How are Alcohol and Depression Related?

Psychoactive substances are substances that have a pronounced psychological effect after ingestion, and that long-term use can adversely affect health. Psychoactive substances include alcohol, opioids, cannabis, sedative hypnotics, cocaine, other central stimulants, hallucinogens, tobacco, and volatile solvents. Alcohol is a neurotropic substance, and heavy drinking at one time can cause mental disorders. It can cause a variety of mental disorders if consumed for a long time, including dependence, withdrawal syndrome, and psychotic symptoms. In addition to mental disorders, physical symptoms and signs often occur.

Basic Information

Visiting department

Department of Psychological Medicine

Multiple groups

Alcoholic

Common causes

Genetic factors, biochemical abnormalities, social environmental factors, psychological factors

Common symptoms

Irritable and vented, highly excited, extremely nervous, frightened, etc.

Causes of mental disorders caused by alcohol

Genetic factor

Investigation data confirm that the family aggregation of alcoholism is very obvious. The more severe parental alcoholism is, the greater the risk that their children will develop the same illness. Individuals with alcohol dependence among first-degree relatives experienced twice as many drinking problems as those without this genetic history. This situation also occurs in individuals with alcohol dependence among secondary and tertiary relatives. The study also found that individuals with a disorder of conduct, depression and high neuroticism, antisocial, novelty, and outgoing personality have a significantly increased risk of inheriting alcohol dependence.

2. Biochemical abnormalities

Alcohol can cause abnormal dopamine (DA) system function in certain areas of the brain. The results show that the administration of DA antagonists in experimental animals can increase their alcoholism, and chemically destroying DA neurons can also strengthen the animal's alcohol-seeking behavior. The above studies suggest that experimental animals need to ingest alcohol to compensate for insufficient DA function. Other studies have reported that alcoholism is associated with serotonin (5-HT) system abnormalities. The content of serotonin (5-HT) and its metabolite 5-hydroxyindanoic acid (5-HIAA) in the brain regions of the frontal cortex, striatum and hippocampus of alcoholic rats was significantly lower than that of the control group; Murine 5-HT neurons decreased.

3. Social environmental factors

Research suggests that factors such as values, social customs, social roles, economic development, eating habits, and social stress are closely related to mental disorders caused by alcohol. Many patients have tried to relieve the tension and anxiety caused by stress by drinking alcohol before they became ill, so as to promote the continuous strengthening of drinking behavior. Studies at home and abroad have found that the following social factors have a greater relationship with drinking-related issues: men, lower education, marriage breakdown, heavy physical labor, social tolerance for drunks, low income, etc.

4. Psychological factors

Studies of patients with alcoholism have found that other mental disorders often coexist with alcoholism. Nearly 80% of patients with alcoholism have at least one other mental disorder at the same time. Depression, anxiety, and antisocial personality disorder are the most common. Conversely, patients with depression, anxiety, or antisocial personality disorder often drink a lot of alcohol. The above results suggest that the relationship between alcohol-induced mental disorders and other mental disorders is difficult to determine and may be causal to each other.

Clinical manifestations of alcohol-induced mental disorders

Drunk state

(1) Simple intoxication Simple intoxication, also known as ordinary intoxication, is an acute poisoning caused by a large amount of alcohol consumption. The severity of clinical symptoms is related to the patient's blood alcohol content and alcohol metabolism rate. In the early stages of drunkenness, the drunken person's self-control ability diminishes, his speech increases, and the content is too exaggerated; emotional excitement, emotional instability, and irritability and venting; his actions also increase when drunk, and his behavior becomes frivolous. Provocative and sometimes reckless. Clinically, some drunks also experience depression, whispering, laxative weeping, or drowsiness. At the same time, the vast majority of drunks have unclear articulation, ataxia, unstable gait, accompanied by increased heart rate, decreased blood pressure, flushing of the face and skin, and sometimes nausea or vomiting. If drunkenness develops further, there will be disturbances of consciousness, such as a decline in consciousness and / or a narrow range of consciousness, or even lethargy or coma. Except for those who are severely ill, they generally recover naturally and have no aftereffects.

(2) Pathological drunkenness This is a psychotic episode caused by a small amount of alcohol. After drinking alcohol, the patient suffered from severe environmental awareness and self-consciousness disorder, and was often accompanied by fragmentary horror hallucinations and victim delusions. His clinical manifestations were highly excited and extremely nervous and terrified. Under the control of hallucinations and delusions, patients often have sudden aggression, mostly violent behaviors, such as destroying objects, self-harm or attacking others. The drunk state usually lasts for several minutes, hours, or even a whole day, and ends when the patient enters a doze state. After awake, the patient cannot recall the seizure. Unlike drunkenness alone, patients with pathological drunkenness do not have increased speech, euphoria, and significant toxic neurological symptoms. These patients have very low tolerance to alcohol, and the amount of alcohol consumed will not cause poisoning for most people. In addition, excessive fatigue or long-term severe insomnia may sometimes contribute to pathological drunkenness.

(3) Patients with complex drunkenness usually have a history of cerebral organic diseases or physical diseases that affect alcohol metabolism, such as epilepsy, cerebrovascular disease, craniocerebral trauma, encephalitis, and liver disease. On this basis, the patient's sensitivity to alcohol increased, acute poisoning reactions occurred after a small amount of drinking, and obvious conscious disturbances appeared, often accompanied by delusions of delusions, hallucinations, and fragmentation, and significant emotional excitement and irritability. Attacks and sabotage are common, with occasional repetitive actions. Such episodes usually last for several hours, and patients are partially or completely forgotten after remission.

2. Chronic alcoholism

(1) Dependence Syndrome This is a special psychological state caused by repeated drinking. Patients have a craving for alcohol and a compulsive sense of constant need for drinking. It can appear continuously or intermittently. If you stop drinking, you will experience psychological and physical withdrawal. symptom.

(2) After long-term drinking, patients with tremor and delirium suddenly reduce alcohol consumption or stop drinking, which can quickly cause a short-term conscious disturbance. Tremor delirium can also be induced by physical illness and mental stimulus, but it is rare; some patients have precursor symptoms such as depression, anxiety, and insomnia a few days before the attack. At the time of the attack, the patient was unconscious, had disorientation such as time and place, and had vivid and vivid hallucinations and delusions of victimization; therefore, he showed extreme fear or impulsivity. At the same time, patients with limb tremor and ataxia can be seen, and often accompanied by fever, sweating, increased heart rate, increased blood pressure, and dilated pupils. In severe cases it can be life threatening. The duration of tremor and delirium varies, typically 3 to 5 days. After recovery, the patient was partially or completely forgotten.

(3) Alcoholic hallucinations This is a hallucinatory state caused by long-term drinking. After abruptly reducing or stopping drinking, the patient appeared a large number of rich and clear hallucinations, and hallucinations and hallucinations were regarded as the main. Common primitive hallucinations and critical and imperative hallucinations. On the basis of hallucinations, there may also be fragment delusions and corresponding nervousness or depression. During the onset, the patient's state of consciousness was clear, and there were no obvious symptoms of psychomotor excitement and autonomic nerve hyperfunction. The duration of alcohol hallucinations is variable, ranging from a few hours to less than 6 months.

(4) Patients with paranoid alcoholism have jealousy delusions and victimized delusions in the case of clear consciousness. The former is more common clinically. Patients have unprovoked suspicions of spouse infidelity. Frequent anger reactions can also lead to attacks on suspects or spouses, sometimes resulting in murderous results. It has also been called alcoholic jealousy in the past. The occurrence of jealousy delusions is usually related to the decline of sexual function caused by patients' long-term drinking. The onset of alcoholism delusion is slow and the course of disease is prolonged, such as long-term adherence to alcohol abstinence can gradually return to normal.

(5) Alcoholic encephalopathy, also known as Wernicke encephalopathy, is the most serious mental illness in chronic alcoholism, and is the result of long-term heavy drinking caused by organic damage to the brain. Onset is acute or subacute, and some patients may experience a triad following tremor and delirium: lethargy, ocular paralysis, and ataxia. Sometimes pupillary reflexes and seizures can occur. Clinical manifestations of mental symptoms are characterized by delirium, memory loss, dementia, and personality changes. The prognosis is poor, and most patients cannot return to normal. Survivors generally leave Kosakoff mental illness.

3. Kosakoff mental illness

Also known as Korsakov syndrome, most patients develop after one or more tremors and delirium. They can also start slowly on the basis of drinking for 10 years and nutritional deficiencies. The clinical features are prominent near memory deficits, difficulty in learning new knowledge, and often fictional and misconceptions. Patients inadvertently fabricate experiences and plots or distances to close the gaps in memory. In addition to near memory impairment, many patients have euphoric expressions, disorientation, and sensorimotor disorders. Despite their severe condition, most patients had no obvious immediate memory impairment, disturbance of consciousness, and extensive cognitive impairment.

4. Alcoholism dementia

Due to prolonged drinking and multiple episodes of tremor and delirium, it can gradually develop into a state of dementia, showing a variety of advanced cortical dysfunctions, such as impairment of memory, thinking, understanding, calculation, orientation and language function. Serious people often affect daily life and cannot take care of themselves. Personality changes are also significant, with patients becoming selfish, losing control, rude and cruel.

5. Mood disorders caused by alcohol

Alcohol-induced mood disorders often appear after severe alcohol dependence, and a marked depression is closely related to drinking. It is estimated that one-third of mood disorders in alcohol-dependent patients are depressed before they drink heavily, and two-thirds are after drinking. Repeated heavy drinking can often cause severe depression symptoms. It has been reported that 80% of patients with alcohol dependence have experienced a strong depression experience, and about 35% of patients meet the diagnostic criteria for depression.

6. Personality changes caused by alcohol

Long-term alcohol dependence may lead to personality decline, the need for drinking more than all other activities, increasing self-centeredness, selfishness, falling standards of behavior, dishonesty or even theft and fraud in order to get alcohol, loss of family and social responsibility.

Examination of mental disorders caused by alcohol

Nervous system tests and laboratory tests are available.

Diagnosis of mental disorders caused by alcohol

The main basis for diagnosing mental disorders caused by alcohol is a definite drinking history, and there are good reasons to conclude that the patient's mental symptoms are directly caused by drinking or withdrawal.

Differential diagnosis of mental disorders caused by alcohol

On the basis of grasping the diagnostic points of alcohol-induced mental disorders, it is generally not difficult to distinguish them from other mental disorders. The differential diagnosis of acute alcoholism should exclude: acute attacks of cerebral organic diseases, delirium caused by physical diseases, mental disorders caused by other psychoactive substances, manic attacks, etc.

Treatment of mental disorders caused by alcohol

Abstain from drinking

Abstinence is a key step in the success of treatment. Abstainers should generally be treated under hospital conditions to cut off the source of alcohol. Clinically, the progress of alcohol withdrawal should be controlled flexibly according to the severity of alcohol dependence and poisoning of patients. The lighter can try one-time withdrawal, and the patients with severe alcohol dependence should gradually reduce alcohol to avoid severe withdrawal symptoms. Endangering life. Regardless of the one-time or one-time abstinence, close clinical observation and monitoring are required. Especially in the first week after quitting drinking, pay special attention to the patient's temperature, pulse, blood pressure, consciousness, and orientation ability, and deal with possible withdrawal reactions in a timely manner. At present, there are no mature drugs for quitting alcohol. Although naloxone and naldrone have been used in clinical trials, further accumulation of data is needed for routine clinical use.

Symptomatic treatment

In response to the symptoms of anxiety, tension and insomnia, anxiolytic drugs such as diazepam, methyltriazolidine, and atalol can be used symptomatically. The lowest dose that can control withdrawal symptoms should be given. If the patient develops convulsions, he can be injected intramuscularly, and the injection can be repeated every 4 hours if necessary, or can be administered orally. Because these drugs can cause dependence, they should only be used for a short period of time. For patients with significant agitation, chlorpromazine or haloperidol can be given intramuscularly or in small doses. The application of brain nutritional metabolism therapy has a better effect on reducing withdrawal symptoms.

3. Supportive treatment

Because most patients have damage to the nervous system and poor nutritional status of the body, they should be given medications that promote neurotrophy, while supplementing a large number of vitamins, especially B vitamins. For patients with gastritis and liver dysfunction, gastroenteritis and hepatoprotective drugs are commonly used.

4. Psychotherapy

The first step in psychotherapy is to establish a good therapeutic relationship. Alcohol addicts often deny their problems. Therapists need to listen and help patients with sincerity and patience. Patients can record their daily drinking situation, including the amount, frequency, environment, alcoholic drinkers, and inner activities while drinking, so that therapists can fully understand the patients' drinking-related problems and conduct targeted interventions. Clinical practice has proven that behavioral therapy has a certain effect on helping patients to quit drinking.

5. Behavioral Therapy

Quit alcohol is a drug that blocks the oxidative metabolism of alcohol, which can cause acetaldehyde to accumulate in the body. Patients who drink alcohol while taking the medication can develop nausea, headache, anxiety, chest tightness, and increased heart rate caused by acetaldehyde. The use of sulphur abstinence is a technique often used in behavioral therapy to encourage patients to establish an aversion to drinking. The drug has certain toxicity and cannot be used for a long time.

6. Management of acute alcoholism

The principles of treatment are consistent with those of other central nervous system inhibitors, including general measures such as emetic, gastric lavage, maintenance of vital signs, and enhanced metabolism. Naloxone and other drugs can be used for the treatment of acute alcoholism. The method is intramuscular injection, and naloxone can be dissolved in a 5% glucose solution. It can be reused until the patient is awake.

Prevention of mental disorders caused by alcohol

Actively publicize the harm caused by alcohol to the human body and improve the overall awareness of the population. It is strictly forbidden for minors to drink alcohol and strengthen legal supervision and inspection. Promote the production of low alcohol, control or prohibit the production of hard alcohol.