Development of delirium tremens in humans

Delirium tremens, or, in scientific medical terms, delirium tremens, occurs in a person suffering from chronic alcoholism most often, oddly enough, precisely in the period after the cessation of binge drinking. The risk of alcoholic delirium may persist for up to 15 days after alcohol withdrawal.

The specialists at the Preobrazhenie Clinic have extensive positive experience in treating delirium tremens and preventing it. In addition, we provide rehabilitation therapy for patients who have suffered this serious condition.

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Symptoms of delirium tremens

In medical science, delirium is defined as alcoholic psychosis. It usually occurs when a person at stage II or III of alcoholism decides to stop drinking. Symptoms appear as:

• delirium;
• visual and auditory hallucinations;
• trembling all over the body;
• chills;
• high temperature;
• headache.

In their hallucinations, those suffering from delirium often see devils, huge insects, and various monsters that threaten their lives. Sometimes this condition is actually fatal . In many cases, this is caused by damage that a person inflicts on himself.

It is characteristic of the disease that it does not develop during heavy libations, but precisely when there is a sudden cessation of drinking alcoholic beverages. But there are exceptions to this rule, when the “squirrel comes” during a binge.

Who is susceptible to the disease

People at risk of contracting fever can be roughly divided into four groups:

1. The first risk group. As a rule, delirium follows alcohol abuse for five to seven years. This is the period when one enters the II-III stage of alcoholism. Against the background of daily drinking for two or three weeks or after several weeks or months of binge drinking, when it stops.
2. Second group. In some cases, people who are not chronic alcoholics get sick after they have drank a lot and for a long time or consumed an alcohol substitute.
3. The third risk group includes those who have previously suffered traumatic brain injuries or diseases of the central nervous system.
4. The fourth category includes people who have already experienced severe alcoholic psychosis in the past. It can come again in a situation where even a small amount of alcohol is taken.

Delirium concept

After drinking alcohol for a long time, a person’s behavior changes and the whole body is rebuilt. Delirium is a consequence of debility, a natural reaction to constant stress and toxic exposure.

Taken together, all the consequences of regular drinking create fever. It is called delirium, a condition that a person cannot control.

The shorter the break between binges, the greater the likelihood of such an attack. Only a doctor can provide the necessary assistance during an attack; it is very difficult to get rid of delirium on your own.

Symptoms

One of the signs is headache and disorientation.

The signs of delirium tremens differ in men and women: the development of alcoholism depends on the psyche of the addict. Men are more resilient, it is easier for them to endure heavy loads on the body without noticeable consequences. Female alcoholism occurs in a complicated form.

The first symptom of delirium tremens is a severe headache. A migraine attack occurs spontaneously, against a background of general weakness and slight dizziness. An alcoholic suffers from speech impairment and confusion. He is confused and disoriented. With sleep disturbances that accompany chronic alcoholism, the psyche is weakened, and the first signs of delirium are reflected in thinking and perception of the environment.

It is difficult for a person to distinguish reality from hallucination. Auditory hallucinations are accompanied by delirium, which lasts several hours. With visual illusions, chills appear: the alcoholic gets pounding, tremors appear in the arms and legs. The motor system may fail.

The onset of delirium tremens after heavy drinking

Approximately one third of cases begin when a person abruptly stops drinking because he develops physical ailments such as heart and vascular disease, liver, kidney, and gastrointestinal tract damage.

In these cases, delirium occurs, as a rule, on the first to third days, less often on the fourth to sixth days after the so-called beginning.

Before the onset of psychosis itself, the first stage of delirium tremens occurs - abstinence . Its manifestations are divided into two stages of alcoholism – II and III. The second stage, in turn, has three degrees of severity.

The first degree at the initial stage of alcohol dependence is characterized by vegetative-asthenic disorders , that is, at first it is not the psyche that suffers, but the somatics (body).

These include the following:

• Increased sweating.
• Dry mouth and throat.
• Cardiopalmus.
• Fighting the urge to get hungover.

Development of withdrawal syndrome

The second degree manifests itself when drinking alcohol for many days and is associated with the addition of neurological manifestations to the somatic ones:

1. Hyperemia - overflow of blood vessels and organs due to increased work of the heart.
2. A sharp drop or increase in blood pressure.
3. Severe redness of the eyes and entire face.
4. Heaviness in the head and headache.
5. Vomiting.
6. Hand trembling.
7. Gait disturbances.
8. Frequent hangovers interfere with leading a normal, active lifestyle.

In the third degree, mental :

• inexplicable anxious mood;
• poor sleep;
• nightmares;
• feeling of guilt before others and approaching trouble;
• feeling of melancholy.

Withdrawal syndrome at stage III of alcoholism includes all of the above symptoms - both physical and mental.

Approximately 10% of patients experience cramps throughout the body . Note! Withdrawal syndrome should not be confused with a hangover, which is similar to its first degree.

How to treat delirium tremens

Patients suffering from delirium tremens must be hospitalized in a drug treatment or psychiatric department. In the hospital, they undergo deintoxication procedures, restore vital functions, and are also prescribed nootropics, vitamins and some other drugs. In some cases, psychotropic drugs can be used, but this is done only in exceptional cases, since in general they are ineffective for the treatment of alcoholic delirium. In addition, psychotropic drugs are not allowed for professional or persistent delirium tremens. An important part of treatment is to replenish the lack of fluid and mineral salts in the patient’s body.

At home, delirium tremens can be treated only if it is in its earliest stages. Typically, in such cases, phenazepam is used, which is taken by the patient for several days. If it does not help and the patient’s condition only worsens, you can try stronger drugs. However, experts advise not to self-medicate, but to immediately consult a doctor.

The only prevention of alcoholic delirium is a healthy and sober lifestyle. It is known that withdrawal syndrome, which develops into delirium delirium, does not develop in the first stage of alcoholism. This means that you should not get too carried away with alcoholic beverages. If you want to drink, it is better to prefer quality drinks. If a person has mental disorders or intellectual problems, then he is strongly advised not to touch alcohol at all, since in these cases the likelihood of developing delirium increases sharply.

Second stage – third, fourth day

At this stage, after severe nightmares, insomnia appears, which is accompanied by visual hallucinations - images that appear in the human mind without the presence of external stimuli.

And also – illusions, distorted perception of really existing objects or phenomena. The first and second are often bright, intense.

They contain various insects, animals, and sometimes fairy-tale characters, such as the already mentioned devils, as well as gnomes, elves, orcs, goblins, and leprechauns. The movements of shadows are “caught” by peripheral vision, as if a cat, dog or person was running by. However, these visions are individual in nature.

Tactile hallucinations also occur . The patient feels as if insects are crawling on him and biting him. He begins to brush them off, throw them off, crush them or blow them away.

Sometimes voices are heard . It can be just talking or singing, but sometimes it seems to a person that the voices are giving orders or mocking him, calling him a drunk or a complete loser. This brings additional suffering to a person. You may also hear ringing calls, loud steps, or slamming doors.

The main symptoms of the disease and its signs

At the very initial stage of the disease, a person becomes subject to terrible, inexplicable fear and panic, and is constantly in anticipation of something terrible, some kind of trouble. Arms and legs begin to tremble violently, sleep is disturbed, up to its complete loss. The temperature often rises, the patient alternates between fever and chills, he becomes covered in sticky sweat, his heart literally jumps out of his chest, and his blood pressure rises. The skin of the face either becomes very pale, turning almost into a white mask, which gives the disease its name, or, on the contrary, becomes crimson. If the patient manages to fall asleep, then the sleep is interrupted by nightmares, and hallucinations begin in reality.

The reality of delirium tremens is much worse than the worst nightmare. As the disease develops, a person begins to hear extraneous sounds: clapping, knocking, doorbells. He imagines that someone is walking nearby, constantly calling him. With peripheral vision, the patient notices that something is moving: a cat or rat, or maybe even a huge spider or snake, has darted past. Later, visual hallucinations become much brighter and more colorful. Alcoholics see devils, gnomes, elves and other fantastic creatures, as well as small animals. Often they try to drive them away or throw them off. Trying to tell them that this doesn’t exist is actually useless, they simply won’t believe it.

Then comes the turn of tactile hallucinations, when it begins to seem as if insects are crawling over the body. By this time, the auditory senses are greatly enhanced, and the patient begins to hear voices that can tease him, scold him, force him to do something, frighten him, or call for help. In this state, a person becomes insane and inadequate. Usually, during delirium tremens, people described hallucinatory delirium in different ways, but most of the visions that haunt them still coincide.

While in the grip of hallucinations, people performed the following actions:

• got tangled in ropes or webs;
• ran away from maniacs or monsters;
• they were running somewhere, screaming;
• talked to strange voices;
• saw corpses everywhere;
• crushed insects.

Confusion, however, does not affect the memories. On the contrary, the brain probably works in enhanced mode, since patients usually become very talkative and can recall any episode of their own life in the slightest detail. But literally after about half an hour the speech again becomes fast, incoherent and fragmentary.

Often in this state, persecution mania and uncontrollable jealousy arise. Sometimes the patient tries to prove his courage and tries to perform some heroic deeds. However, such impulses are fleeting, because the patient’s consciousness is unstable: aggression is often replaced by good nature, strong excitement by apathy, and anger by joy. In moments of enlightenment, patients even regain their appetite.

During an attack, a person is overcome by severe weakness, he is practically unable to even move on his own. He constantly needs help from people who are close to him.

Also, somatic manifestations of delirium tremens include:

• yellowness of the whites of the eyes;
• dilated pupils that practically do not react to light;
• brown coating on the tongue.

The patient's facial expressions also change. Often the victim’s face expresses fear, anguish, pain, and disgust. Some moments become scary when the alcoholic’s consciousness clears up a little and he begins to understand that something incomprehensible is happening to him. He begins to ask for help, but does not understand why, since the thin line between reality and numerous visions is practically erased.

During daylight hours, the attacks noticeably subside, the patient even sometimes behaves the same as before, but with the arrival of evening the fever again seizes the patient’s consciousness. In this case, lack of sleep plays a big role, a person does not know peace and rest, and hallucinations still continue to haunt the sick consciousness. On average, an attack of alcoholic delirium lasts three to five days.

Third stage

At the third stage, which begins around the fourth or fifth day, a person, as they say, completely falls into inadequacy. In his imagination, he communicates with voices, fights off or shoots back from monsters or bandits or murderers attacking him.

The patient begins to delirium . In science, delusion is understood as a disorder of mental activity in which a person has ideas, reasoning and conclusions that are not related to the actual state of affairs.

Moreover, such ideas cannot be corrected by external influence. This could be, for example, delusions of persecution, poisoning, self-blame, delusions of jealousy.

A state of strong excitement may also occur . It is characterized by restlessness in movements, expressed to varying degrees - from fussiness to the destruction of any objects.

Often motor excitement is accompanied by speech: shouting phrases, words, individual sounds; long stories about one's own imagined heroic deeds or great merits.

Some nuances of the third stage

At the third stage, the following affective disorders are possible:

• Aggressiveness.
• Anger.
• Malice.
• Confusion.
• Unreasonable anxiety or gaiety.

Often, excitement is abruptly replaced by calmness , and then occurs again. During the day, the state of psychosis may subside for a while. Then the person gradually begins to come to his senses and become aware of the surrounding reality. He remembers what happened to him at night and realizes that he is sick.

But such “enlightenment”, as a rule, does not last long. As evening approaches, the psychosis returns. It usually lasts from three to five days , during which the patient either sleeps very little or does not sleep at all. After five days, delirium tremens begins to subside. The first sign of improvement is the onset of sleep without nightmares and sudden jumping up.

Consequences of delirium tremens after binge drinking

Consequences can be of several types: complete recovery; recovery with negative residual effects; death of the patient.

Recovery with residual effects of a negative nature involves the following defects: organic psychosyndrome; amnestic syndrome.

Organic psychosyndrome is a deterioration of memory, a decrease in the level of intelligence. Incontinence of affects - short-term states of insanity or limited sanity. And also with psychoorganic syndrome, asthenic phenomena often occur.

Asthenia or chronic fatigue syndrome is a condition in which there occurs:

• increased fatigue;
• unstable mood, moodiness, tearfulness;
• inability to endure prolonged mental stress;
• intolerance to loud sounds, bright lights, strong odors.

Amnestic syndrome

Amnestic syndrome is a set of symptoms that includes: memory impairment for current events; loss of orientation in time, place and environment; the presence of false memories.

In this state, memory impairment for current events is most pronounced. The patient may immediately forget what he or another person with whom he spoke a few minutes ago said.

That's why he asks the same question and greets the same people several times. He cannot remember what he just ate or did. Sometimes he reads a book on the same page for several weeks.

But at the same time, distant events are remembered well, especially some of their episodes. And events that occurred before the illness itself, spanning several weeks or even several years, may completely fall out of memory.

Among orientation disorders, the most pronounced is time orientation . A person is not able to name not only the exact date, but he also does not know what time of year it is. False memories are expressed in the replacement of memory gaps for current events with actual events of the past. False recognition may also be present.

Consequence of death

Death occurs in approximately a tenth of all patients in the absence of treatment. In a severe condition with delirium, which can lead to death, a person exhibits the following symptoms:

1. Temperatures reach 40 degrees or more.
2. Rapid dehydration occurs.
3. The level of nitrogen in the blood increases, which means that the kidneys do not remove metabolic products from the body well.
4. Leukocytosis appears - the composition of the blood changes, which indicates the presence of pathological processes.
5. The erythrocyte sedimentation rate increases, which also indicates pathologies, including the onset of the inflammatory process.

In addition to these disturbances in the functioning of the body, the cause of death may be the patient’s inappropriate behavior , leading to injuries incompatible with life. As well as suicide committed against the background of a delusional state.

Note ! Anyone who has already suffered from delirium once, after drinking alcohol, albeit in small quantities, is much more susceptible to other painful conditions that can lead to death.

Treatment

At any stage of alcoholic tremens, you need the help of a narcologist. If treatment occurs in a hospital, complex injections are used to remove toxins from the body.

During hallucinations and seizures, mental disorders can develop, which a psychiatrist works with. The sooner the patient seeks help from a narcologist, the fewer consequences delirium tremens will have.