Alcoholic paranoid - causes and clinical picture
Alcoholic paranoid is one of the types of alcoholic psychosis, the main symptom of which is severe delusions of persecution.
The only cause of such psychosis is alcohol abuse. The disorder usually occurs in people only in the second or third stages of alcoholism; the majority of patients are people who have been constantly drinking alcohol for more than 7-8 years.
The greatest risk of developing alcoholic paranoid is in people who drink 0.5-1.5 liters of vodka daily. Delirium begins much less often in alcoholics who drink 200-300 ml per day.
There are also several risk groups - paranoid is more often diagnosed in alcoholics who have suffered a head injury, who have severe heredity, and in patients with epileptoid psychopathy.
The clinic of alcoholic paranoid consists of 3 main phenomena. These are affective disorders (sharp mood swings), sensory (figurative) delusions and inappropriate behavior.
Causes
The main factor for the onset of the syndrome is considered to be long-term alcohol consumption. Drinking alcohol in large quantities disrupts the nervous system and can therefore lead to mental illness.
More often, the disease appears in people with a paranoid character, and alcohol worsens the course of the disease. Even before the first signs of the syndrome, patients can regulate and control the lives of those around them. They are demanding and cannot accept refusal to comply with the rules they have established.
Many people with this disease have been drinking alcohol for 10 years or more. Sometimes personality degradation develops. After reviewing the patient's chart, the doctor can identify an ailment such as delirium tremens.
Varieties
Alcohol paranoid is diagnosed exclusively in “experienced” alcoholics. It develops either in a state of intoxication, after a long binge, or during severe withdrawal syndrome. The second case occurs most often - usually delusions of persecution begin precisely during the period of a painful hangover.
The duration of the disease and its course largely depend on the form of psychosis. Scientists identify 3 main types of alcoholic delirium.
Abortive
Lasts from 3 hours to a day, begins mainly in a state of alcohol intoxication. First, affective disorders appear (bad mood, feelings of anxiety, then fear), which sharply develop into delusions of persecution.
Spicy
Lasts from 2 to 25 days and is most often diagnosed. This form of psychosis develops only during a hangover. First, prodromal phenomena appear that last for several days. These are classic withdrawal symptoms - depressed mood, problems with sleep and appetite, arrhythmia, trembling of limbs, feelings of anxiety, confusion, etc. Soon confusion develops into severe fear, delirium begins, and sometimes hallucinations.
Protracted
Such psychosis can drag on from 1.5-2 months to several years. It begins as a typical acute alcoholic paranoid, but over time the feeling of fear weakens and is replaced by a stable low-anxious mood. The specifics of delirium change - the alcoholic’s motives and suspicions become more logical and selective. This form of alcohol use disorder often occurs in periodic relapses that last for several months.
Some narcologists and psychiatrists divide prolonged alcoholic paranoid into subacute (lasts up to 6 months) and chronic (from 6 months to several years).
Protracted
Such psychosis can drag on from 1.5-2 months to several years. It begins as a typical acute alcoholic paranoid, but over time the feeling of fear weakens and is replaced by a stable low-anxious mood. The specifics of delirium change - the alcoholic’s motives and suspicions become more logical and selective. This form of alcohol use disorder often occurs with periodic relapses that last for several months.
Some narcologists and psychiatrists divide prolonged alcoholic paranoid into subacute (lasts up to 6 months) and chronic (from 6 months to several years).
Symptoms and signs
The signs of alcoholic paranoid are similar for all types of the disease, the only difference is their extension over time. A very long binge or a sharp increase in the dose of alcohol can provoke the first attack of paranoid in an alcoholic.
The very first stage of psychosis is withdrawal symptoms (somatovegetative signs, insomnia and nightmares, bad mood). Then affective disorders take over. A painful melancholy, unreasonable anxiety, fear appears, which quickly develops into panic.
Alcoholic delirium soon develops, which can take different forms:
- delusions of persecution (the most common form);
- delusions of relationship;
- delirium of jealousy;
- delusions of self-blame;
- delirium of poisoning, etc.
At the first stage of psychosis, hallucinations may begin - auditory and visual, they last no longer than 1-2 days. The main symptom of alcoholic paranoia is always delusion, which is based on a single thought - that the patient is in danger of physical harm.
The alcoholic is convinced that they want to kill him, and in a very specific way - by poisoning, stabbing, hanging, shooting, quartering, torture, etc. Sometimes the patient believes that his family members are also in danger.
The source of danger is usually specific people - friends, neighbors, random people met on the street. In delusions of jealousy, this could be a wife who dreams of leaving for her lover; if the delirium of self-condemnation begins, then the patient is sure that he has done a great deal and deserves death.
If the delusion of relationships is involved, then it seems to the person that all people treat him with contempt or hatred in advance, and deliberately arrange various nasty things.
The course of alcoholic delirium is traditionally accompanied by a strong feeling of fear. The patient constantly performs impulsive actions: tries to run away, grabs people by the hands, asks for help, screams loudly, hides in the apartment, in attics, in sewer hatches, etc.
Differential diagnosis
One of the most difficult moments in the treatment of alcoholic paranoid occurs at the diagnostic stage. It is often difficult to distinguish between alcoholic psychosis and paranoid schizophrenia complicated by alcoholism. The most severe cases are when the patient suffers from schizotypal disorder due to alcoholism, in which personality changes are quite minor.
To make a correct diagnosis, it is necessary to collect a complete history of the disease. If a person’s psychosis is not associated with binge drinking, hangover, or appears at an early stage of alcoholism, we are talking about paranoid schizophrenia.
There are several other signs that can clearly distinguish between the two disorders:
| Alcohol paranoid | Paranoid schizophrenia associated with alcoholism |
| Always formed due to exacerbation of alcoholism - during binge drinking or severe withdrawal symptoms | There is no obvious clinical picture of alcoholism, withdrawal syndrome is not expressed |
| There is no dissociation (split) in behavior, but there are signs of antisocial behavior, the patient provokes quarrels and conflicts | There are practically no open conflicts, there is a split personality |
| The patient is harsh and rude in communication, can be cruel towards loved ones, especially in a fit of jealousy | The main features are detachment, aloofness, suspicion, emotional coldness towards loved ones |
| Delusional ideas are very specific, based on fear or jealousy, and always logically justified. Hallucinations are rare and very simple | Delusional thoughts often change, do not lend themselves to any logic, all ideas are very strange. Hallucinations are constant and closely related to delusions |
| After an attack of psychosis, alcoholics fully recover their emotional sphere; they often treat their delusional thoughts with humor | Patients with schizophrenia experience obvious emotional disorders - interest in the environment decreases, problems with thinking develop and increase. |
The essence of pathology
Alcoholic paranoid, or alcoholic delusion, is a mental disorder in alcoholism, one of the forms of alcoholic psychosis. This pathology is most typical for the 2nd stage of alcoholism, when alcohol withdrawal syndrome manifests itself for a long period. Alcoholic schizophrenia most often occurs after a long binge against the background of pronounced prodromal phenomena, but it can appear in alcoholics suddenly, like a seizure.
The manifestation of paranoia can cause various forms of delusions: most often, delusions of persecution and alcoholic delusions of jealousy, but forms such as delusions of relationships, self-flagellation or one’s own guilt, poisoning or dangerous illness can also appear. The most interesting thing is that delusional thoughts are realistic in nature, there is very little absurdity or otherworldly in them. They are consistent and systematized, which can sometimes even cause a certain amount of confidence in such assumptions.
Seizures of alcoholic delirium are primary in nature and do not result from hallucinations. With alcoholic paranoia, hallucinations may be an additional background, but they are more likely to be of a secondary nature. The characteristic symptoms in the form of fear or obsession are so convincing that often a sick person turns to the police, loses sleep, and becomes aggressive. As a result, mental disorders associated with alcoholism become very dangerous, both for the alcoholic and for the people around him.
Treatment
Treatment of alcoholic paranoid is carried out exclusively in inpatient settings. In mild forms of psychosis, after hospitalization and the removal of the first symptoms, the patient can be observed and treated on an outpatient basis. In severe cases, the patient is left in the hospital for several days.
Drug treatment is carried out by several groups of drugs:
- neuroleptics;
- tranquilizers;
- antidepressants;
- vitamins, etc.
Immediately after hospitalization, intravenous administration of antipsychotic drugs is required to relieve fear and eliminate behavior disorders (chlorpromazine, haloperidol, diazepam). If attacks of delirium are combined with depressed mood, antidepressants are prescribed. Discharge from the hospital is possible only after the complete disappearance of delusional ideas and signs of aggression.
After eliminating the main symptoms of psychosis, comprehensive treatment of alcoholism is necessary to prevent relapses. This includes working with a psychotherapist, Alcoholics Anonymous groups, etc.
Alcohol paranoid usually does not have serious consequences and does not provoke personality changes - provided that the course of treatment has been completed completely and the patient no longer abuses alcohol. If the patient continues to drink alcohol regularly, hallucinosis and prolonged psychosis may develop against the background of paranoia.
Treating the problem through psychology
There are people who have virtually no psychological problems or blocks, but not everyone is so lucky. Many people have been visiting psychoanalysts for years to overcome their own complexes and fears. When a person abuses alcohol, he develops psychological problems gradually and this cannot be avoided. Over time, such ailments become so serious that they are clearly visible to the patient’s loved ones and even to outsiders.
When an alcohol-dependent person develops alcoholic paranoia, he should think about the need to go to a psychoanalyst. A person in such a state, of course, will not be able to think soberly, but his relatives must take him for treatment. In a hospital setting, very serious psychological work is carried out with patients, the main goals of which should be called:
- finding out in the near future the true cause of the delusional state;
- a person’s conviction that all his problems are hidden exclusively in his head, and real life does not involve them;
- convincing the patient that he is very important for society and is needed by his loved ones.
The combination of psychological work and standard pharmacological medications are the factors that will allow an addicted person to throw his mania into the background. After the work done by doctors, family and friends should understand that the rate of preservation of this positive effect depends solely on their actions.
People suffering from mental disorders constantly require emotional support from the family. A good atmosphere in the house will become a trigger for the fact that over time a person will completely stop drinking vodka and only then will he be able to completely forget about such a psychological disorder as alcoholic paranoid. Relatives should soberly assess the situation, which will help them understand and support their loved one.
