tailieunhanh - PRINCIPLES OF NEUROLOGY - PART 8

Xảy ra sự không nhất thiết là một yếu tố tiên đoán cho sự phát triển của nghiện rượu, như thường được giả định. Bệnh lý nhiễm độc (nhiễm độc phức tạp, rượu hoang tưởng nhà nước, nhiễm độc không điển hình) | CHAPTER 41 ALCOHOL AND ALCOHOLISM 387 of the severity of intoxication. Their occurrence is not necessarily a predictor for the development of alcohol addiction as has commonly been assumed. Pathological intoxication complicated intoxication alcohol paranoid state atypical intoxication The boundaries of this syndrome have never been clearly drawn as one might gather from its diverse designations. Well known are certain idiosyncratic reactions to alcohol in which a few drinks predictably evoke behavioral abnormalities seemingly alien to the personality of the subject argumentativeness assaultiveness acute paranoia indiscriminate sexual advances or criminality. All that can be said is that the disinhibitory effects of alcohol have exposed a latent sociopathic trait. More often the term pathological intoxication designates an outburst of blind fury with assaultive and destructive behavior the patient being subdued only with difficulty and massive sedation later the patient has no memory of the episode. This state needs to be distinguished from temporal lobe seizures and sociopathy which occasionally take the form of explosive outbursts of rage and violence. A similar paradoxic reaction sometimes follows the administration of barbiturates. ABSTINENCE OR WITHDRAWAL SYNDROME This is a symptom complex consisting of tremulousness hallucinations seizures confusion and psychomotor and autonomic overactivity which develop within several hours or days after an addictive drinker abstains from alcohol. The parts of the brain upon which alcohol acts and that come to tolerate increasing amounts of the drug appear to be disinhibited and become overactive when alcohol is withdrawn. Clinical Features These are depicted diagrammatically in Fig. 41-1. In effect there are two syndromes a minor and a major one. The minor or early syndrome is characterized by tremulousness nausea and vomiting insomnia flushed facies relatively mild diaphoresis hallucinations visual and auditory rarely .