Alcoholic abstinentny syndrome: clinical picture

Alcoholic abstinentny syndrome: clinical pictureAlcoholic abstinentny syndrome (AAS) – one of most often meeting conditions in narcological practice. Key feature is the emergence of the mental and physical discomfort arising after the termination of regular alcohol intake against the expressed inclination to it.

Term AAS definition in its modern understanding, and also ordering of its symptoms belong to S. G. Zhislin.

Abstinentsiy (absatinence) in English-speaking literature is understood as complete abstention from alcohol including after treatment, and for designation of an abstinentny syndrome the term «a syndrome an otnyatiya» is used (withdraqal syndrome).

AAS considerably differs from a "usual" condition when the person simply drank the superfluous. It is necessary to emphasize that AAS is an obvious symptom of alcoholism that means that the person who had AAS, cannot refuse the diagnosis alcoholism any more. Quite often AAS develops in a hospital at the patients hospitalized in connection with other diseases, but regularly drinking before hospitalization.

In most cases formation of AAS occurs after 2-7 years of abuse of alcohol. Clinically AAS is distinctly shown in the II stage of alcoholism. In some cases, at the extremely intensive alkogolizatsiya of AAS, terms are reduced till 1-1,5 years. Recently the tendency of sharp reduction of terms of formation of AAS (hereditary predisposition to alcoholism, the early beginning of alcohol intake etc.) is traced. At alcohol intake renewal in case of long-term abstention from it (for example, long remission) the hungover phenomena are observed again, against alcoholism recurrence with clinical signs of the same stage on which remission began.

Assessment of extent of development and expressiveness of clinical manifestations carry out on F scale. Iber:

Severity of AAS on F scale. Iber (1993)

AAS degree

Clinical signs

I

Minimum signs of AAS
Feeling of weakness, "running eyes", inability to concentrate attention

II

Moderately expressed AAS
Violation of visual contact to the doctor, agitation increase, pulse rate and breath strengthening, sleeplessness, anorexia

III

Expressed AAS
The minimum visual contact ("a wandering look"), the insomniya, anorexia, Episodes of violation of consciousness on depth or on quality, are possible hallucinations

IV

Heavy AAS
The expressed hyper reactance, tachycardia, short wind, гипергидроз, the expressed independent dizregulyatsiya, absence of visual contact, a hallucination, are possible the spasms, total absence of a dream and appetite

In a clinical picture allocate two groups of symptoms: easy (early) and heavy (late). There is an opinion that easy symptoms without treatment are always replaced heavy and that heavy symptoms are preceded surely by lungs. However in practice this regularity is observed far not at all patients, and to be guided by it does not follow; late symptoms can develop at once, without harbingers.

Easy (early) symptoms: emergence terms – from several hours to 10 days (usually 6-48 hours) after the alcohol intake termination; at alcohol intake renewal they quite often disappear.

Gastroenteric violations:

  • Lack of appetite
  • Nausea
  • Vomiting
  • Unpleasant feelings in a stomach
  • Diarrhea

Muscular symptoms:

  • Muscular weakness
  • Painful spasms

Dream violations:

  • Sleeplessness
  • Nightmares

Vegetative violations (excitement of sympathetic nervous system):

  • Tachycardia
  • Systolic arterial hypertension
  • Perspiration
  • Tremor
  • Hyperthermia

Behavior violations:

  • Irritability
  • Aggression
  • Concern
  • Excitement
  • The strengthened chetverokholmny reflex (reaction to a sudden irritant)

Disorders of cognitive functions:

  • Attention violation
  • Memory violation
  • Violation of judgment and other highest mental functions

Heavy (late) symptoms: emergence terms – in 48-96 h after the alcohol intake termination. Sometimes an alcoholic abstinentny syndrome call only the heaviest form – alcoholic deliriya, or delirium tremens. However the alcoholic abstinentny syndrome is very diverse. Prodromalnye symptoms can be hardly appreciable (easy irritability and negativism). The tremor and acoustical hallucinations are sometimes observed only, and developed alcoholic deliriya does not come. Quite often alcoholic abstinentny syndrome begins with a big epileptic seizure (in these cases exclude other reasons of an attack – a craniocereberal trauma, the metabolic reasons, infections, in particular meningitis). Therefore "alcoholic deliriya", "menacing alcoholic deliriya" it is necessary to use terms only when the diagnosis does not cause doubts.

Strengthening of early symptoms, especially following:

  • Tremor
  • Perspiration
  • Tachycardia
  • Excitement
  • The strengthened chetverokholmny reflex

Consciousness obscuring:

  • Fast (within one hour) changes of semiology and weight of a condition
  • Disorders of cognitive functions
  • Disorientation in a place and in time

Hallucinations:

  • Acoustical, visual, tactile
  • Often – menacing hallucinations

Nonsense:

  • Usually paranoidny
  • It is caused by the maintenance of hallucinations
  • It can be accompanied by fear and excitement

Epileptic seizures:

  • Usually initially generalizovanny, but happen also partsialny to secondary generalization
  • Attacks in the anamnesis can not be
  • Develop in the first 48 h after the last alcohol intake
  • Usually pass without treatment
  • The attack is preceded always by the expressed excitement, confusion of consciousness, a hallucination

Treatment of not complicated AAS can be carried out in house conditions. However, considering not always predicted current of AAS it is necessary to know about indications to hospitalization. At emergence of the developed picture alcoholic a deliriya the probability of a lethal outcome makes 1 %.

Indications to hospitalization of patients with AAS:

  • The expressed tremor
  • Hallucinations
  • Expressed dehydration
  • Body temperature from above 38,3°C
  • Epileptic seizure without instructions on epilepsy in the anamnesis
  • Consciousness obscuring
  • Encephalopathy to Vernika (ataxy, нистагм, internuclear oftalmoplegiya)
  • Injury of the head with the confirmed loss of consciousness

Existence of accompanying diseases:

  • Dekompensirovanny hepatic insufficiency
  • Respiratory insufficiency
  • Infections of respiratory ways
  • Gastroenteric bleeding
  • Pancreatitis
  • Heavy exhaustion
  • Mental disease (heavy depression, risk of suicide, exacerbation of schizophrenia or MDP)
  • Existence in the anamnesis of the alcoholic abstinentny syndrome, accompanied deliriy, psychosis, epileptic seizures

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