Delirium tremens


Alcoholism is a serious disease, very dangerous to the patient himself and those who are around him because of psychosis, called “derilium tremens”, popularly also called “barrel fever”. In Latin “delirium” means “insanity, madness”, which describes this state in the best way possible. Delirium tremens is characterized by mental disorders and developing horrible optical and hearing hallucinations.

Alcoholism and delirium tremens always come together. In a state of alcohol abuse the patient does not know his way around and cannot tell the time, he is also aggressive and extremely overwrought.

Delirium tremens

According to cases history, delirium tremens can start on the 2-4th days after the binge drinking, but it can also happen during it. The first delirium tremens attack usually occurs after a long-time heavy drinking. The next ones can happen even after shorter periods of drinking alcohol. Very often aggravation of a chronical infection goes before delirium tremens, and sometimes a patient suffers from the new infection before it.

Delirium tremens symptoms

There are special symptoms, which show the beginning of a delirium tremens attack.

1. Lack of hunger for alcohol. Right before the beginning of alcohol delirium, alcoholics feel lack of hunger for alcohol and sometimes even disgust to drinking alcohol.
2. Mood swings. The change in the mood from happiness to depression, sadness or fear can also show the close start of delirium tremens.
3. Limbs shaking.
4. Insomnia, sleep, troubled with nightmares. After awaking, the patient can see non-existent images and hear non-existent noises.

How to escape delirium tremens? The answer to this question is simple – quit drinking alcohol if the person is not addicted to alcohol yet. And if the patient already suffers from alcoholism, start immediate treatment.

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Delirium tremens hallucinations

Delirium tremens attacks usually happen at the dark time of the day. The way attack is usually happens is progressive. Among all hallucinations that alcoholic can see are images of insects, reptiles and small animals, like spiders, mice or rats, which person is afraid in real life. In former times, religious alcoholics saw the images of devils. They can also see the images of nets, webs, ropes, that trapped him and he cannot find the way out of them; or he can see the scenes from horror movies with chaos and destruction prevailing. Very often those images are not three-dimensional, they look more like the movie watching. Hearing hallucinations are always connected to what the patient sees in his optical hallucinations. He can hear the sounds of animals, horror or threat. Sometimes, in a state of delirium tremens, the patient experiences alcoholic jealousy.

Everything alcoholic can see or hear during delirium tremens attack, expresses on his face with mimic. Facial expressions of  fear, horror and perplexity change each other during this attack. He is trying to get rid of imaginary insects and reptile, pushes someone away from himself or tries to hide. He feels like insects and reptiles are crawling on him, like someone or something bites him, cuts or beats him. The state of feeling foreign body in his mouth is very common while delirium tremens attack, thus the patient is trying to spit it or get it out of his mouth with his hands. The speech of the patient is unclear and sharp, very often he just shout out separate phrases, talking to the imaginary images he sees.

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Delirium tremens dangers

Delirium tremens or “Belochka”, which is a pet name for it given by alcoholics, is a type of psychosis that is dangerous for both patient’s health and those who are around him. In this state a person can suddenly jump out of the window, or try to help the injured, as it seems to him, but in reality, only making damage to someone, who is next to him. While trying to get rid of obsessive horrible hallucinations or obeying the inner voices in his own head, the patient can commit suicide.

During delirium tremens attack, the patient loses control over the place where he is. He does not realize where he is exactly and where to go. At the same time, he will give you exact details about himself, like his name and other information.

Hallucinations, that are common in a state of delirium tremens, weaken during the day time, becoming bright and vivid by the evening and at night. There are so called delirium free intervals, when the patient does not have hallucinations and can describe them.

Delirium tremens

There are more severe forms of delirium tremens. For example, professional delirium, when a person is sure he is at his working place. He moves and makes sounds that are common for his professional activity.

Muttering delirium is one of the most complicated forms of a disease. Being in the state of muttering delirium, the patient, laying in bed, constantly mutters and makes movements, that remind touching, sponging –down or smoothing. This kind of behavior can become the reason of lethal outcome – from collapse to joined pneumonia.

Delirium tremens badly damages human organism. Alcohol delirium has negative effect on physical state of a patient. The state of his health gradually worsens. The temperature rises ( from +38 С to 40 C and even higher) and his blood pressure also rises. The patient experiences dehydrating, the frequency of heart beating is affected as well. Alcoholic cannot move, he suffers from fever, changing with sweating, his eye whites turn yellow and his skin becomes pale, or very seldom red. His body has specific unpleasant smell.

Delirium tremens is also characterized by blackouts. The patient can better remember imaginary events he saw in his hallucinations and what he felt, rather than real life events and his own behavior.

It might be difficult to diagnose delirium tremens if the patient also took other hallucinations causing substances together with alcohol. The fact, that proves delirium to be after drinking alcohol, is that it always happens on the second or third stage of alcoholism and before delirium attack starts, the patient usually experience withdrawal symptoms. If delirium tremens happen on the first stage of alcoholism, then other toxic matters caused it.

Pathogenesis of alcohol delirium tremens happens because of the intoxication of the organism because of the alcohol-induced liver injury. Morbid anatomy  describes heavy lethal outcomes, when alcoholics suffer from brain edema, fat degeneration of the liver, splinter hemorrhages of the brain and cardiopathy signs.

Lethal outcomes during alcohol delirium goes up to 15%. Prognosis for the patients in serious cases are poor. During muttering delirium the percent of lethal outcomes is high; during professional delirium  alcohol Korsakoff syndrome can occur very often.

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Alcohol Korsakoff syndrome

This kind of psychosis was first described by Russian psychiatrist Korsakoff S.S. (1887). This type of psychosis can occur on the third stage of alcoholism among patients, who are between 40 and 50 years old, who drink alcohol surrogates like low quality alcohol, cologne etc. Alcohol Korsakoff syndrome is characterized by obvious mental disorders together with peripheral nervous system breakdown.

The clinical picture of this disease is characterized by the memory disorders of a patient with fixation amnesia. The patient immediately forgets everything he was asked about, does not remember his past and even present, his ability to reproduce the events that had happened to him is disrupted. People who suffer from alcohol Korsakoff syndrome cannot memorize the names of the people who are around them and can greet the same person several times. The patients are disoriented in time and space, anxious and nervous. On the next stage of this disease they can show organic psychosyndromes like feeling euphoria, the state of placidity or even apathy and weakness. Neurological disorders are characterized by sense shock,

Weakening or disappearing of tendon reflexes, pain in nervous trunks.

During alcohol Korsakoff syndrome, the patients develop paresis, palsies, which makes the patients disabled. A lot of patients  stay bedridden. This disease lasts for a long time. if the patient quits drinking completely, his state and his memory can improve and normalize in 203 years, but in most cases ability to work declines dramatically and stays like this.

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Delirium tremens treatment

What to do if someone has a delirium tremens? Delirium tremens attack is a reason to immediate hospitalizing of a patient to psychiatric specialized hospital, where he will receive treatment with medications. Without professional help the patient can die.

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First help during delirium tremens attack

The patient should be taken to the bed and one has to try and keep him there. If necessary, he can even be tied to the bed until the doctor arrives. You should put ice on his head and hive him plenty of liquid to drink. A cold shower can also be of help.

You should try to calm the patient down. Give him some tranquilizers and sleeping pills. You should keep an eye on the patient in a state of delirium tremens, otherwise he can harm either himself or those who are around him.

How to treat delirium tremens? To treat this disease doctors use mood-altering drugs or disintoxication medicines, which normalize metabolism and fluid-and-electrolyte balance in patient’s organism, normalize heart functioning and breathing.

Relanium is the most often used medication among mood-altering drugs. Small doses of galoperidol and droperidol also suppress anxiety and hallucinations for some time. To take down  psychomotor excitement patients get injections of diphenylhydramine, seduxen and sodium.

To eliminate organism intoxication, doctors use intravenous drop infusions of glucose, haemodes, reopoliglukin and hemosorption. In many cases infusions of unitiol, sodium thiosulfate and isotonic solution is also used. The heart functioning is supported by cordiamin and corglicon. To avoid brain edema, patients get infusion of 1% furosemide solution. Group B vitamins are also prescribed to the patients (2-3 ml of 5% solution of vitamins B1 and B6) and vitamin C (10 ml of 5% solution).

When a patient is diagnosed with delirium tremens, the treatment is taking place in special rooms of intensive therapy. The state of delirium tremens usually lasts from 2 to 8 days. During the day time the patient feels relief, but at night the symptoms aggravate. Recovery usually happens after a long deep sleep in most cases.

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