Euphoria (BAC = 0.03 to 0.12%)
Subject may experience an overall improvement in mood and possible euphoria. They may become more self-confident or daring; they may become more friendly or talkative, and/or social. Their attention span shortens. They may look flushed. Their judgment is not as good—they may express the first thought that comes to mind, rather than an appropriate comment for the given situation. They have trouble with fine movements, such as writing or signing their name.
Lethargy (BAC = 0.09 to 0.25%)
Subject may become sleepy. They have trouble understanding or remembering things, even recent events. They do not react to situations as quickly. Their body movements are uncoordinated; they begin to loose their balance easily, stumbling; walking is not stable. Their vision becomes blurry. They may have trouble sensing things (hearing, tasting, feeling, etc.).
Confusion (BAC = 0.18 to 0.30%)
Profound confusion—uncertain where they are or what they are doing. Dizziness and staggering occur. Heightened emotional state—aggressive, withdrawn, or overly affectionate. Vision, speech, and awareness are impaired. Poor coordination and pain response. Nausea and vomiting sometimes occurs.
Stupor (BAC = 0.25 to 0.40%)
Movement severely impaired; lapses in and out of consciousness. Subjects can slip into a coma; will become completely unaware of surroundings, time passage, and actions. Risk of death is very high due to alcohol poisoning and/or pulmonary aspiration of vomit while unconscious. Loss of bodily functions can begin, including bladder control, breathing, heart rate.
Coma (BAC = 0.35 to 0.50%)
Unconsciousness sets in.., pupils do not respond. Reflexes are depressed (i.epropriately to changes in light). Breathing is slower and more shallow. Heart rate drops. Death usually occurs at levels in this range.
The long term effects of alcohol in excessive quantities is capable of damaging nearly every organ and system in the body.
Nervous system
- Peripheral neuropathy
- Seizures
- Cerebellar degeneration
- Cognition and dementia
- Essential tremor
- Wernicke's Encephalopathy Korsakov's Psychosis
- Marchiafava Bignami Disease
- Central Pontine Myelinolysis (CPM) Midline Cerebellar Degeneration
- Subacute combined degeneration of the spinal cord
- Strokes
- "Rum Fits": seizures in the alcoholic.
- Usually occur 48-72 hours after cessation of drinking.
- Usually uncomplicated, generalized seizure that requires no treatment.
Cognition and dementia
- Alcohol misuse can cause structural brain atrophy.
- Chronic excessive alcohol intake is also associated with serious cognitive decline.
- Acetaldehyde is produced by the liver during breakdown of ethanol. People who have a genetic deficiency for the subsequent conversion of acetaldehyde into acetic acid may have a greater risk of Alzheimer's disease.
- Degeneration with loss of myelin in the central aspect of the corpus callosum.
- Presumably nutritional, although exact etiology unknown.
- Clinical syndrome of personality change, seizures and dementia.
Central Pontine Myelinolysis (CPM)
- Approximately 75% of cases seen in alcoholics who are hospitalized for other reasons.
- CPM is associated with a clinical syndrome of declining mental status, quadriparesis and cranial nerve abnormalities.
- Recovery is rare.
- Excessively rapid correction of hyponatremia is thought to lead to an osmotic instability in the pons with marked edema and secondary demyelination. Macrophages containing digested myelin are a prominent pathologic feature.
Alcohol related Psychiatric disorders
- Intoxication Phenomena
- Withdrawal phenomena
- Toxic or nutritional disorders
- Other
Alcohol interact with neuronal membranes to increase their fluidity and give rise to release of range of neurotransmitters which will leads to various pharmacological effects.
e.g.
Pleasurable effects – mediated by release of dopamine & opioids in mesolimbic forebrain.
Anxiolytic effects – brain GABA activity.
Idiosyncratic alcohol intoxication
Marked maladaptive changes in behaviour occurring within minutes of taking an amount of alcohol insufficient to induce intoxication.
Short term amnesia
Usually occur after heavy drinking. The events of the night before are forgotten even though consciousness was maintained at the time.
Withdrawal phenomena
Delirium tremens - Following alcohol withdrawal there is a dramatic & rapid changing picture of disordered mental activity.
- Clouding of consciousness
- Disorientation
- Memory loss
- Hallucinations
- Agitation
- Restlessness
- Insomnia
- Ataxia
- Autonomic disturbance
- Korsakov’s psychosis
- Wernicke’s encephalopathy
- Alcoholic dementia
- Korsakov's is a separate entity caused by neuronal loss and degeneration in the dorsomedial nucleus of the thalamus.
- This is most likely a nutritional disorder secondary to chronic alcohol abuse.
- The clinical syndrome is confabulatory amnesia.
- Thiamine deficiency.
- Clinical triad of ataxia, ophthalmoplegia, and mental confusion of acute onset.
- Treatment with thiamine may completely reverse the clinical syndrome if given early in the course.
- Pathology involves mammillary bodies (confusion), periaqueductal gray area (ophthalmoplegia), and floor of the 4th ventricle (ataxia), and includes petechial haemorrhages, capillary vascular proliferation, and astrocytosis.
- Alcohol misuse can cause structural brain atrophy.
- Chronic excessive alcohol intake is also associated with serious cognitive decline and a range of neuropsychiatric complications.
- The elderly are the most sensitive to the toxic effects of alcohol on the brain.
- Personality deterioration
- Mood disorder
- Depression
- Suicidal behavior
- Impaired psychosexual function
- Pathological jealousy
- Alcoholic hallucinations
Personality deterioration
As the patient addicted to alcohol interpersonal skills, interests & responsibilities may deteriorate.
Mood disorder
After the period of euphoria the patient goes into a low mood.
Depression
Induced by prolonged alcohol use.
Suicidal behaviour
Impaired psychosexual function
Erectile dysfunction or delayed ejaculation.
Impaired relationship with sexual partner.
Pathological jealousy
Non delusional suspiciousness.
Alcoholic hallucinations
Auditory hallucinations & delusional misinterpretation.
Social damage due to alcohol
- Family violence.
- Emotional & conduct problems in the patient’s children.
- Poor work performance.
- Unemployment.
- Road traffic accidents.
- Inability to deal with crisis.
- Prolonged reaction time & lack of color discrimination.
- Over confident or excessive caution.
- Increased distractibility.
- Bad judgement.
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