Alcoholic hallucinosis is a mental disorder resulting from the constant use of alcohol. 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 appear to them in their true light. However, in psychology there is such a thing as hallucinosis. It is organic, alcoholic and spicy. Each has its own symptoms, causes and treatments.

Hallucinosis includes hallucinations that a person sees, believing them 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 a person can have based on what he perceives.

Alcoholic hallucinosis is common, because it is in people who can hear sounds, see pictures, experience sensations that are not really there. This is a deviation from the norm, which can progress if not treated.

What is hallucinosis?

Speaking of hallucinosis, you should consider what it is. Hallucinosis is a psychotic disorder that is accompanied by hallucinations and delusions. The hallucinatory syndrome is promoted by fears, anxieties and anxieties. Visual hallucinations are common, although all others are not excluded.

A common cause of hallucinosis is alcoholism. It takes second place after delirium. Hallucinosis develops in the 10th year after the onset of alcoholism. It is 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 the 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.

Preservation of consciousness distinguishes hallucinosis from amentia, delirium and other clouded conditions, in which hallucinations can also be observed.

Hallucinosis occurs in three forms:

Acute. She is the brightest and most emotional.
Chronic. She 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 is acute, protracted and chronic. Often resembles alcoholic psychosis.

First, symptoms of alcoholic delirium develop. The appearance of hallucinations begins when 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, wishing to find those who produce these voices. Further, 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 can be accompanied by visual or tactile hallucinations, while being bright and involving a 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 the actions of a person, which are commented on by voices. Especially if a person starts drinking, the voices begin to condemn him.

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

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

organic hallucinosis

Sometimes the causes of hallucinosis are damage to the brain. A person suffers not because of mental problems, but because of organic ones. In this case, hallucinations appear in the waking state, which helps to differentiate organic hallucinosis.

The factors that influence the occurrence of this type of hallucinatory syndrome are:

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

Auditory hallucinations are common in organic hallucinosis. However, visual and olfactory hallucinations are not excluded. At the same time, cognitive function is not impaired.

The duration of hallucinations depends on what caused them. If diseases are curable, then they last no more than a few weeks. If the diseases are chronic, then hallucinations acquire a similar character.

Treatment of organic hallucinosis is due to:

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

Acute hallucinosis

Acute hallucinosis is manifested in alcoholic hallucinatory delirium or insanity of drinking people. It is a consequence of a hangover syndrome, anxiety, paranoia, vegetative-somatic symptoms. It rarely appears in the last days of binge 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, hallucinations disappear immediately. The patient exhibits a low-anxious mood.

Separately, these types of acute hallucinosis are distinguished:

Acute hallucinosis with delirium.
Acute abortive hallucinosis.
Acute hallucinosis associated with delirium.

This state 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 decades. 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 the chronic form.

Chronic hallucinosis manifests itself mainly in verbal hallucinations. A person hears voices that lead a meaningful dialogue and discuss the daily affairs, actions and thoughts of the patient. At first, a person can interfere in the conversation, trying to be indignant, to challenge, to 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 reason for the appearance of hallucinosis is damage to the departments (occipital, temporal, parietal) of the brain after transferring:

Trauma
Encephalitis. Visual hallucinations are common
epilepsy. Hallucinations occur before attacks in the form of bright, large-scale, massive pictures.
Malformations.
Vascular diseases of the CNS.
Schizophrenia. Verbal hallucinations usually appear, which over time can be supplemented by visual and delusions. They are varied in structure.
Intoxication.
symptomatic psychoses. Accompanied by delirium, verbal hallucinations and psychomotor activity.
Bipolar afferent disorder.
Malfunctions of the thyroid gland.
Neurosyphilis.
Chorea of Huntington.
meningitis.

Alcoholic hallucinosis is a consequence of prolonged use of alcoholic beverages. Also, drug abuse should 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 the clarity of consciousness is maintained. Tactile hallucinosis is accompanied by objectivity and localization. In epilepsy, hallucinosis is characterized by photopsias (geometric figures, circles), parosmia (unpleasant odors), acoasma (humming, whistles).

At first, the patient begins to hear sounds and noises, which gradually turn into voices. He does not critically evaluate them, but simply wants to find the source of their sound. Over time, there are more and more voices, they begin to condemn, threaten, criticize the patient. All this is manifested against a background of fear, confusion, anxiety. Then there may be voices that defend the patient. An argument starts between them.

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

The symptoms worsen in the evening and at night. It is during this period that a person begins to be afraid of everyone, beware, accuse of persecution. He can apply 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 the cure. 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 avoiding alcohol. When ethanol is eliminated from the human body, then its symptoms will go away on their own. As for organic hallucinosis, its elimination lies in the treatment of the underlying disease.

Symptoms - anxiety and irritability - are removed by prescribing sedatives, neuroleptics (Azacyclonol). Acute hallucinosis usually stops after one month. It is treated with ACTH (vitamins, insulin, adrenocorticotropic hormones, adrenal cortex extracts). Chronic hallucinosis is eliminated by holding an insulin coma, taking neuroleptic drugs and electroshock.

Intravenously administered:

Seduxen.
Relanium.
diazepam.
Aminazine intramuscularly.

An individual course of psychotherapy is prescribed.

Forecast

The prognosis for hallucinosis is good, although mixed. Some patients remain able to work, despite the presence of hallucinations and delusions.

Not without treatment. The condition is progressive, especially if the person continues to poison their body with psychotropic chemicals or becomes ill. The causes must be eliminated so that the symptoms, which are hallucinations and delusions, go away on their own.

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

- a kind of metal-alcohol psychosis, develops almost more often than delirium tremens.

The pathology is characterized by auditory hallucinations of different intensity and degree of reality, as the condition worsens, delirium develops. An adequate perception of space, signs of personality are preserved. There are independent attempts to end life, during an attack of aggression, harm to others is possible.

Therapeutic measures are carried out only in a specialized clinic, under the supervision of doctors. The scheme of therapy is selected individually, based on their physiological, mental indicators of the patient.

Information about the diagnosis

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

Good to know! 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, one's own personality is preserved.

The main reason for the development of pathology- systematic, uncontrolled use of alcohol.

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

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

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

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 "alcohol dependence of the second stage";
with alcohol dependence that has reached the third stage, more than 45% of patients are at risk.

With this form of metal-alcohol psychosis, the patient shows low resistance to alcohol. The results of studies confirm that the pathology develops as a result of damage to brain tissue. At the same time, before hallucinosis, the patient is more difficult to tolerate the withdrawal syndrome.

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;
at risk are patients with the second and third stages of alcohol dependence;
permanent 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 drunk alcohol, a person has to constantly increase the dose, respectively, the likelihood of developing hallucinosis increases.

Classification

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

acute;
subacute;
chronic.

Each form has certain signs, symptoms and characteristics.

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

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

Hallucinosis in the acute stage has a certain classification:

classical form- the nature of typical symptoms - auditory hallucinations, consciousness remains normal;
reduced form- extraneous voices are heard at the time 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, it seems to the patient - he does something, says, but in fact the person is motionless, all thoughts and actions are perceived as hostile;
mixed form- in addition to auditory hallucinations, there is delirium, consciousness becomes confused, orientation is disturbed.

Subacute form

There are such types:

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

Chronic alcoholic hallucinosis

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

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

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

The chronic form is often accompanied by a delusional state. In this case, the patient worries about his life and the lives of his relatives, such behavior leads to emotional instability. The patient's mood changes dramatically at the slightest change in the familiar 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 auditory hallucinations– voices scold, condemn, treat with threats. The patient hears voices from all objects in the house, surrounding people.

Sometimes there are optical illusions, but they are usually blurry, fuzzy, but add unpleasant emotions to the patient. As a result of hallucinations, delirium develops, it seems to a person that he is being pursued in order to torture and kill him. The degree of anxiety in hallucinosis differs from the level of fear experienced by the patient in 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, mutilation of others is possible.

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

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

At the chronic stage, delusional states are absent. Develop first vivid, real auditory and visual hallucinations, as the disease progresses, they become less intense and the person gets used to them. If the delusional state still appears, it can be corrected.

Treatment and prognosis

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

Hospitalization is a must. Only in a specialized clinic is it possible to restore the patient's psyche and protect others from the patient's aggression. The absolute indication for hospitalization is auditory hallucinations, which are ordered in nature. A person is placed in a medical facility by force.

The patient is prescribed a multi-stage treatment:

complete detoxification;
relief of symptoms of psychosis;
restoration of the functionality of internal organs;
prevention of manifestations of cognitive impairment.

To cleanse the body, the following drugs are used:

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

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

To stop the symptoms of this form of meth-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 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?

The long course of the disease - alcoholic hallucinosis develops, as a rule, not earlier than 10-14 years of the existence of an advanced alcoholism, is more often observed in women.
Prolonged systematic alcohol intoxication.

Symptoms of alcoholic hallucinosis

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

With the further development of psychosis, multiple verbal hallucinations appear, secondary delusions (relationships, influences, accusations, persecution or physical destruction) join them. Patients are extremely prone to attack fears and panic attacks, extremely suspicious. Gradually, the delirium begins to line up with the sick in a certain system - hallucinatory experiences are woven into real events (sometimes quite plausibly). After the appointment of 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, acoasma or simple in form and neutral in content verbal hallucinations arise - individual words, singing, etc. After waking up, 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 a full-blown hallucinosis of a more complex structure.

Acute abortive hallucinosis

May be limited to simple verbal hallucinations of neutral content. With the complication of the psychopathological structure, hallucinations can become threatening, accusatory, imperative, addressed directly to the patient. Accordingly, a delusional concept is not formed, affective disturbances arise in the form of anxiety, fear, behavior changes, motor excitation increases, and a critical attitude towards the experienced disorders disappears. The duration of such a psychosis is from several hours to a day. The output is critical. Sometimes abortive hallucinosis precedes developed 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 a long, daily drunkenness, accompanied by insomnia.

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

The onset of the disease is usually acute. For several weeks, there may be warning signs in the form of restlessness, anxiety, depressed mood, dizziness, etc. Psychosis usually develops in the evening or at night. The patient is seized by severe anxiety, he cannot fall asleep or in fear, sweating, wakes up after a short sleep. At first, auditory hallucinations are elementary - noise, ringing, crackling, rustling, whispering, screaming, separate simple words. In the future, they rapidly take on the character of a monologue, a dialogue, and, in the final stage, a polyvocal verbal hallucinosis in the form of successively replacing each other scenes connected by the unity of the theme. As a rule, voices speak of the patient in the third person, but sometimes they directly address him. There are many voices, they are sometimes quiet, sometimes loud, reaching the roar. They talk together, intertwining, arguing and cursing. The content of hallucinations is unpleasant for the patient. These are various threats, accusations, condemnation of the patient for past deeds, especially for immoderate drunkenness and the consequences associated with it. Voices confer, 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, of course, 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 the influx of hallucinatory experiences, a short lethargy and detachment occurs, but it can be qualified as a phenomenon of a hallucinatory substupor or stupor.

Delusions are closely related in content to hallucinations, so they are fragmented, fragmentary and not systematized. With a developed hallucinosis, the affects of fear, anxiety, and despair prevail. The patient is always the mind of the ongoing 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 that has been created, or when imperative voices prevail, we make suicidal attempts. In the future, with the predominance of the affect of anxiety, the patient begins to flee, he develops motor excitation. Often patients in this state resort to desperate self-defense, barricade doors, board windows, disable communications, create 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, waiting for invisible enemies, armed with sharp objects, knives or firearms. At the next stage, the patient turns from a persecuted into a persecutor. This can lead to unforeseen consequences: he can 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 misbehavior. However, in the future, the behavior of patients may 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 inspire him with other hallucinations.

Alcoholic hallucinosis occurs against the background of unclouded consciousness, this is evidenced by an undisturbed orientation in one's own personality, at the location, this significantly distinguishes it from delirium tremens. Only with a thorough clinical and psychopathological study 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, the patients reproduce them almost unmistakably consistently. Memory with alcoholic hallucinosis does not suffer. Confabulations are practically not observed.

Psychosis, as a rule, ends critically after a long deep sleep. With the lytic end of hallucinosis, the intensity of verbal hallucinations first decreases, then the affective charge disappears, and then delusional constructions fade. A critical attitude to the experience does not arise immediately, residual delirium is possible in men (women often develop depressive disorders). Duration of acute hallucinosis from several days to 4 weeks.

Mixed acute alcoholic hallucinosis

Acute hallucinosis with severe delusions

Distinctive features of this psychosis are a combination of relatively poor, not abundant verbal hallucinations of a predominantly threatening nature with pronounced delusions of persecution. Other than the typical bullshit. associated with the content of hallucinations, there are mediated delusional constructions that are not reduced with hallucinatory disorders. Delusions in structure are sensual, figurative, this is evidenced by a symptom of confusion, an affect of intense anxiety and fear, an illusory perception of the environment, single false recognitions. The reduction of mental disorders occurs gradually and sequentially: affective disorders - "verbal hallucinations -" delusional disorders. Residual delirium is not uncommon.

Acute hallucinosis associated with delirium

Delirious disorders occur at any stage in the development of hallucinosis. They usually join at night. In the initial period and at the end of hallucinosis, these are single episodes, and at the height of the development of hallucinatory psychosis, detailed symptoms of delirium can be observed. Rarely, delirium pictures become predominant, more often verbal hallucinosis remains a core disorder. Patients have influxes of visual hallucinations, tactile and thermal hallucinations may appear. The affect of fear alternates with euphoria. With such a psychosis, fragmentary symptoms of occupational delirium may occur. The reduction of psychopathological disorders begins with the disappearance of symptoms of clouding of consciousness, further development is similar to acute hallucinosis. The exit is usually critical.

Atypical acute alcoholic hallucinosis

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

Acute hallucinosis with oneiroid stupefaction

Oneiric disorders in hallucinosis are more common 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 with the oneiroid disorders that occur in delirium, patients mostly note scenes of fantastic content, representing various world cataclysms, star wars, interplanetary flights, etc., however, these topics remain plot-incomplete, fragmentary, as in a restless dream; often "fantasy" experiences are combined with scenes of drunkenness.

The onset of hallucinosis is classical, then polyvocal verbal scene-like hallucinosis joins: the patient has a pronounced affect of fear, he is in a substupor. Then there is a figurative delusion with an illusory perception of the environment, at night visual pseudohallucinosis may develop, reflecting the content of verbal hallucinations. The reduction of psychosis begins with oneiroid disorders, verbal hallucinosis disappears at the end.

Acute hallucinosis with stuporous disorders (alcoholic stupor)

The development of alcoholic stupor or substupor is indicated by disorders of the motor sphere that join alcoholic hallucinosis. As a rule, at the height of hallucinosis, the immobility of the patient, his detachment from the outside world, and workload are observed. There is no negativity. Inhibition can be replaced by excitation or alternate with it. The duration of the above disorders is from several minutes to several hours.

Acute hallucinosis with psychic automatisms

Like other, atypically proceeding forms of psychosis, mental automatisms appear at the height of its development, during the formation of polyvocal hallucinosis. They always intensify and become more complicated 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 thoughts, forcibly emerging 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 in the content of delusional statements and the emergence of a tendency to systematize them. Have with automatisms delirious and oneiric disorders can occur. When leaving psychosis, mental automatisms are reduced first.

Subacute (protracted) alcoholic hallucinosis (F10.75)

Subacute include hallucinosis, lasting 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 occur 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. According to the predominance of certain disorders in the clinical picture (verbal hallucinations, depressive disorders or delusions), protracted alcoholic hallucinosis is conventionally divided into three variants.

Subacute alcoholic hallucinosis with predominance of verbal hallucinations

They are relatively rare. In the clinical picture, after the reduction of affective disorders and delirium, verbal hallucinations come to the fore. The behavior of patients is ordered, often the performance of everyday and even professional duties is preserved. As a rule, the patient is aware of the presence of the disease.

Subacute alcoholic hallucinosis with a predominance of depressive affect

At the height of the development of hallucinosis, a transformation of motor and affective disorders occurs. In the clinical picture, a lowered background of mood, depression, and pronounced melancholy begin to prevail. 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, beginning with affective disorders.

Subacute alcoholic hallucinosis with a predominance of delirium

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

Chronic alcoholic hallucinosis

Chronic alcoholic hallucinosis - a relatively rare disease Psychosis can begin as an acute alcoholic hallucinosis, less often as an alcoholic 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 firms 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 anxiety, and sleep disturbance are significantly expressed. Falling asleep, patients hear that someone is sneaking up on them, wants to grab them, etc., in fear they jump up and scream. Soon there are profuse auditory hallucinations. Their content is unpleasant, threatening, commentary or antagonistic hallucinations can join. In the acute period, auditory hallucinations are distinguished by a bright emotional coloring, as a result, patients perceive them as a reality. In the background are visual hallucinations (insects, small animals, unreal creatures, various shadows, etc.). In the acute period, kinesthetic, tactile, bodily hallucinations may occur. Against the background of hallucinatory disorders, a delusion of persecution or relationship is formed. Consciousness, similarly to other types of hallucinosis, is not disturbed, but at the height of the development of psychosis it becomes not entirely clear. After 7-10 days, the fear in patients decreases, from the entire spectrum of disorders, only auditory hallucinations remain, less threatening than before. Subsequently, patients begin to get used to them. At the same time, external forms of behavior are normalized, patients can perform daily activities, are able to engage in professional activities. Noticeable changes in memory for the past are not noted, memory for current events suffers a little. Over time, alcoholic hallucinosis loses its intensity. Hallucinations can become simple, sometimes disappear completely, appearing only with external stimuli (the so-called reflex hallucinations). Consciousness of the disease appears even in the acute period and persists throughout the duration of painful disorders. With the resumption of alcohol consumption, the previous symptoms of hallucinosis reappear and become aggravated. This form of chronic hallucinosis is stationary and does not progress. Sometimes it lasts for many years without leading to dementia and personality decline.

Chronic verbal alcoholic hallucinosis with delusions

In this case, a characteristic hallucinatory syndrome accompanies delirium, which is of a peculiar nature. Unlike the usual one, it lends itself to a certain correction and does not have an absurd character. More often in such patients, delusions of persecution are detected, which are of a stereotypical nature (the patient expresses delusional ideas in the same formulations); complication of delusional ideas over time does not occur. Under the influence of alcoholic excesses, naturally, exacerbation of painful phenomena periodically occurs. In terms of intellectual safety, this form of chronic alcoholic hallucinosis does not differ from the first variant.

Chronic verbal hallucinosis with mental automatisms and paraphrenic change in delirium

It is considered the rarest form of chronic hallucinosis. The core disorder is a 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 pseudo-hallucinations, openness of thoughts, anticipatory thoughts, mentism; note individual ideas of influence. With the further course of psychosis, a change in the content of auditory hallucinations and pseudohallucinations is observed, megalomaniac delusions are formed. Patients talk about their unusual, special position, but not in the present, but in the future (he will be fabulously rich, receive a high position, be awarded for merit, etc.); very often the content of delirium has a shade of puerilism, childishness. Labile affect prevails, euphoria is easily replaced by irritability. This variant of psychosis is characterized by sufficient intellectual safety, but organic decline slowly increases.

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

Treatment of acute hallucinosis and delusional psychosis


Acute alcoholic hallucinosis and delusional psychosis	Antipsychotics with a predominantly antipsychotic effect [eg, haloperidol 5–10 mg 2–3 times daily or risperidone (rispolept) 4–6 mg/day]
	Therapy aimed at stopping affective disorders: 0.5% solution of diazepam (Relanium), 2-4 ml intramuscularly or intravenously, up to 0.06 g / day; or 0.1% solution of phenazepam, 1-4 ml intramuscularly or intravenously, 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
	Hepatoproteins: ademetionine 400 mg 1-2 times a day, thioctic acid 600 mg 1 time a day Symptomatic therapy of somatic complications

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

For prolonged and chronic hallucinosis and paranoia (F10.75 *), antipsychotics are mainly used: haloperidol and other drugs of the butyrophenone, phenothiazine series or atypical antipsychotics (sometimes in combination). Assign 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 delirium of jealousy, Griftazin 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. In disorders of the anxiety circle, hydroxyzine is used, but 25-75 mg / day.

Chronic encephalopathies (F10.73*) and Corsaconian psychosis (F10.6*) require long-term treatment with nootropic agents, amino acids (methionine 2 g/day, glutamic acid 1.5 g/day, glycine 0.05 g /day), drugs that improve the metabolism and blood circulation of the brain (instenon, pentoxifylline, inosine, etc.), multivitamins.

Treatment of chronic alcoholic psychoses


Protracted and chronic alcoholic psychoses	With 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; triftazin 5-15 mg / day
	In affective disorders of the anxiety circle, hydroxyzine is used at 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
	Course of hyperbaric oxygen therapy
	Symptomatic treatment of somatic and neurological diseases

Under alcoholic hallucinosis it is necessary to understand a disease that is characterized by mental disorders as a result of excessive consumption of alcoholic beverages on an ongoing basis. This pathological condition is considered one of the most frequent psychoses that occur 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 course of the pathological condition.

As already noted, alcoholic hallucinosis is a psychosis that is formed as a result of constant and prolonged use of alcohol-containing beverages. Its main characterizing symptoms will be auditory hallucinations, while the patient will be conscious, understand who he is and navigate in time and space.

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

As for the causes of this disease, this is a long and regular use of alcohol (after all, delirium, incomprehensible sounds and voices appear after about 12 years of drinking). According to observational data, most cases of the disease are 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 of hallucinosis, there are:

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

Hallucinosis of this type is considered the easiest, its manifestations are formed during a severe course of a hangover. It manifests itself as confusion, groundless anxiety, which transforms into a feeling of fear, up to horror.

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

The patient in most cases understands the nature and cause of these sounds, but he still has a feeling of fear and surprise. To eliminate the manifestations of this pathological condition, it will be enough to sleep well.

Acute abortive

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

These sensations are changed by symptoms that manifest as auditory hallucinations. The alcoholic begins to hear sounds, but he does not pay attention to them. After that, he begins to hear voices, as if someone:

talking to him;
characterizes his actions;
accuses of some problems;
threaten or demand something.

The duration of this pathological condition can be several days. It must be taken 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 a prolonged hard drinking combined with insomnia. It begins with feelings of anxiety, sadness and panic, over time, delusional thoughts and auditory hallucinations join them.

As for hearing deceptions, they manifest themselves most often in the evening or at night. At first they look like sounds that change into monologues, dialogues (voices can argue with each other).

After that, the alcoholic begins to worry about the delusions of persecution, accusations. Moreover, all the crazy ideas of the patient associated with the deception of hearing. It should be noted that such nonsense bothers the patient not 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 mixed hallucinosis

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

Hallucinosis, which is accompanied by intensely expressed delirium. It is characterized by a combination of deception of hearing and delirium of persecution. The oppression of the patient, his anxiety and a sense of fear will testify to its formation.

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

Hallucinosis 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 (tremor, palpitations, hypertension), hallucinations (in the form of sounds, pictures, and even touches) and delirium. These manifestations can appear unexpectedly, and at any stage of the disease and at any time of the day (but still more often at night). Please note that auditory hallucinations are considered the main symptoms of this hallucinosis.

This group includes hallucinosis with:

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

Subacute hallucinosis

Subacute hallucinosis refers to mental disorders lasting from 1 to 6 months. They are characterized by a typical onset of acute hallucinogenic psychosis and the addition, in the future, of auditory hallucinations and other syndromes. Allocate hallucinosis:

With the addition of hallucinations of a verbal nature. The onset of the disease is accompanied by affective disorders with the addition of delirium and voices. The characteristic feature of this state is that anxiety and delirium almost do not manifest themselves over time, only verbal deceptions of hearing remain. At the same time, the patient is quite adequate, performs his daily activities and even goes to work, while he is clearly aware of the presence of the disease.
With the dominance of depression. In this state, anxiety is quite intense, the patient is in a depressed state, he has a bad mood. Delusion appears in the form of self-accusation.
With the dominance of manifestations of delirium. We can talk about this pathological condition if the patient at the peak of hallucinogenesis has a deterioration in mood, the appearance of delusional ideas and fear of physical reprisals against him. In most cases, delusions of persecution and relationships are observed. To all the listed symptoms, there is also an adaptation disorder, it 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 the usual acute, but the duration of such conditions can be delayed for several years. Allocate:

Chronic alcoholic hallucinosis without manifestations of delirium. It is considered the most common, characterized by oppression, unreasonable anxiety. Over time, a feeling of extraneous sounds begins to join, conversations that are expressed so vividly that the patient perceives them as reality. After that, visual hallucinations may also join, 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 a normal phenomenon and returns to his usual rhythm of life. Sounds and voices rarely disturb him, their appearance is usually accompanied by external stimuli. But with the first use of 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 persecution 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 the effectiveness of therapy, first of all, it is 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 the case of a complete cure for alcoholism, relapses of hallucinosis will not occur.

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

For the treatment of the chronic form of the disease, antipsychotic drugs are used that have an antipsychotic effect (Haloperidol, Risperidone), in some cases, insulin therapy may be additionally performed.

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

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

- the second most common meth-alcohol psychosis after delirium tremens. It can be acute, subacute or chronic. Usually auditory hallucinations predominate, in most cases delirium develops. Unlike alcoholic delirium, orientation in the surrounding world and one's own personality is preserved. Consciousness is not disturbed. At the height of hallucinations and delusional disorders, suicide attempts and harm to others are possible. Treatment is stationary, neuroleptics, sedatives, vitamins, drugs to improve metabolism in the brain and drugs to correct somatic disorders are used.

General information

Alcoholic hallucinosis is one of the most common alcoholic psychoses. It develops in 5-11% of patients suffering from chronic alcoholism. It usually occurs over the age of 40 years on the background of constant long-term use of alcohol. 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 severe harm (maim, kill, rape). Against the background of these voices, a patient with alcoholic hallucinosis may hear the cries of children or a wife pleading 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 narcology and psychiatry.

Causes of development and classification of alcoholic hallucinosis

The reason for the development of alcoholic hallucinosis is the prolonged systematic use of large doses of alcohol. As a rule, the disease occurs in patients with chronic alcoholism experience 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, there is a lower tolerance to alcohol than with alcoholic delirium. 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 symptoms. It is noted that before psychosis, withdrawal symptoms in many patients are 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. Delusion is an interpretation of hallucinations. Patients experience severe fear.
Reduced hallucinosis- auditory hallucinations hypnagogic (occur at the time of falling asleep) or simple, fragmentary. A delusional concept, as a rule, is not formed or is not sufficiently formed. There are affective disturbances in the form of anxiety, depression and fear.
Atypical hallucinosis- against the background of auditory hallucinations, uncharacteristic disorders occur: 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, with delirium or with delusions not associated with auditory hallucinations).

Symptoms of alcoholic hallucinosis

A typical acute alcoholic hallucinosis begins suddenly. Within a few days before the onset of the first symptoms of the disease, precursors can be observed in the form of increased anxiety, fear, distrust 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 optical illusions, which are never as vivid and plausible as in alcoholic delirium, but they 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 himself 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 there is an immediate real threat to his own life. Patients try to somehow protect themselves from the "danger": they barricade themselves in a room, run away from the city, hide in garages or dachas, etc. If a delirious clouding of consciousness occurs (observed in 10% of patients), a suicide attempt or desperate serious damage to others.

In other cases, the orientation in the surrounding world is preserved, the patients behave quite reservedly, but this does not give a 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 influence the content of patients' delusions in any way, therefore, in case of aggression, relatives or ambulance doctors are deprived of the opportunity to persuade patients and find some acceptable explanation for the need to "peacefully" receive medical assistance.

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

Treatment and prognosis for alcoholic hallucinosis

Treatment is carried out by a narcologist in the conditions of 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 process of detoxification, 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. Preparations for the correction of somatic pathology are selected taking into account the disorders identified in a particular patient.

To stop psychotic phenomena in acute hallucinosis, azacyclonol, haloperidol, olanzapine, risperidone, etc. are used. Drugs are usually administered parenterally, less often orally. The rate of disappearance of hallucinations directly depends on the prescription of the onset of psychosis. The earlier treatment is started, the faster psychotic symptoms stop. In chronic hallucinosis, antipsychotics, electroshock and insulin coma are used. In all cases, a prerequisite for successful treatment is the complete rejection of alcohol.

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