Introduction: • Mankind Has Lived With The

8/14/2019 Introduction: Mankind Has Lived With The

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Alcohol 1

ALCOHOL

Introduction:

Mankind has lived with the use and abuse

of Alcoholic beverages for along, long time.

It plays an important role in the social and

religious life of many communities.


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Alcohol 2

Adverse effects documentation

Were done many centuries before Christ.

Knowledge prompted the Buddhists toprohibit its use in 6th Century B.C.

And followers of Islam in the 7th century

B.C.


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Alcohol 3

Current situation

Approximately 20% in patients admissions

in acute psychiatric admissions are due to

alcohol.


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Alcohol 4

The nature of alcohol

Varieties of alcohol are many.

Ethyl alcohol or ethanol or the alcohol used

as beverage is only one of these.

It is a natural product of fermentation-when

sugars,as in fruits or grains, are converted

into alcohol through the action of yeast which

is abundant in nature or added by man.


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Alcohol 5

Contd

Alcohol boils at temperatures lower than

water hence it is possible to make stronger

beverages from weaker ones. Alcohol is name coined from Persian name

of powder distillable known as al kohl.

Pure alcohol is colourless and mixes readily

with water.


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Alcohol 6

Categories of alcoholic beverages

Wines and CidersAre products of direct fermentation of fruit

sugars by natural yeast.

Beers and AlesStarch of grain is converted into sugars by the

process called malting. The sugars are then

fermented by yeasts. Spirits

Distilled from malted beverages or wines.


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Alcohol 7

Metabolism

Alcohol is rapidly absorbed and distributed

throughout all the tissues.

Solubility in water is 30 times greater thanit is in fat.

90% is metabolised in liver

Two to five per cent is eliminated

unchanged through lungs and in urine.


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Alcohol 8

Cont;d

Amount of alcohol breathed out the

concentration in the blood.

Food can retard absorption of alcohol

Breakdown of alcohol occurs at a set rate.


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Alcohol 9

Acute or short term effects of alcohol

Alcohol reaches most organs within minutes.

Subjective effects are felt within 15 to 30

minutes.

Effects are basically governed by the level of

alcohol in the body and the strength of thedrink.


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Alcohol 10

Contd

Concentrated drinks rather than diluted

ones.

Quick drinking rather than sipping drinks

slowly.

Drinking on an empty stomach lead to

stronger and speedier effects.


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Alcohol 11

Alcohol

Progressively depresses many parts of the

brain.

Conspicuous effects are reflected in changes in

Mood

Judgement; and

Behaviour.


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Alcohol 12

Contd

Alcohol is not a stimulant

General effects include:lowering of

temperature

Impaired concentration, co-ordination,

memory and judgement.

these may result in accidents and risk takingbehaviour


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Alcohol 13

Contd

Dehydration

Irritation of stomach and increased secretion

of acid in the stomach Fall in blood sugar increased, leading to

fainting.


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Alcohol 14

Contd

It may also cause rise in blood sugar

Potentiating effect on tranquillizers Sexual desires are increased but

performance is decreased


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Alcohol 15

Effects of long term abuse

Terminology used:

Alcoholism

Alcohol addiction

Alcohol dependence

Problem drinking.


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Alcohol 16

Contd

The first three terms (Alcoholism, Alcoholic

addiction, Alcoholic Dependence) are old andestablished and they are often used

interchangeably.

They all suggest that the condition is chronic.

The term alcoholic is overinclusive and vague

but is preferred by Alcoholics Anonymous

(A.A).


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Alcohol 17

Contd

Alcoholic addiction is claimed to imply moral andsocial judgements.

Dependence is said to be too narrow and clinical.

Furthermore all these three terms (Alcoholism,

Alcoholic addiction, Alcohol dependence) accepts

that alcohol is a disease.


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Alcohol 18

Contd

The vast majority of drinkers who experience

problems or difficulties are not dependent on

or addicted to alcohol. They do not show signs of illness or

experience continued craving.

They resent the label of being an alcoholic


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Alcohol 19

Contd

A relatively new term Problem drinking is

being used to overcome the difficulties of

(Alcoholism, Alcoholic addiction, Alcoholdependence)

A problem drinker is any one who suffers

from harm or causes harm to others due to

the abuse of alcohol.


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Alcohol 20

Contd

Alcoholics, Alcoholic addicts and alcohol

dependents have all experienced harm to

themselves or caused to harm others.

Drinking problem simply means that

there is a problem which is directly linked

with the pattern of drinking.


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Alcohol 21

Contd

Problems may be varied; they may be acute,

Chronic; they may also vary in the type of

harm or difficulty such as social difficulties,

Criminality or disease of the liver.

They can be identified as distinct entities

One need not to be chronic abuser toexperience problems.


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Alcohol 22

Contd

A one-off incident has results in both acute

& long term problems for anyone who is not

an addict or dependent.

Chronic excess may lead to chronic

problems(addiction) as well as acute onessuch as acute inflammation of pancreas.


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Alcohol 23

Contd

Patients find the term drinking problems

more acceptable and especially young

people who are in a phase of abuse ofalcohol.


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Alcohol 24

Increased Tolerance and Dependence

Repeated excessive drinking leads to increasedtolerance and dependence.

Increased tolerance is shown by the ability tohandle the effects of large amounts of alcohol

without obvious signs of intoxication & need

to drink more to experience desired effects.


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Alcohol 25

Contd

The following are some of the morecommonly observed indicators of dependence:

Fear of losing controlInability to feel normal without a certain

amount of alcohol in the blood.

Increasing preoccupation with and cravingfor the effects of alcohol and ensuringadequate supplies


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Alcohol 26

Contd

Realisation of loss of control

Repeated minor withdrawals symptoms

put right by use of alcohol, such asirritability, feeling shaky or anxious etc.

Increased episodes of not remembering

events during drinking (lapses of

memory)


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Alcohol 27

Contd

Unfortunately the process of the dependent

state insidious and may take years to

develop although it may take place morerapidly in women and in some young men,

in a matter of 4 to 5years.


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Alcohol 28

Withdrawal or Abstinence Syndrome

The severity of the syndrome will vary with thedegree of the dependence and from person to

person.

In its severe form it can be life threatening and

10% or more may die if untreated.

Its main feature is marked excitation of the brain,

and these symptoms begin to be evident from the

third or fourth day of sudden abstinence.

They are all more severe if the person is debilitated

or has an acute infection.


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Alcohol 29

Contd

The Main features are:

Increasing in restlessness and agitation

Visible tremor of hands, especially when

trying to use them

Marked apprehension

He looks frightened


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Alcohol 30

Contd

Feeling of being persecuted and chased

Seeing frightening creatures esp in the

dark

Confusion interspersed with short periods

of lucidity Unpredictable mood may be violent or

suicidal.


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Alcohol 31

Contd

Raised temperature

Profuse sweating

Loss of fluids

Feels sick and unable to eat

Epileptic fits


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Alcohol 32

Assessment of alcohol abuse

Features that comprise the alcohol

dependence syndrome may form a basis for

assessment:Narrowing of Repertoire

Silence of drinking


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Alcohol 33

Contd

Increased tolerance

Repeated withdrawal symptoms

Drinking to avoid or relieve withdrawal

symptoms

Subjective compulsion to drink

Reinstatement after abstinence


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Alcohol 34

Abstinence Syndrome

Features of Delirium Tremens:

Tremor

Autonomic overarousal

Clouding of Consciousness

Disorientation

Altered motor activity


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Alcohol 35

Contd

Disorientation

Mood Instability

Illusions

Delusions

Convulsions


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ALCOHOLIC HALLUCINOSIS

Condition is characterized by a prolonged

state of: auditory hallucinations and

delusions:

Preservation or slight clouding of

consciousness

Absence of distinct schizophrenic features suchas thought disorder


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Alcohol 37

Contd

Hallucinations are in third person

Delusions are secondary

The syndrome does not have a clear link

with alcohol withdrawal


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Alcohol 38

ALCOHOLIC PARANOIA

Distinctive feature is the combination of paranoid

delusions with high alcohol consumption.

Auditory hallucinations my be present

Personality is well preserved

Impotence is common in male alcoholics both as an

immediate effect of alcohol intake and as a long-termresult of hypogonadism, hence morbid jealousy.


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Alcohol 39

Contd

Heavy use of alcohol affects production andmetabolism of testosterone testicular

atrophy, oligospermia and erectile impotence.

Gynaecomastia from excess oestrogens.

Opioids reduce the release from the brain of

gonadotrophic hormones in other sexes

reduction of sexual drive and in women ofreproduction functions.


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Alcohol 40

CEREBRAL DAMAGE

Cognitive deficits are common among of

substances other than alcohol.

Prolonged use of benzodiazepines may impair

memory


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Alcohol 41

CEREBRAL DAMAGE IN

ALCOHOLISM Brain shrinkage due to alteration with

ventricular dilation of white matter.

Neuronal damage in the cerebral cortex Subcortial dementia due to damage of

nucleus basalis of Meynert hence cognitiveimpairment of alcoholism.

Psychometric anomalies e.g impairedabstracting and problem-solving functions.


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Alcohol 42

Contd

Reduced visual-spatial performance

Defective memory for recent events

3 cortical areas are predominantly involved:a) The frontal areas features of frontal damage

b) Parietal lobe on the non-dominant side since

vision-spatial deficits point to that regionc) Overall cortical damage not concentrated to a

specific area.


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Alcohol 43

Wernicke-Korsakoff Syndrome

Lesions are located in the medical areas of the

base of the brain around the third ventricle,

sylvian aqueduct and brain stem nuclei.

Mamillary bodies are always affected. Medial

dorsal of nucleus of the thalamus is also

involved when memory loss occurs


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Alcohol 44

Contd

Features include:

Mental changes

Cerebellar ataxiaOphthalmoplegia


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Alcohol 45

Contd

Psychological:

Drowsiness

Disorientation

Amnesia

Stupor or come Ataxia is trunk type


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Alcohol 46

Contd

Occulomotor palsies involves the sixth

cranial nerve leading to weakness or

paralysis of the lateral rectus muscle.

Paralysis of gaze also occur.


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Alcohol 47

Korsakoffs

Features: memoryloss

Condition follows as a long-standing sequel of

Wernickes disorder

Amnesia of events occurring before and after the

onset of illness


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Alcohol 48

Contd

Patients tend to conceal forgetfulness by

confabulations

Thiamine supplements are proposed as a preventive means for the Wernickes

Korsakoffs syndrome


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Alcohol 49

Subdural Haematoma

Alcoholics are liable to develop subdural

haematoma from head injury when intoxicated

Headache

Memory Impairment

Drowsiness and impairment of consciousness

develop often in fluctuating manner

Papilloedema can be absent


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Alcohol 50

Investigative Developments

New techniques for investigations of cerebral

structure and functions hold promise to

deepen understanding of brain damage inalcoholism e.g. magnetic resonance

imaging (MRI) reveals atrophy of the

mammilary bodies in Wernickes disease.


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Alcohol 51

Contd

Changes in the water content of the brain

especially of the matter , are shown by M & I C.

Positron Emmission Tomography (PET) and

Single Photon Emisson Tomography (SPET)

allow evaluation cerebral metabolism, cerebral

blood flowandneuroceptor system.


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Alcohol 52

Magnetic Resonance

Spectroscopy(MRS) Potential powerful non-evasive exploration of

tissue chemistry in vivo.

An integrated examination using RI and

MR & S unifies the anatomical and

biochemical identification of abnormalities


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Alcohol 53

Disorders of Mood

Substance misusers are prone to mood

disturbances of depression and anxiety.

Comorbidity of depression and alcoholism

is commoner in women than in men.


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Alcohol 54

Reasons for Coexistence of Alcoholic

Dependence and Depression Loss of social supports, unemployment due to

drink secondary alcoholism

Pharmacological effects of alcohol

Primary depressive disorder (but secondary

alcoholism may then have its own course)

Alcohol misusers more likely to attend clinics

if depressed


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Alcohol 55

Contd

Fall in blood sugar > leading to fainting.

It may also cause rise in blood sugar.

Potentiating effect on tranquillizers.

Sexual desires are increased but performance

is decreased.


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Alcohol 56

Contd

Some genetic components are common-

possibly

Both secondary to other conditions ofantisocial personality disorder

Drug misuse, characterological depression


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Alcohol 57

MEDICAL ASPECTS OF DRUG

AND ALCOHOL MISUSEDisorders of every bodily system have been

associated with alcohol misuse.

These include:

Gastritis

Liver disorders

Pancreatitis

Cardiomyopathy: amythmias


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Alcohol 58

Contd

Carcinoma: Oropharnyx, larynx,

oesophagus and liver

Peripheral neurophathy

Cerebral ataxia is reversible and benign


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Alcohol 59

Contd

Some patients with longstanding cirrhosis

develop liver cancer. The stigmata of

chronic liver diseases are:

Telangiectasia

Palmar erythema

Hypogonadism and feminisation in men


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Alcohol 60

Contd

In fatty liver hepatic function is preserved.

Alcohol hepatisis is characterized by

leucocytosis, elevated ALT and in severe

cases by prolonged prothrombrin time and

renal failure.


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Alcohol 61

ContdClinical features of chronic pancreatitis:

Jack-Knife pain patient assumes a stoopedposition

Nausea and Vomiting

Weight lossSteatorrhoea

Diabetes

Jaundice (in later stages)Ultrasound and CT scanning are main diagnostic aids


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Alcohol 62

OTHER NEUROLOGICAL

DISORDERS Peripheral Neuropathy

Sensorimotor Neuropathy

It begins as weakness diminished reflexes, pain and

numbness in the lower limbs

Walking downstairs may become particularly

difficult, as proprioception is lost. Foot drop may

develop.


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Alcohol 63

Contd

Histology in alcoholic neuropathy shows

destruction of the myelin sheath and axon.

This neuropathy improves with abstinence andthiamine, but worsens even with vitamin

therapy if the patient continues to drink

Recovery is slowly and may not be complete insevere cases, the patient may need a wheelchair


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Alcohol 64

CEREBELLAR ATROPHY

Presents as gait axatia and nystagmus is

rarely seen. The gait is wide-based and the

patient may look drunk as he walks. CT Scan

shows atrophy, which can be present beforeclinical signs.

Treatment is abstinence from alcohol and

vitamin supplements. Once established thesyndrome is largely irreversible.


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Alcohol 65

Skin & Skeletal Complications

Psoriasis is worsened by heavy alcohol

consumption

Alcohol may play a part in the developmentdiscoid eczema. The coin-shaped patches of

eczema occurring particularly on the shins

of middle-aged men.


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Alcohol 66

Contd

Some genetic components are common-

possibly

Both secondary to other conditions ofantisocial personality disorder

Drug misuse, characterological depression



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Alcohol 67


AND ALCOHOL MISUSE

Disorders of every bodily system have been

associated with alcohol misuse.

These include:Gastritis

Liver disorders

PancreatitisCardiomyopathy: amythmias


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Alcohol 68

Contd

Carcinoma: Oropharnyx, larnyx, oesophagus

and liver

Peripheral neurophathy

Cerebral ataxia is reversible and benign

C d


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Alcohol 69

Contd

Alcoholic hepatitis (degeneration of hepatocytes),inflammatory infiltration and mallorys hyaline

can lead to liver failure with jaundice,

hepatomegally and severe coagulopathy: cirrhosis

(widespread fibrosis connecting the portal triads

and central veins and degenerative nodules

leading to architectural disruptions) complicated

by portal hypertension, ascites, hepatic encephalo-phathy or renal failure


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Contd

Some patients with longstanding cirrhosis

develop liver cancer. The stigmata of

chronic liver diseases are:Telangiectasia

Palmar erythema

Hypogonadism and feminisation in men

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Introduction: • Mankind Has Lived With The

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