Mental disorders caused by alcohol use

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

Acute: Alcohol intoxication[edit | edit source]

Clinical features[edit | edit source]

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

Treatment[edit | edit source]

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

Chronic: Alcohol use disorder[edit | edit source]

Epidemiology and Etiology[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

  • 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

Alcoholic cerebellar degeneration due to chronic alcohol use[edit | edit source]

Chronic alcohol use: Marchiafava-Bignami disease[edit | edit source]

  • 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[edit | edit source]

  • 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

Wernicke-korsakoff syndrome[edit | edit source]

Alcohol withdrawal (separate question)[edit | edit source]

  • 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