Delirium Tremens

Alcoholism is considered as a disease that harms not only the health of a sick person, but also his psyche, affecting negatively on his social life and provoking the degradation of the individual. Psychosis, which often becomes a natural result of development of alcoholism, popularly called “delirium tremens” or delirium. Full medical name of this type of psychosis – is delirium tremens. Translated from the Latin, “delirium” means insanity, blurred, dementia, and even madness. These words describe very well the state, known as delirium.

Among the main symptoms of delirium scientists distinguish the next ones:

• severe dizziness of alcoholic;
• the occurrence of auditory hallucinations;
• appearance of visual hallucinations.

In addition, delirium is characterized by an absolutely improper behavior, which is not usual for the patient in a state of sobriety.

We can’t deny the fact that delirium tremens – is a natural consequence of alcoholism. It’s almost impossible for an alcoholic to consume strong drinks and do not have all those discomforts, which are brought by the delirium. Very often a patient, who is told about all those things he has done being in a state of delirium tremens, he feels a horror, because he cannot believe he actually allowed himself to do everything described.

The alcoholic in a state of delirium is often prone to the following things:

• excessive aggressiveness;
• being in an excited state;
• inability to take your bearings in the locality adequately.

Simply put, the patient, being in a state of delirium, is incapacitated and does not perceive well what is happening around.

As a rule, delirium occurs during the booze. The third or fourth day of booze – is the time, when the delirium tremens disclose fully “their” wings, grasping the body and the psyche of the person with alcoholism. If the alcoholic has already had the first attack of delirium tremens, then the appearance of the next ones is practically assured. For the first time delirium tremens occurs in such situation:

• long and severe booze;
• lack of adequate food;
• lack of the necessary medical care.

Before appearance of thee next attack of delirium the exacerbation of chronic diseases can happen. In addition, very often an infection disease comes before delirium tremens, taking away alcoholic’s forces and debilitating the body.

Symptoms of alcoholic delirium

Symptoms, by which we can distinguish the appearance of delirium tremens, are the following:

• thirst for alcoholic beverages disappears, which is normal for a usual state;
• an aversion to alcohol appears (not always);
• alcoholic suffers from mood swings (from depression to overly excited);
• an excessive excitement appears, interfering the patient to sit in one place;
• there is a tremor of limbs;
• there are sleep disorders (nightmares, insomnia, broken light sleep, etc.);
• the occurrence of frightening images after awakening;
• the occurrence of transient visual and auditory hallucinations.

Patients who are wondering how to get rid of negative and frightening manifestations of delirium tremens should remember that the only way to get rid of the unpleasant sensations that occur during delirium tremens – is to give up drinking and start to lead a sober and meaningful lifestyle.

In case, when there is no alcohol dependence yet, it is easier to get rid from delirium tremens, because it will be enough to refuse from alcohol. In case if alcoholic have already has dependence, it is necessary to get rid from pathological craving for alcohol, and the delirium tremens will also break off.

Hallucinations and delirium tremens

Nighttime – is a fertile time for the next attack of delirium tremens. Besides, delirium tremens has a typical progressive nature. Hallucinations, disturbing the patient, are usually associated with those animals, which people afraid being sober. We are talking about different rats, spiders, snakes, mice and similar creatures. It is known that early believers alcoholics in a fit of delirium tremens saw devils and the like, all the inhabitants of the circles of hell. It is known that previous to this time alcoholics believers in a fit of delirium tremens saw devils and similar inhabitants of all circles of hell. Thus, we can say that the patient during delirium tremens will be pursued by that what inspires him a fear or disgust in a sober state. Scary, isn’t it?

Scenes of horror films and thrillers – is also a usual phenomenon for delirium tremens. Auditory hallucinations are accompanied by images that are scrolled in the head of the patient: it may be the sounds that are produced by animals or “soundtrack” to the horror film, which an alcoholic has seen. Unfounded and painful spasm of jealousy, during which an alcoholic is able to make almost any rash, even a terrible act, it is also not unusual for delirium.

Alcoholic’s mimicry during delirium tremens reflects directly what he sees in his hallucinations. You can often see the grimace of a fear, disgust, horror or even pain on the patients’ faces. Alcoholic’s behavioral reaction is also appropriate: he tries to shake off the insects, snakes or drop to get away from the horrors that have been plagued him in the “Scary Movie.”

Tactile hallucinations are a usual part of the overall clinical picture at the time of occurrence of an attack of delirium tremens. It can seem for a patient that those insects and toads, which he is afraid of, crawl on him, and he could feel their touch to his skin. If the point is that a suffering from delirium tremens man feels like living in a horror movie, then he may feel like he was beaten, cut or scratched.

The feeling that there is a foreign object in the mouth – is a wide spread phenomenon for delirium tremens. As a rule, an alcoholic is doing everything possible to take or split out of his mouth this foreign object. A speech of a suck person also is becoming strange and unbelievable: it is difficult to understand what he says. Alcoholic’s thoughts are in a mix and he can’t express what he wants to say, and also has distinct problems with articulation, which make his understanding even more difficult.

In addition, the patient “communicates” with the objects of his hallucinations that can make his behavior, from a distance, truly frightening. Trying to shake off the imaginary amphibians, the patient can talk loudly to them, threatening them or begging them to leave him alone. By and large, during an attack of delirium it can be expected almost any behavior from a patient, which is considered abnormal for a healthy and sober person.

What is dangerous in delirium tremens?

Alcoholics affectionately call the delirium tremens as a “squirrel”, but it’s the only funny moment associated with delirium tremens. The fact is that such obfuscation carries a direct danger not only for the health of a patient, but also to the health and safety of the people around him. Alcoholic psychosis is often a reason why the patient behaves strange and even frightening way: he can start to dash to people, to threaten to throw out of the window (or even do it), to beat someone, etc. there are documented cases in which a patient, driven by his hallucinations, allegedly rushes to assistance “a sufferer”, while in fact he harms a person.

There are also known cases, when alcoholics are reaching a suicide. This typically occurs for two reasons:

• the patient is trying to get rid of the terrible hallucinations and obsessions;
• an alcoholic submits to the “voice”, sounding in his head, and ordering to commit suicide.

In a fit of fever, the patient usually doesn’t forget his passport details and place of residence, but the ability to navigate well in space is usually lost. Especially dangerous for alcoholics is the dark, because rights then the hallucinations capture him with extraordinary power. Daytime – is a time, when hallucinations almost don’t bother him. In the daytime an alcoholic can sleep, resigning himself to deep sleep, dreamless. It is clear that the state of delirium is very exhausting for the body and mind, and therefore, the body and brain of the alcoholic use short daytime lull to regain strength.

The worsening of hallucinations at night – it is a known phenomenon for delirium tremens, which alcoholics with “experience” are so afraid of. Many of those who lived through several such attacks, talk about what a relief comes during those brief instants when the hallucinations and visions are receding, giving the patient an opportunity to think adequacy and regard things in a sober. It is known that there are several forms of delirium tremens:

• severe form of delirium tremens;
• a mild form of delirium tremens.

Depending on the form in which the disease occurs, an alcoholic can see in his hallucinations different things. During a severe form a patient may “dwell” at his workplace, by all his movements and behavior imitating what he used to do while working. Also, the patient can “talk” with colleagues, leading the long dialogues. It often happens when the working situation that the patient sees in his “hallucinations” is getting horrible traits: an alcoholic gets a terrible trauma, his working equipment “alive” and chasing him, he is fired without severance pay, etc.

Muttering delirium – one of the most terrible and difficult forms of alcoholic delirium. An alcoholic who is in a lying or sitting position, looks like begins to feel or smooth some invisible objects. This form of delirium tremens is extremely dangerous because it may become a reason of alcoholic’s decease from collapse. Muttering delirium – is the most complicated form of this psychosis that often ends by death. Experts, who watch muttering delirium, slope to do the most dismal assumptions and provide tragic diagnoses to the patient’s relatives.

Delirium tremens has an extremely negative impact on a human body. Among the negative consequences are the following:

• persistently elevated body temperature;
• high blood pressure;
• dehydration of the body;
• violation of the heart rate.

It is clear that such changes in a normal functioning of a human body leads to gradually progressive deterioration of health.

Also among the symptoms that occur in a fit of delirium tremens, can be observed the next ones:

• yellowing of the eyes white;
• excessive sweating;
• ongoing fever;
• pale skin (or sometimes redness);
• peculiar smell coming from the body.

One of the worst consequences of delirium tremens – is an episodic amnesia which can torture the patient. As a rule, alcoholic remembers better what happened to him during nightmares and hallucinations than actual events, which took place in his life in a fit of delirium tremens or earlier. Often alcoholics are inclined to mix oddly reality and hallucination, telling absolutely fantastic versions of “what is happening”.

There are cases when the diagnosis of delirium tremens has difficulties. We are talking about situations when an alcoholic except vodka and other alcoholic beverages, also takes hallucinogens. In such cases, it’s almost impossible to get know whether the patient has a delirium, or he has just taken the next portion of the substance. Hence, it is impossible to get know which of the therapeutic schemes has to be applied to the patient in this case.

Delirium tremens usually occurs when the patient’s case is already neglected much. As a rule, the time of occurrence of delirium tremens – is the third or even the fourth stage of alcoholism. Often, a withdrawal state becomes sure sign of a coming delirium, exhausting the patient. Experts report that an attack of delirium, which happened to patients at an earlier stage of alcoholism development, is provoked not by an alcohol, but by some other toxic substance.

Doctors are inclined to believe that the formation of delirium tremens develops as a consequence of pathological lesions of the liver, resulting from drinking too much alcohol. There are known clinical cases, when in a patient, suffering from alcoholic delirium, fatty degeneration of the liver cells were found, brain swelling, cerebral hemorrhages, and also symptoms, associated with cardiomyopathy.

According to statistics, 15% of those alcoholics who are suffering from delirium tremens, die. If a case of delirium tremens is heavy then a forecasts of experts will be the most unfavorable. Doctors warn that the earlier you start a treatment from alcoholism, the more likely you can get rid of delirium tremens. Accordingly, the fewer negative effects on the body will be caused by progressive delirium tremens.

Korsakoff’s disease

This kind of psychosis was first described by Russian psychiatrist S.S. Korsakov in 1887. It is believed that the psychosis usually occurs at such category of patients:

• they are at the third stage of alcoholism;
• are aged 40-50 years;
• drink substitutes that contain low-quality alcohol (cologne, substandard alcoholic beverages, etc.).

During a Korsakov’s syndrome patient’s peripheral nervous system is damaged, and also there are manifest and numerous psychiatric disorders, which are normal for Korsakov’s syndrome:

• patient’s memory impairment;
• fixation amnesia;
• impossibility to play a short series of events;
• inability to remember the people’s names, places and names;
• disorientation in time frame;
• disorientation on the ground;
• depression;
• the presence of fearfulness syndromes.

Fixation amnesia – is a disease, characterized by the fact that an alcoholic cannot repeat what he said a few minutes ago. Also this condition is characterized by the fact that the patient forgets the questions asked to him and can get acquainted with the same people several times. The developing of Korsakoff’s psychosis may become a reason that the patient’s mental state will be permanent, which is unusual for him, for example, a constant complacency, timidity, irritability or euphoria.

Among neurological disorders, which accompany this psychosis are often met the follows:

• violation of tendon reflexes;
• loss of sensation;
• painful of nerve trunks.

Besides, at a neglected Korsakov’s syndrome the paralysis may also develop that often cause the disability of alcoholics. There are not rare the situations when patients stay whole their life confined to bed. If an alcoholic is completely abandons the use of alcohol, in a few years many properties of his body and psyche can be restored: memory will back to normal, nerve function will recover. It is unnecessary to hope that the patient’s efficiency will be the same as before the start of the disease, because experience shows that alcoholics, who has recovered from this psychosis, have a sustained reduction of efficiency at after rehabilitation period.

How to treat delirium tremens?

The patient, who is suffering from delirium tremens, must surely receive first aid, because otherwise the outcome can be tragic. Naturally, relatives, who know that their family member – is an alcoholic and he can have a case of delirium tremens, should not run the situation, and visit a doctor in time. Those families, who are faced with delirium for the first time, should remember the following rules of first aid to the patient:

• put an alcoholic to bed and hold him in such position, because there are less chances that patient injures himself and others;
• tie a patient to bed, if you understand that it isn’t possible to hold him in a supine position;
• put an ice on the patient’s head;
• force the sufferer to drink plenty of water (do not forget that delirium is characterized by constant dehydration);
• if possible, try to arrange cold shower for a patient;
• calm alcoholic using hypnotics or sedatives;
• do not leave the sufferer alone, be constantly on hand to monitor his condition;
• call a doctor, who can lead the further measures of alcoholic’s rehabilitation.

Preparations for the treatment of delirium tremens

Experienced professionals usually use a set of tools for the treatment of delirium tremens. We should also emphasize that self-treatment of delirium is unacceptable and dangerous. Remember that treatment should be provided only by experienced professional, who has specialized education and experience of work with alcoholics.

As a rule, in the course of complex treatment of delirium tremens experts use the following tools:

• psychotropic substances;
• detoxification remedies;
• medicines, normalizing metabolism;
• drugs, leading to normal fluid and electrolyte balance;
• medicines, normalizing the heart;
• medicines, leading to normal respiratory function of the body.

Among psychotropic drugs the most often used is haloperidol, droperidol or relanium. Psychomotor agitation is usually removed with the help of such preparations:

• seduxen;
• hydroxybutyrate sodium;
• diphenhydramine.

In order to cleanse the body and rid it of the alcoholic toxins is common to use a range of special tools:

• intravenous infusion of glucose;
• dropper with hemodez;
• dropper with rheopolyglucin;
• hemosorption.

Moreover, it is not uncommon when unitiol, sodium thiosulfate, isotonic solution is used. Also there are definitely products, which support heart functions, among such remedies are used:

• cordiamin;
• corglyconum.

Lasix solution is used in the treatment of delirium in order to avoid cerebral edema, which often occurs during delirium tremens. Vitamins are also the required therapeutic remedy for the treatment of delirium. As a rule, droppers are prescribed, which are composed of vitamins (B1 and B2), and also vitamin C.

Treatment of delirium tremens is provided in special chambers designed for intensive care. The usual duration of an attack of delirium is from six to eight days. All this time, the patient must be under the supervision of experienced medical personnel who will provide therapeutic measures, and also will be able to provide a qualified help in the event of need. Especially it is necessary to keep an eye on a patient at night, when the attacks of delirium tremens with hallucinations will renew. A deep and restful sleep, which may be provided in a hospital, is one of the prerequisites for the healing of the sick from delirium.