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A retrospective study of alcoholic psychoses is reported. The phenomena of the illnesses corresponded poorly with classical descriptions of alcoholic hallucinosis, delirium tremens and alcoholic paranoia. Alternative diagnostic approaches were tried (Catego, restrictive definition of alcoholic hallucinosis). The problems of distinguishing psychoses with associated organic factors from 'idiopathic' forms are discussed.
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In 35 females and 22 males with acute alcoholic disorders and in 44 individuals of a control group the author studied the indices of thiamine balance--the content of thiamine and pyruvic acid in the blood and urine, concentration of citric acid in the blood, activity of transketolase of erythrocytes and TDP-effect. The results demonstrated that a thiamide deficiency in excretion and insufficiency in coenzyme functions of oxidative decarboxylation of pyruvic acid and in the pentose cycle is seen not only in alcoholic psychoses, but in the withdrawal syndrome. Sex differences of these indices and their development were not noted. It is assumed that the clinical traits of alcoholic disorders in females are not related to changes in the thiamine metabolism.
A clinico-epidemiological study was made of 446 patients who suffered from alcoholic psychoses during 1946--1970. An analysis of the quantitative and qualitative modification of the syndromes, the regularities in their dynamics demonstrated that the transformation of the symptomatology to a large extent depend upon the type of development of the alcoholic psychoses. Transitory psychoses are more frequently replaced by psychopathy-like personality changes. In a remittent development, repeated psychoses are characterized, as a rule, by a delirium or hallucinosis. Following a delirium there are typical acute verbal hallucinosis. During relapses there is an increasing amount of atypical symptoms. In patients with mixed and especially a continuous development of the psychoses, the pathokinesis of syndromes proceeds on the level of profound psychopathological disorders. As a result there may be either schizoform and crude organic clinical pictures and eventually there is a deep organic symptomatology (pseudoparalysis), or against the background of crude alcoholic personality changes, after lucid periods, there may be acute psychotic conditions.
Results of a long-term clinico-catamnestical study of 489 patients with atypical alcoholic psychoses indicate that only the following cases develop atypically; a) where in the framework of separate attacks there is a combination of verbal hallucinosis, diverse more or less systematized delusional ideas (including delusions of influence), separate traits of the syndrome of psychic automatisms and oneiroid episodes; b) where there is a transformation (atypization) of the syndromokinesis from attack to attack; c) where there is a continuation of the process of atypization up to a development of signs of partial or total alcoholic or alcoholic-organic dementia.
An analysis of the clinical picture and development of acute alcoholic psychosis in 300 inhabitants of the North Region permitted to distinguish some traits of these conditions. Psychoses were characterized by an expressed atypicity of the psychopathological picture, somato-vegetative disorders, a complication of the development of the psychoses in comparison with the inhabitants of the middle latitudes. The authors also distinguished some differences in the predilectiveness of some syndromes or symptoms, the character and content of them in alcoholic psychoses in natives and newcomers. It was also possible to establish disorders of psychophysiological adaptation to conditions of the North Regions in the newcomers and first of all in the clinical picture and development of alcoholic delirium.
Among the 36 patients with sluggish schizophrenia in combination with alcoholism there were 6 cases of psychoses appearing against the background of chronic alcoholic intoxication. On the basis of the clinical picture the conclusion is made that the atypicity of clinical signs depends upon the double influence of alcohol on the endogenous process. The described psychoses, in the opinion of the author, are of transient nature changing the development of sluggish schizophrenia under the influence of alcoholism.
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Some results of audiometric studies in 272 patients with different psychoses (schizophrenia, presenile psychoses, alcoholic hallucinoses) were analyzed. The authors examined the auditory adaptation to threshold stimula and the time of reverse adaptation. In most of the cases adaptation was not attained or was lengthened. These studies did not reveal any nosological specificity in adaptational disturbances. In cases of auditory hallucinations the index of adaptational time had no principal differences either. These facts gave ground to consider the adaptational shifts as general nonspecific mechanisms in the pathogenesis of psychoses. An analysis of audiometric data make it possible to use them for prognostical purposes.
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A study of plasmocellular reactions of the bone marrow in alcoholism and alcoholic psychoses demonstrated an increase in the amount of plasmatic cells, a prevalence of mature plasmatic elements with distinctly marked basophilia and a reaction of clasmatosis. These facts indicate the functional preservation in alcoholism of the system of B cells, the derivatives of which are plasmatical elements; of an increase in the protein synthesis (including antibodies) as well as a prevalence of the so-called productive phase of immunogenesis over the adaptive.
Organic psychoses are caused by a variety of disorders. In general, they are due to diffuse dysfunction of the brain without any specific anatomical basis, but they may be modified by disorders of some distinct neuronal systems as a result of local accentuation of a dissuse morbid process or localized brain damage. Acute organic psychoses are usually caused by disorders of the blood-brain barrier (cerebral oedema), acute neuronal dysfunction of disorders of synaptic transmission. Acute lesions may be reversible or terminate in stationary defective states or progressive neuronal degeneration. In late stages, the anatomical sequelae of the basic process and of secondary lesions are hardly to be separated. The non-specificity and inconsistency of brain lesions is demonstrated in chronic alcoholic psychoses. In senile organic psychoses there are quantitative correlations between psychopathological, neurophysiological (slowing of the basic rhythm) and morphological changes, mainly characterized by loss of neurons and synaptic contacts. Vascular syndromes are often over-diagnosed clinically. Localized mental syndromes are non-specific, but show characteristic locations, as they are commonly associated with dysfunction of neuronal systems engaged in storing and recall of information (frontobasal region and limbic system). Further detailed studies are needed in order to achieve better correlation between specific features of behavioural and intellectual defects and anatomical location and quantitiy of lesions.
The paper deals with epidemiological data, concerning the indices and dynamics in the prevalence and incidence of chronic alcoholism and alcoholic psychoses in different contingents of an urban population. The population amounted to approximately 500 000 and was studied during a period of 5 years. The authors note a positive influence of legislative measures, directed against alcoholism and the influence of some social factors (the existence of a family, profession, etc.), on the fullness of the patients detection out of the population. The report contains data on the effectiveness of various approaches in screening patients from different population contingents.
The term "medically clear" has a greater capacity to mislead than to inform correctly. The overuse of this term, especially in emergency room settings, may indicate difficulties in medical education and in the consultation/referral process between psychiatry and other specialties; further, it results in poor patient care. Nonpsychiatric physicians may prematurely refer patients as medically clear because of their unfamiliarity or discomfort with clinical psychiatry. Psychiatrists often ask for medical clearance of patients to hide their discomfort with or antipathy toward clinical medicine. The use of emergency room settings for interspecialty collaboration and training helps minimize the underlying difficulties that lead to the use of this term by fostering psychiatric skills in nonpsychiatrists and a sense of medical identity in psychiatrists.
Death rates from alcohol-related causes correlated with over-all mortality and reflected general health conditions and demographic characteristics as well as the prevalence of alcoholism.
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