5. Alcoholic personality changes and the weakening of situational control. Observed the sharpening of premorbid personality traits in the beginning in a condition of alcoholic intoxication, and then out of communication with him, to obscure, to some extent, social adaptation. The first signs of moral and ethical decline of the individual. In particular, the increase of sexual activity on stage I, and the neglect of moral constraints leads to casual sexual relations. A manifestation of the weakening of situational control is the lack of adequate assessment of the situation associated with alcoholism and its consequences, for example, when the appearance in a state of intoxication threatens serious trouble. Adolescents and young people often neglect the situation because of bravado, desire to draw attention to themselves.
Except for pathological craving and mental dependence, other signs are less permanent and therefore less reliable for the diagnosis of alcoholism. However, signs of altered reactivity indicated the formation of the initial manifestations of physical dependence related to changes in the metabolism of alcohol in the body, which increase as the progression of alcoholism.
Main clinical signs II (expanded) stage of alcoholism
1. Of primary pathological attraction to alcohol is becoming more intense, comparable to such vital needs as hunger or thirst. It manifests itself often the type a compulsive (irresistible) desire to drink alcohol, which is urgently needed. His absence causes painful disorder.
2. The syndrome of altered reactivity manifests the further growth of tolerance (5-6 times), reaching of the individual maximum for a particular patient. As a rule, loss of quantitative control. Often there is a “critical” dose of alcohol, after which further control the quantity of alcohol becomes impossible. Often, there is a transition to the use of stronger, low-grade drinks. The maximum tolerance is kept at this level for several years – a plateau of tolerance.
3. The change in the pattern of intoxication is expressed in the increase in modified forms of intoxication by type of dysphoric, hysterical, distimicescie, apathetic, etc the Euphoria of intoxication is becoming shorter and weaker. It is replaced by irritability, explosiveness, discontent, propensity for scandal, and aggression. Strengthen secondary attraction to alcohol, an even deeper loss of the quantitative control lead to frequent heavy (superslim) degrees of intoxication with subsequent amnesia (amnestic forms of intoxication).
4. The formation of alcohol withdrawal syndrome (physical dependence). Abstinence is called a painful condition resulting from the cessation of intake of usual dose of alcohol syndrome “deprivation of alcohol.” The appearance of withdrawal syndrome indicates the final formation of the alcoholic disease, because a complete large on narcotics syndrome. Physical dependence is reflected in the fact that all violations that occur during abstinence, in time, eliminated or mitigated by drinking alcoholic beverages. The abstinence is shown mental, neurological and somatic disorders.
Psychic manifestations withdrawal syndrome can be exhausted in mild cases with asthenia irritability, causeless anxiety, various fears, joined by insomnia, restless sleep with nightmares. Depending on the premorbid features can be dysphoria, a hysterical forms of behaviour with demonstrative suicidal attempts, depression with true suicidal intent, paranoid ideas of jealousy, of persecution, relationships. In cases of severe withdrawal symptoms can develop alcoholic (metacholine) psychosis: delirium (“delirium tremens”), hallucinosis, paranoid.
Somatic disorders expressed General physical discomfort, complaining of headache, palpitations, and other unpleasant sensations in the heart area. Blood pressure often improves, sometimes significantly. Typical vegetative symptoms: the game of vasomotion, puffy face, injection of sclera, alternating chills and heavy sweats, dry mouth, thirst and loss of appetite. Can cause nausea and vomiting, not associated directly with alcohol, and appearing a few hours after alcoholic excess, other diarrhoeal disorders.
Neurological manifestations are characterized in mild cases tremor of the fingers, severe – tremor of the whole body, dysarthria due to tremor of the tongue, with elements of ataxia, which is manifested in the walk and recorded in Romberg, sometimes deployed or abortive seizures (“alcoholic epilepsy”).
Abstinence begins in 12-24 hours after drinking. Its duration depending on the severity from 1-2 days. up to 1-2 weeks. Under intensive treatment, aimed at eliminating the main links of pathogenesis, it is completed quickly and is easier.
5. The change of use of alcohol due to the need “to stop” withdrawal phenomenon with the help of apollania. Usually this is reflected in the formation of pseudotyping, “intermittent” or permanent type of alcohol abuse. Pseudonapaea (about binges) usually last from several days to weeks, sometimes longer. The beginning and end of alcoholic excesses, usually associated with psychosocial factors (significant event, the end of the week, getting money, etc.). The reasons for the interrupt are usually active opposition to the continued drunkenness of the environment (discipline, family and other conflicts, etc.) or lack of funds to purchase alcoholic beverages. However, this desire and physical ability to continue drink continue. With the constant abuse (the permanent type of alcoholism on the background of high tolerance) almost every day, mostly in the afternoon or evening, patients drink large amounts of alcohol and morning “hangover” with the help of small doses of spirits or beer and other alcoholic drinks to avoid withdrawal. Drinking an intermittent combination of long continuous use of small doses of alcohol on this background the more massive episodes of alcohol abuse, lasting up to several days.
6. Personality changes grow it in stage II. Notes sharpening and callous traits: hypertime become more euphoric, illegible in Dating, inclined to break rules and laws, to take risks, careless lifestyle, schizoid becoming even more insular epileptoid – explosive and prone to dysphorias, isteroidov increase their inherent demonstrative and theatrical. More obvious is the loss of situational control – drink with anyone and anywhere. In the absence of alcohol have resorted to surrogates – different alcohol-containing liquids (antifreeze for cleaning windshields, pharmaceutical tinctures, etc.).
7. Somatic complications of alcoholism may appear under the expanded alcoholism. Especially characteristic of alcoholic fatty liver and chronic alcoholic hepatitis. Often, the liver acts from under the costal arch, painful on palpation. Can disrupt liver function tests (particularly sensitive bromsulfaleinovy), which can serve as an indirect symptom alcoholic disease. Liver damage threatens to go further in alcoholic cirrhosis. Another frequent complication is alcoholic cardiomyopathy (tachycardia, expanding the boundaries of the heart, muffled heart tones, shortness of breath during physical exertion). Meet alcoholic pancreatitis, both acute and chronic, and alcoholic gastritis. Alcoholism contributes to the development of gastric ulcer and duodenal ulcer.