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ALCOHOL RELATED

DISORDERS

Alcoholism
most

common psychiatric disorders


observed in the Western world
2 million injuries each year
22,000 deaths

Alcohol
causes

both acute and chronic


changes in almost all neurochemical
systems
serious temporary psychological
symptoms
can produce tolerance

Prevalence
90%

of the
population
early to middle
teens most
people begin to
drink
1.3 men to 1.0
women
middle or late
teens to the mid-

Prevalence

Comorbidity
Antisocial

personality disorder
Mood disorders
Anxiety disorders
Suicide

Etiology
Psychological

theories
Psychodynamic Theories
Behavioral Theories
Sociocultural Theories
Childhood History
Genetic Theories

Psychological Theories
decreases

nervousness
helps them cope stress
enhanced feeling of well-being
improved ease of interactions
muscle tension
nervousness
tension

Psychodynamic Theories
fixated

at the oral stage of


development

Behavioral Theories
rewarding

effects of drinking
cognitive attitudes toward
responsibility for ones behavior
subsequent reinforcement

Sociocultural Theories
Ethnic

Groups
Environmental events 40% of
alcoholism risk

Childhood History
a

range of deficits on neurocognitive


testing
low amplitude of the P300 wave on
evoked potential testing
variety of abnormalities on
electroencephalography (EEG) recording
ADHD
conduct disorder
Antisocial personality disorder

Genetic Theories
1.

a threefold to fourfold increased


risk for severe alcohol problems is
seen in close relatives of alcoholic
people
2. twin studies
3. adoption-type studies
4. studies in animals

Genetic Theories
1.

a threefold to fourfold increased


risk for severe alcohol problems is
seen in close relatives of alcoholic
people
2. twin studies
3. adoption-type studies
4. studies in animals

Effects of Alcohol

Effects of Alcohol
refers

to a large group of organic


molecules that have a hydroxyl
group (-OH) attached to a saturated
carbon atom

Effects of Alcohol
Ethyl

alcohol
also called ethanol
common form of alcohol
beverage alcohol
used for drinking
Chemical formula: CH3-CH2-OH.

Effects of Alcohol
single

drink: 12 g of ethanol: 12
ounces of beer (7.2 proof, 3.6
percent ethanol in the United
States), one 4-ounce glass of
nonfortified wine, or 1 to 1.5 ounces
of an 80-proof (40 percent ethanol)
liquor (e.g., whiskey or gin

Effects of Alcohol
beers

vary in their alcohol content


single drink: increases the blood
alcohol level of 15 to 20 mg/dL (a
150-pound man)
1 or 2 glasses of red wine : lower the
incidence of cardiovascular disease

Absorption
10%:

stomach
remainder: small intestine
Peak blood concentration of alcohol: 30
to 90 mins, usually in 45 to 60 minutes
Dependent on the time during which
the alcohol was consumed
Absorption is most rapid with
beverages containing 15 to 30 percent
alcohol (30 to 60 proof)

Metabolism
90

percent: metabolized in the liver


(oxidation)
10 percent: kidneys and lungs (oxidized)
Rate of metabolism: 15 mg/dL per hour,
with a range of 10 to 34 mg/dL per hour
In persons with a history of excessive
alcohol consumption, upregulation of the
necessary enzymes results in rapid
alcohol metabolism.

Effects of the Brain


no

single molecular target has been


identified as the mediator for the
effects of alcohol
short-term use: intercalating itself
into membranes, increasing fluidity
of the membranes with
long-term use: the membranes
become rigid or stiff

Effects of the Brain


Enhanced
nicotinic acetylcholine
serotonin 5-hydroxytryptamine3 (5-HT3)
GABA type A (GABAA) receptors

inhibited
glutamate receptors
voltage-gated calcium channels

Behavioral Effects
0.05

%: thought, judgment, and restraint


are loosened and sometimes disrupted
0.1 %: voluntary motor actions usually
become perceptibly clumsy
0.1 to 0.15 %: legal intoxication:
0.2 %: entire motor area of the brain is
depressed, control emotional behavior
are also affected
0.3 %: confused or stuporous
0.4 - 0.5 %: coma

Sleep Effects
ease

of falling asleep (decreased


sleep latency
a decrease in rapid eye movement
sleep (REM or dream sleep) and
deep sleep (stage 4) and more sleep
fragmentation, with more and longer
episodes of awakening

Alcohol Use Disorder


A need for daily use of large amounts of

alcohol for adequate functioning


a regular pattern of heavy drinking
limited to weekends
long periods of sobriety interspersed
with binges of heavy alcohol intake
lasting for weeks or months

Alcohol Use Disorder


Associated

with certain behaviors:

inability to cut down or stop drinking


repeated efforts to control or reduce

excessive drinking by going on the wagon


(periods of temporary abstinence) or by
restricting drinking to certain times of the day
binges (remaining intoxicated throughout the
day for at least 2 days)
occasional consumption of a fifth of spirits (or
its equivalent in wine or beer)

Alcohol Use Disorder


amnestic periods for events occurring

while intoxicated (blackouts)


the continuation of drinking despite a
serious physical disorder
and drinking nonbeverage alcohol
impaired social or occupational
functioning, legal difficulties and
arguments or difficulties with family
members or friends about excessive
alcohol consumption.

ALCOHOL INTOXICATION
recent

ingestion of ethanol
maladaptive behavior
At least one of several possible
physiological correlates of
intoxication

ALCOHOL WITHDRAWAL
Impairment

Likely to be Seen at
Different Blood Alcohol
Concentrations

ALCOHOL WITHDRAWAL
Predisposed

by:

Fatigue
Malnutrition
Physical illness
Depression

ALCOHOL WITHDRAWAL
cessation

or reduction of alcohol use


that was heavy and prolonged
presence of specific physical or
neuropsychiatric symptoms
allows for the specification with
perceptual disturbances.

ALCOHOL WITHDRAWAL
low

rate of metabolic activity


especially low in the left parietal and
right frontal areas.

ALCOHOL WITHDRAWAL
tremulousness classic sign
Tremulousness (commonly called the
shakes or the jitters) - 6 to 8
hours
psychotic and perceptual symptoms
- 8 to 12 hours
seizures - 12 to 24 hours
DTs anytime - first 72 hours to the 1 st
week

ALCOHOL WITHDRAWAL
general

irritability
Gastrointestinal
Anxiety
Arousal
Sweating
facial flushing
Mydriasis
Tachycardia
mild hypertension

ALCOHOL WITHDRAWAL
general

irritability
Gastrointestinal
Anxiety
Arousal
Sweating
facial flushing
Mydriasis
Tachycardia
mild hypertension

WITHDRAWAL SEIZURES
stereotyped,

generalized, and tonic


clonic in character
more than one seizure 3 to 6 hours after
the first seizure
Status epilepticus: rare; less than 3
percent of patients
anticonvulsant medications are not
required
long-term alcohol abuse: hypoglycemia,
hyponatremia & hypomagnesemia

WITHDRAWAL SEIZURES
The

primary medications:
benzodiazepines
help control seizure activity, delirium,
anxiety, tachycardia, hypertension,
diaphoresis, and tremor
orally or parenterally
neither diazepam (Valium) nor
chlordiazepoxide (Librium) not given
IM

Drug Therapy for Alcohol


Intoxication and Withdrawal

Delirium
most

severe form of the withdrawal


syndrome
medical emergency
significant morbidity and mortality: 20%
may be assaultive or suicidal or may act
on hallucinations or delusional thoughts
as if they were genuine dangers
commonly preceded by withdrawal
seizures

Delirium
essential

feature: delirium occurring


within 1 week after a person stops
drinking or reduces the intake of
alcohol
features of alcohol intoxication
delirium:
autonomic hyperactivity
fluctuating levels of psychomotor

activity

Delirium
5

% of hospitalized alcohol-related
disorders
Usually begin in a patients 30s or
40s
Physical illness predisposes to the
syndrome

Delirium
Prevention:

Benzodiazepine
Delirium: chlordiazepoxidine