Mental disorders caused by alcohol use

For all mental disorders caused by substances- F10-19→ subclassification

Clinical features

 * alteration in consciousness, cognition, perception, judgement, affect and/or behavior

Treatment

 * benzos or haloperidol if aggressive
 * mechanical restraints
 * fluid-therapy
 * thiamine
 * correction of electrolyte dysbalance, hypoglycemia and hypothermia..

Epidemiology and Etiology

 * m>w
 * associated mental disorders: personality disorders, mood disorders (e.g. depression, anxiety..
 * genetic factors? neurobiologic factors (dysregulation of endogenous reward system?)?, psychosocial factors?

Dx

 * Screening tests e.g. AUDIT-C (alcohol use disorder identification test)
 * 0-12, + if > 4 in men and > 3 in women
 * CAGE test
 * DSM-5 criteria
 * mild, moderate, severe

Tx

 * psychosocial (AA)
 * Pharmacotherapy
 * Naltrexon (1st line): to reduce craving
 * disulfiram: negative conditioning
 * acamprosate: blocks central glutamate receptors to reduce cravings for alcohol
 * topiramate or gabapentin: for refractory cases
 * Give vitamins
 * b1,6,9,12

Chronic alcohol use: Marchiafava-Bignami disease

 * degeneration and necrosis of the corpus callosum due to malnutrtion due to chronic alcohol use → cognitive impairment and dementia, behavioral changes, epileptic seizures

Wernicke encephalopathy

 * acute, reversible due to b12 deficiency due to chronic heavy alcohol use
 * triad of: confusion, oculomotor dysfunction and gait ataxia (33% of patients)
 * can progress to korsakoff syndrome → personality changes, amnesia (anterograde and retrograde) and confabulation
 * MoA: thiamine is a cofactor for enzymes involved in cerebral glucose metabolism → depleted ATP and injury of neurons

Alcohol withdrawal (separate question)

 * after 6-36 hours of last drink
 * tremor, insomnia, anxiety, palpitations, sweating, headache...
 * withdrawal seizures
 * alcoholic hallucinations (auditory, visual, tactile, delusions...)
 * Delirium tremens
 * 2-3 days after the last drop of alcohol
 * features of delirium (changes in conciousness, hallucinations) + autonomic instability (tachycardia, HT, anxiety, nausea, sweating), seizures, psychomotor agitation, tremor...
 * can last 1-5 days
 * Treatment
 * IV fluid therapy, electrolyte correction
 * Thiamine...
 * IV benzos