallucinations usually predominate, and delusions develop in most cases. Unlike alcoholic delirium, orientation in the surrounding world and one’s own personality is preserved. Consciousness is not impaired. At the height of hallucinations and delusional disorders, suicide attempts and harm to others are possible. Treatment is inpatient, using antipsychotics, sedatives, vitamins, drugs to improve metabolism in the brain and drugs to correct somatic disorders.

General information

Alcoholic hallucinosis is one of the most common metal-alcohol psychoses. Develops in 5-11% of patients suffering from chronic alcoholism. Usually occurs over the age of 40 years against the background of constant long-term alcohol consumption. Women are affected more often than men. Depending on the form, it can last from several days to a year or more. The main difference from alcoholic delirium is the predominance of auditory hallucinations, as well as the preservation of orientation in the environment and one’s own personality.

Auditory hallucinations are perceived as absolutely real voices that scold the patient or threaten to cause him serious harm (mutilate, kill, rape). Against the background of these voices, a patient with alcoholic hallucinosis can hear the cries of children or a wife begging for help. All of the above contributes to the formation of delusions of persecution, the emergence of severe anxiety and fear. The patient may begin to defend himself against non-existent enemies. Socially dangerous actions, harm to loved ones and suicide attempts are possible. Urgent hospitalization is required under the supervision of specialists in the field of addiction and psychiatry.

Causes of development and classification of alcoholic hallucinosis

The cause of the development of alcoholic hallucinosis is prolonged systematic consumption of large doses of alcohol. As a rule, the disease occurs in patients with an experience of chronic alcoholism of 10-15 years or more. In 54% of patients, the second stage of alcohol dependence is diagnosed, in 46% - the third. All patients have neurological pathology. With this type of psychosis, lower tolerance to alcohol is observed than with delirium tremens. There are studies confirming that hallucinosis develops against the background of alcoholic encephalopathy with damage to the hypothalamus. Pathological changes in the brain are aggravated due to withdrawal syndrome. It is noted that before psychosis, withdrawal in many patients is more severe than usual.

There are acute, subacute and chronic alcoholic hallucinosis. Taking into account the characteristics of the course and the prevailing symptoms, the following are distinguished:

Classic or typical hallucinosis– accompanied by multiple true auditory hallucinations. Delusions are interpretations of hallucinations. Patients experience marked fear.
Reduced hallucinoses– auditory hallucinations are hypnagogic (occur at the moment of falling asleep) or simple, fragmentary. The delusional concept, as a rule, is not formed or is not sufficiently formed. Affective disorders in the form of anxiety, depression and fear are observed.
Atypical hallucinoses– against the background of auditory hallucinations, uncharacteristic disorders arise: clouding of consciousness, stupor, mental automatisms, etc. Affective disorders may predominate.
Mixed hallucinosis– there is a combination of hallucinosis with other mental disorders (for example, delirium or delusions not associated with auditory hallucinations).

Symptoms of alcoholic hallucinosis

Typical acute alcoholic hallucinosis begins suddenly. Within a few days before the first symptoms of the disease appear, precursors may be observed in the form of increased anxiety, fear, mistrust and internal tension. Typical auditory hallucinations predominate. The patient hears voices that say something unflattering about him, condemn, scold or threaten. It may seem to the patient that these voices come from walls, objects, surrounding people, or from somewhere outside.

Sometimes auditory hallucinations are supplemented by visual illusions, which are never as vivid and believable as in delirium delirium, but have their negative effect, complementing the picture of “what is happening” in the patient’s creation. Against the background of hallucinations, delusional ideas are formed (usually relationships or persecution). The patient may believe that someone is going to subject him to painful torture, beat him to death, brutally kill him and his immediate family, etc.

The level of anxiety and fear in a patient suffering from alcoholic hallucinosis is similar to the level of anxiety and fear that an ordinary person experiences when faced with an immediate, real threat to his own life. Patients try to somehow protect themselves from “danger”: they barricade themselves in a room, run away from the city, hide in garages or dachas, etc. If delirious stupefaction occurs (observed in 10% of patients), a suicide attempt or desperate defense with serious harm to others.

In other cases, orientation in the surrounding world is preserved, patients behave quite restrained, but this does not give reason to assess the situation as safe, since their condition can change at any moment. In addition, with alcoholic hallucinosis, unlike alcoholic delirium, other people cannot in any way influence the content of the patients’ delusions, therefore, in the event of aggression, relatives or emergency doctors are deprived of the opportunity to persuade patients and find some acceptable explanation for the need to “peacefully” get medical assistance.

Acute abortive hallucinosis differs from classical hallucinations by weakly expressed, few hallucinations. Delusional ideas are not formed. Recovery from psychosis occurs acutely a few days after the onset of the illness. In chronic hallucinosis, delusions are usually absent. At first, threatening, disturbing auditory hallucinations (often in combination with visual ones) appear acutely. Subsequently, the intensity of hallucinations decreases and patients get used to them. If delirium does occur, it is less absurd and is more amenable to correction.

Treatment and prognosis for alcoholic hallucinosis

Treatment is carried out by a narcologist in a narcological hospital. The treatment plan includes intensive detoxification, elimination of psychotic phenomena, normalization of metabolism, restoration of the functions of organs and systems, as well as prevention of the development of persistent cognitive impairment. In the detoxification process, rheopolyglucin, hemodez and saline solutions are used. Patients are prescribed B vitamins, cocarboxylase, inosine and ascorbic acid. Piracetam, ethylmethylhydroxypyridine and meldonium are used to prevent brain disorders. Drugs for the correction of somatic pathology are selected taking into account the disorders identified in a particular patient.

To relieve psychotic phenomena in acute hallucinosis, azacyclonol, haloperidol, olanzapine, risperidone, etc. are used. Medicines are usually administered parenterally, less often orally. The rate at which hallucinations disappear directly depends on how long ago the psychosis began. The earlier treatment is started, the faster psychotic symptoms are relieved. For chronic hallucinosis, neuroleptics, electric shock and insulin coma are used. In all cases, a prerequisite for successful treatment is complete abstinence from alcohol.

The prognosis for acute hallucinosis is favorable. Typically, hallucinations last from several days to 1 month, and then end abruptly after deep sleep. Less commonly, gradual fading of symptoms is observed. Residual delirium may persist for some time, and depression sometimes develops (more often in women). There is no intellectual decline. In chronic hallucinosis, cessation of alcohol consumption causes a decrease or disappearance of hallucinations. Subsequently, hallucinations can occur only at critical moments (during extreme fatigue, high levels of stress, etc.). Drinking alcohol provokes an exacerbation of the symptoms of hallucinosis. Even with a long course, intellectual preservation is usually observed.