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Alcohol related disorders

'

10% 20% - -
alcohol abuse



Comorbidity
-


( , 40% 30% )

heterogenous - Etiology
childhood :

ADHD
conduct disorder

psychodynamic:

overly punitive superego ( ") "


fixation in oral stage -> anxiety

social and cultural

genetic
D2

hereditary

Effect of alcohol

Single drink 12 g of ethanol =

12 ounces of beer
ounces (1 glass) of wine
1 1.5 ounces of vodka or whyski (40)

15-20 mg/dl in blood

biochemistry

( GABA - )

(fluidity of membrans )
* fluidity -
* rigidity -

fluidity-
,
.

N-ACh
-5HT3
GABAa

Glutamate rp.
Voltage-gates Ca channels

Behavioral effects

0.05 % :

:0.1% ()

:0.2% motor area


:0.3%

Coma :0.4%-0.5%

:0.5% >-


sleep latency -
REM -
deep sleep -
sleep fragmentation -

Physiological effect of
alcohol
Liver:

Accumulation of fats and proteins -> fatty liver


-> enlarged liver
Alcoholic hepatitis
Hepatic cirrhosis

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

uric ac., TG, GOT, GPT

alcohol related disorders


1.

dependence and abuse


need for the daily use of large amount for
adequate functioning, or

2.

regular pattern of heavy drinking in weekend,


or

3.

long periods of binges (Dypsomania)

- Binges "
- nonbeverage alcohol

Subtypes of alcohol dependence


:type A

Type B

Alcohol intoxication
.1
.2

.3

()slurred

Alcohol withdrawal



( 6-8 - )


( ( 8-12

) 12- (grand mal - 3% ,

Delirium tremens
. 72
20% -

1.

Delirium

2. Perceptual distortion:
Visual or tactile hallucination

v
v

3. Autonomic hyperactivity:

Tachycardia
Diaphoresis
Fever
Anxiety
Insomnia
Hypertension

4. Fluctuating levels of psychomotor activity from


hyperexcitability to letargy
5-15 30-40


= DT

ASSIVAL 10 MG X 4-6

CLONIDINE

TEGRETOL

:DT .2

,ICU

ASSIVAL 10-20 MG X 6'

.3

Alcohol-induced persisting
dementia
:




, ,

Alcohol-induced persistent
amnestic syndrome

Wernicke-Korsakoff syndrome

v Wernickes encephalopathy a set of acute


symptoms, completely reversible
v Korsakoff syndrome a chronic condition,
only 20% recoveres

Pathophysiology:
B1 deficiency

Poor nutritional habits

Malabsorbtion

Thiamine:

Cofactor

Involved in the conduction of the axon


potential along the axon and in synaptic
transmission

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

Impaired mental syndrome (espessially


recent memory)
Anterograde amnesia
Confabulation

Treatment
1)

Thiamine 100mg x 2-3 2 weeks for


Wernicke, 3-12 month for Korsakoff

2)

Folic Acid 5mg/d

3)

B12

4)

Vit B-group

Blackout
v

Episodes of transient global amnesia


Neurological mechanism alcohol blocks
the consolidation of new memories into old
memories
Place hippocampus and related temporal
lobe structures

Alcohol-induced psychotic
disorders

Delusions
Hallucinations
most commonly auditory
unstructured
voices maligning, threatening

onset during intoxication or withdrawal


-

Idiosyncratic alcohol intoxication


(pathological intoxication
Severe behavior syndrome after small amount of
alcohol
Clinic:

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

Naltrexan 50mg/d - craving


disulfiram (Antabus):

aldehyde dehydrogenase acetaldehyde

disulfiram (Antabus)
aldehyde dehydrogenase
acetaldehyde

flushing
feeling of hate
BP
dizziness
nausea

2) Naltrexan 50mg/d craving

malaise
palpitation
blurred vision
Numbness
>250mg: allergic-toxic
psychosis

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