'
10% 20% - -
alcohol abuse
Comorbidity
-
( , 40% 30% )
heterogenous - Etiology
childhood :
ADHD
conduct disorder
psychodynamic:
genetic
D2
hereditary
Effect of alcohol
12 ounces of beer
ounces (1 glass) of wine
1 1.5 ounces of vodka or whyski (40)
biochemistry
( GABA - )
(fluidity of membrans )
* fluidity -
* rigidity -
fluidity-
,
.
N-ACh
-5HT3
GABAa
Glutamate rp.
Voltage-gates Ca channels
Behavioral effects
0.05 % :
:0.1% ()
:0.3%
Coma :0.4%-0.5%
:0.5% >-
sleep latency -
REM -
deep sleep -
sleep fragmentation -
Physiological effect of
alcohol
Liver:
Gastrointestinal system
Esopahagitis
Gastritis
Achlorhydria
Gastric ulcer
Esopahagial varices -> rupture
Pancreatitis
Pancreatic insufficiency
Pancreatic cancer
Inadequately digestion
Avitaminoses ( absorbtion vit. B (
Small intestine disorders
blood pressure
dysregulation of lipoproteins and triglycerides
cardio-vascular disease and MI
resting cardiac output
heart rate
myocardial oxygen consumption
cancer (head, neck, esophageal, stomach,
hepatic, colonic, lung)
acute intoxication -> hypoglycemia
estradiol
Laboratory:
GGT
MCV
2.
3.
- Binges "
- nonbeverage alcohol
Type B
Alcohol intoxication
.1
.2
.3
()slurred
Alcohol withdrawal
( 6-8 - )
( ( 8-12
Delirium tremens
. 72
20% -
1.
Delirium
2. Perceptual distortion:
Visual or tactile hallucination
v
v
3. Autonomic hyperactivity:
Tachycardia
Diaphoresis
Fever
Anxiety
Insomnia
Hypertension
= DT
ASSIVAL 10 MG X 4-6
CLONIDINE
TEGRETOL
:DT .2
,ICU
.3
Alcohol-induced persisting
dementia
:
, ,
Alcohol-induced persistent
amnestic syndrome
Wernicke-Korsakoff syndrome
Pathophysiology:
B1 deficiency
Malabsorbtion
Thiamine:
Cofactor
Neuropathological lessions
(symmetrical and paraventricular):
Mammillary bodies
Thalamus
Hypothalamus
Midbrain
Pons
Medulla
Fornix
Cerebellum
Symptoms of Wernickes
encephalopathy
Ataxia
Vestibular dysfunction
Confusion
Ocular motility abnormalities
Horizontal nystagmus
Lateral rectal palsy
Gaze palsy bilateral, but not
symmetrical
Sluggish reaction to light
Anisocoria
May be
spontaneou
s recovery
or
Korsakoff syndrome
Treatment
1)
2)
3)
B12
4)
Vit B-group
Blackout
v
Alcohol-induced psychotic
disorders
Delusions
Hallucinations
most commonly auditory
unstructured
voices maligning, threatening
1.
2.
Confusion
Aggression
Suicide
Prolonged sleep
Unable to recall
Treatment:
3.
4.
restriction
Halidol in small amount
Treatment of alcoholism
1.Psychotherapy
2.Pharmacotherapy:
v
disulfiram (Antabus)
aldehyde dehydrogenase
acetaldehyde
flushing
feeling of hate
BP
dizziness
nausea
malaise
palpitation
blurred vision
Numbness
>250mg: allergic-toxic
psychosis