Mental disorders caused by alcohol use

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

Acute: Alcohol intoxication

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..

Chronic: Alcohol use disorder

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