Mental disorder due to AlcoholTeti Puspita Sari ( 201510401011032)

• Alcohol is a toxic substance in terms of its direct and indirect effects on the chemistry of the brain and other body organs and systems.

• As more alcohol is consumed, increasingly sensitive parts of the brain become affected and behaviour changes accordingly.

Mental disorder due to Alcohol

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The Direct Effects of Alcohol on Behavior

Alcohol raises dopamine levels, decreases serotonin, and increases GABA, a major inhibitor of internal stimuli such as fear, anxiety, and stress.

depresses the parts of the brain that are associated with inhibition, increasing talking

and self-confidence and reducing social anxiety.

Alcohol then depresses the nerve centres in the area that controls sexual arousal

(which increases) and performance (which doesn’t)

The first drink for many people

the areas of the brain associated with emotions and movement are affected anger,

withdrawal, depression or aggressiveness and uncoordinated muscle movements.

As more alcohol enters the bloodstream

Alcohol use, abuse, and dependence are complex behavioral traits influenced by many factors:

genetic and biological responses environmental influencesstages of development, from childhood to early

adulthood

• Alcohol abuse Is an alcohol use disorder characterized by continued drinking despite negative consequences and the inability to fulfill responsibilities.

American Psychiatric Association [APA], defines them as having an alcohol use disorder. includes two categories:

• Alcohol dependence Also known as alcoholism, is characterized by a craving for alcohol, possible physical dependence on alcohol, an inability to control one’s drinking on any given occasion, and an increasing tolerance to alcohol’s effects

Heavy drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes

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Mood Disorders

• Major depressive episodes• Manic episodes• Mixed episodes• Hypomanic episodes.

Manic episode

Hypomanicepisode

Normal moodDepressed mood Elevated mood

Major depressive

episode

Anxiety DisordersVaried disorders that involve excessive or inappropriate feelings of anxiety or worry.

Generalised anxiety disorder (GAD)Obsessive compulsive disorder (OCD)Panic disorder AgoraphobiaSocial phobiaSpecific phobiaPost traumatic stress disorder (PTSD)Acute stress disorder.

Types of Anxiety Disorders

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Schizophrenia

• Most common and disabling of psychotic disorders• To be diagnosed symptoms must have been

continuing for a period of at least 6 months• Symptoms are grouped within 2 types:

– Positive symptoms : such as distortions in thoughts (delusions), perception (hallucinations), and language and thinking and

– Negative symptoms : such as flattened emotional responses and decreased goaldirected behavior.

Mental Disorders Due to Use of Alcohol• Acute intoxication:

– euphoria, flushed face, ataxia, slowed reaction time, impaired motor performance, slurred speech, poor concentration; in higher doses behavioural changes – disinhibition of sexual and aggressive impulses, increased suicidal and homicidal behaviour

• Pathological intoxication:– sudden change of consciousness with aggressive behaviour

and amnesia• Harmful use:

– physical complications – hypertension, arteriosclerosis, heart infarction, cardiomyopathy, brain stroke, liver cirrhosis, fatty liver, gastritis, etc.

– psychic complications - depression

Mental Disorders Due to Use of Alcohol• Dependence syndrome:

– increased tolerance to alcohol, morning drinking, alcohol bouts, blackouts, deterioration in occupational and marital life, behavioural changes, withdrawal symptoms

• Withdrawal state:– tremor, anxiety, easy getting startled, agitation, insomnia,

nausea, sweating, epileptic seizures and delirium tremens• Delirium tremens:

– usually starts in evening hours – growing tremulousness, severe agitation, anxiety and perceptual distortion

– a state seriously endangering patient's life– recovery after several days, retrograde amnesia

Mental Disorders Due to Use of Alcohol

• Other psychotic disorders:– alcoholic hallucinosis– pathological jealousy– Korsakov's psychosis– Wernicke encephalopathy– alcoholic dementia

Alcohol treatment

• Outpatient CD treatment:– support, education, skills training, psychiatric and

psychological treatment, AA• Medications:

– Disulfiram 250mg-500mg po daily– Naltrexone Naltrexone 50mg po daily– Acamprosate(Campral) 666mg po tid

reference• Nora D. Volkow, M.D. Comorbidity: Addiction and Other Mental Illnesses,

National Institute on Drug Abuse (NIDA), 2010.• Ramesh Shivani, M.D., et al, Diagnosis of Alcoholism and Psychiatric

Disorders, Alcohol Research & Health, Vol. 26, No. 2, 2002. • Ismene L Petrakis, MD., et al, Comorbidity of Alcoholism and Pysciatric

Disorders, Alcohol Research & Health, Vol. 26, No. 2, 2002. • Dr Andrew McCulloch, Understanding the relationship between alcohol

and mental health, mental heatlh foundation, 2006. • Alcohol – the Body & Health Effects A brief overview, the Alcohol of

Advisory Councill of New Zaealand,2010.