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Symptoms of OBS vary with the disease that is responsible. However, the more common symptoms of OBS are confusion; impairment of memory, judgment, and intellectual function; and agitation. Often these symptoms are attributed to psychiatric illness, which causes a difficulty in diagnosis.
Both alcoholic hallucinosis and DTs have been thought of as different manifestations of the same physiological process in the body during alcohol withdrawal. Alcoholic hallucinosis is a much less serious diagnosis than delirium tremens. Delirium tremens (DTs) do not appear suddenly, unlike alcoholic hallucinosis. DTs also take approximately 48 to 72 hours to appear after the heavy drinking stops. A tremor develops in the hands and can also affect the head and body. A common symptom of delirium tremens is that people become severely uncoordinated. The biggest difference between alcoholic hallucinosis and delirium tremens is that alcoholic hallucinosis have a much better prognosis than DTs. Moreover, delirium tremens can be fatal when untreated.
Treatment of OBS varies with the causative disorder or disease. It is important to note that it is not a primary diagnosis and a cause needs to be sought out and treated.
The cause of alcoholic hallucinosis is unclear. It seems to be highly related to the presence of dopamine in the limbic system with the possibility of other systems. There are many symptoms that could possibly occur before the hallucinations begin. Symptoms include headache, dizziness, irritability, insomnia, and indisposition. Typically, alcoholic hallucinosis has a sudden onset.
Patients with psychoorganic syndrome often complain about headaches, dizziness, unsteadiness when walking, poor tolerance to the heat, stuffiness, atmospheric pressure changes, loud sounds, neurological symptoms.
The common reported psychological symptoms include:
- loss of memory and concentration
- emotional liability
- Clinical fatigue
- long term major depression
- severe anxiety
- reduced intellectual ability
The cognitive and behavioral symptoms are chronic and have little response to treatment.
Depending on lesion location, some patients may experience visual complications.
"Mood disorder due to a general medical condition" is used to describe manic or depressive episodes which occur secondary to a medical condition. There are many medical conditions that can trigger mood episodes, including neurological disorders (e.g. dementias), metabolic disorders (e.g. electrolyte disturbances), gastrointestinal diseases (e.g. cirrhosis), endocrine disease (e.g. thyroid abnormalities), cardiovascular disease (e.g. heart attack), pulmonary disease (e.g. chronic obstructive pulmonary disease), cancer, and autoimmune diseases (e.g. rheumatoid arthritis).
Mood disorder, also known as mood (affective) disorders, is a group of conditions where a disturbance in the person's mood is the main underlying feature. The classification is in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) and International Classification of Diseases (ICD).
Mood disorders fall into the basic groups of elevated mood, such as mania or hypomania; depressed mood, of which the best-known and most researched is major depressive disorder (MDD) (commonly called clinical depression, unipolar depression, or major depression); and moods which cycle between mania and depression, known as bipolar disorder (BD) (formerly known as manic depression). There are several sub-types of depressive disorders or psychiatric syndromes featuring less severe symptoms such as dysthymic disorder (similar to but milder than MDD) and cyclothymic disorder (similar to but milder than BD). Mood disorders may also be substance-induced or occur in response to a medical condition.
English psychiatrist Henry Maudsley proposed an overarching category of "affective disorder". The term was then replaced by "mood disorder", as the latter term refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others.
Substance abuse, also known as drug abuse, is a patterned use of a substance (drug) in which the user consumes the substance in amounts or with methods which are harmful to themselves or others.
The drugs used are often associated with levels of intoxication that alter judgment, perception, attention and physical control, not related with medical or therapeutic effects. It is often thought that the main abused substances are illegal drugs and alcohol; however it is becoming more common that prescription drugs and tobacco are a prevalent problem.
Substance-related disorders, including both substance dependence and substance abuse, can lead to large societal problems. It is found to be greatest in individuals ages 18–25, with a higher likelihood occurring in men compared to women, and urban residents compared to rural residents. On average, general medical facilities hold 20% of patients with substance-related disorders, possibly leading to psychiatric disorders later on. Over 50% of individuals with substance-related disorders will often have a "dual diagnosis," where they are diagnosed with the substance abuse, as well as a psychiatric diagnosis, the most common being major depression, personality disorder, anxiety disorders, and dysthymia.
Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.
The signs and symptoms for excited delirium may include:
- Paranoia
- Disorientation
- Dissociation
- Hyper-aggression
- Tachycardia
- Hallucination
- Diaphoresis
- Incoherent speech or shouting
- Seemingly superhuman strength or endurance (typically while trying to resist restraint)
- Hyperthermia (overheating)/profuse sweating (even in cold weather)
- Inappropriately clothed e.g. having removed garments
Common symptoms include:
- Sudden changes in behaviour – may engage in secretive or suspicious behaviour
- Mood changes – anger towards others, paranoia and little care shown about themselves or their future
- Problems with work or school – lack of attendance
- Changes in eating and sleeping habits
- Changes in friendship groups and poor family relationships
- A sudden unexplained change in financial needs – leading to borrowing/stealing money
There are many more symptoms such as physical and psychological changes, though this is often dependent on which drug is being abused. It is, however, common that abusers will experience unpleasant withdrawal symptoms if the drug is taken away from them.
It is also reported that others have strong cravings even after they have not used the drug for a long period of time. This is called being "clean". To determine how the brain triggers these cravings, multiple tests have been done on mice. It is also now thought that these cravings can be explained by substance-related disorders as a subcategory of personality disorders as classified by the DSM-5.
Two characteristic symptoms of CSE are deterioration of memory (particularly short-term memory), and attention impairments. There are, however, numerous other symptoms that accompany to varying degrees. Variability in the research methods studying CSE makes characterizing these symptoms difficult, and some may be questionable regarding whether they are actual symptoms of solvent-induced syndromes, simply due to how infrequently they appear. Characterizing of CSE symptoms is more difficult because CSE is currently poorly defined, and the mechanism behind it is not understood yet.
Reported neurological symptoms include difficulty sleeping, decrease in intellectual capacity, dizziness, altered visual perceptive abilities, affected psychomotor skills, forgetfulness, and disorientation. The mechanism behind these symptoms beyond solvent molecules crossing the blood-brain barrier is currently unknown. Neurological signs include impaired vibratory sensation at extremities and an inability to maintain steady motion, a possible effect from psychomotor damage in the brain. Other symptoms that have been seen range from fatigue, decreased strength, and unusual gait. One study found that there was a correlation between decreased red blood cell count and level of solvent exposure, but not enough data has been found to support any blood tests to screen for CSE.
A drug-related blackout is a phenomenon caused by the intake of any substance or medication in which short term and long term memory creation is impaired, therefore causing a complete inability to recall the past. Blackouts are most frequently associated with GABAergic drugs. Blackouts are frequently described as having effects similar to that of anterograde amnesia, in which the subject cannot recall any events after the event that caused amnesia. Research on alcohol blackouts was begun by E. M. Jellinek in the 1940s. Using data from a survey of Alcoholics Anonymous (AA) members, he came to believe that blackouts would be a good determinant of alcoholism. However, there are conflicting views whether this is true. The negative psychological effects of an alcohol-related blackout are often worsened by those who suffer from anxiety disorders. Impairment of the liver will also allow more alcohol to reach the brain and hasten the individual's blackout.
The term "blackout" can also refer to a complete loss of consciousness, or syncope.
Substance intoxication is a type of substance use disorder which is potentially maladaptive and impairing, but reversible, and associated with recent use.
If the symptoms are severe, the term "substance intoxication delirium" may be used.
Generic slang terms include: getting high or being stoned or blazed (all usually in reference to cannabis), with many more specific slang terms for each particular type of intoxicant. Alcohol intoxication is even graded in intensity, from buzzed, to tipsy, all the way up to hammered, smashed, wasted, destroyed, and a number of other similar terms.
Psychoorganic syndrome (POS) is a progressive disease comparable to presenile dementia. It consists of psychopathological complex of symptoms that are caused by organic brain disorders that involve a reduction in memory and intellect. Psychoorganic syndrome is often accompanied by asthenia.
Psychoorganic syndrome occurs during atrophy of the brain, most commonly during presenile and senile age (e.g. Alzheimer's disease, senile dementia). There are many causes, including cerebrovascular diseases, CNS damages to traumatic brain injury, intoxication, exposure to organic solvents such as toluene, chronic metabolic disorders, tumors and abscesses of the brain, encephalitis, and can also be found in cases of diseases accompanied by convulsive seizures. Psychoorganic syndrome may occur at any age but is most pronounced in elderly and senile age.
Depending on the nosological entity, the main symptoms of psychoorganic syndrome are expressed differently. For example, in atrophic cases such as Alzheimer's disease, the symptoms are more geared towards a memory disorder, while in Pick 's disease, mental disorders are more commonly expressed.
Pseudosenility also reversible dementia is a condition where older people are in a state of memory loss, confusion, or disorientation that may have a cause other than the ordinary aging process. Generally, the term "reversible dementia" is used to describe most cases. A more specific term "Pseudodementia" is referring to "behavioral changes that resembler those of the progressive degenerative dementias, but which are attributable to so-called functional causes".
The "New York Times" reports that illnesses such as the flu and hydrocephalus, as well as side-effects to common medications, can produce symptoms in the elderly that are difficult to distinguish from ordinary dementia caused by aging. However, if the real cause of the effects is caught early enough, the effects can be reversed. According to studies cited in Cunha (1990), approximate 10% to 30% of patients who have exhibited symptoms of dementia might have a treatable or reversible pathologic process to some extent.
Examples (and ICD-10 code) include:
- F10.0 alcohol intoxication
- F11.0 opioid intoxication
- F12.0 cannabinoid intoxication
- F13.0 sedative and hypnotic intoxication (see benzodiazepine overdose and barbiturate overdose)
- F14.0 cocaine intoxication
- F15.0 caffeine intoxication
- F16.0 hallucinogen intoxication (See for example Lysergic acid diethylamide effects)
- F17.0 tobacco intoxication
The term contact high is sometimes used to describe intoxication without direct administration, either by second-hand smoke as with cannabis, or by placebo in the presence of others who are high.
Musical hallucinations fall under the category of auditory hallucinations and describe a disorder in which a sound is perceived as instrumental music, sounds, or songs. It is a very rare disorder, reporting only 0.16% in a cohort study of 3,678 individuals.
Different concentrations of alcohol in the human body have different effects on the subject.
The following lists the common effects of alcohol on the body, depending on the blood alcohol concentration (BAC). However, tolerance varies considerably between individuals, as does individual response to a given dosage; the effects of alcohol differ widely between people. Hence, BAC percentages are just estimates used for illustrative purposes.
- Euphoria (BAC = 0.03% to 0.12%):
- Overall improvement in mood and possible euphoria
- Increased self-confidence
- Increased sociability
- Decreased anxiety
- Shortened attention span
- Flushed appearance
- Impaired judgment
- Impaired fine muscle coordination
- Lethargy (BAC = 0.09% to 0.25%)
- Sedation
- Impaired memory and comprehension
- Delayed reactions
- Ataxia; balance difficulty; unbalanced walk
- Blurred vision; other senses may be impaired
- Confusion (BAC = 0.18% to 0.30%)
- Profound confusion
- Impaired senses
- Analgesia
- Increased ataxia; impaired speech; staggering
- Dizziness often associated with nausea ("the spins")
- Vomiting (emesis)
- Stupor (BAC = 0.25% to 0.40%)
- Severe ataxia
- Lapses in and out of consciousness
- Unconsciousness
- Anterograde amnesia
- Vomiting (death may occur due to inhalation of vomit (pulmonary aspiration) while unconscious)
- Respiratory depression (potentially life-threatening)
- Decreased heart rate (usually results in coldness and/or numbness of the limbs)
- Urinary incontinence
- Coma (BAC = 0.35% to 0.80%)
- Unconsciousness (coma)
- Depressed reflexes (i.e., pupils do not respond appropriately to changes in light)
- Marked and life-threatening respiratory depression
- Markedly decreased heart rate
- Most deaths from alcohol poisoning are caused by dosage levels in this range.
It should be noticed that describing the causation of reversible dementia is extremely difficult due to the complicated biopsychological systems and the hard-to-define collection of factors associated with cognitive decline.
Roughly, the etiological factors that contribute to cognitive decline could be assigned into four categories: chemical, environmental, physical, and psychiatric. Chemical intoxication might be attributed to anesthesia, alcohol, heavy metal and commonly used medications. Jenike (1988) has recorded a certain amount of medications which may induce cognitive change in elder people.
The list is provided below.
Environmental sources include overstimulation, radical changes in lifestyle, and sensory impairment. Physical disorders which are mostly induced by the aging process, consist of thyroid and other endocrine-system deprivation; metabolic disturbance, and vitamin deficiency. Psychiatric disorders, such as chronic schizophrenia and depression could also produce cognitive decline.
In summary, the etiological factors of reversible dementia are various, subtle and frequently interactive. Therefore, in-depth medical and psychosocial evaluations are vital for accurate diagnosis and treatment design. It is important for families and patients to understand the difficulties in determining an correct diagnosis and be prepared for probable frustration and confusion during evaluation and assessment process.
Acute alcohol poisoning is a related medical term used to indicate a dangerously high concentration of alcohol in the blood, high enough to induce coma, respiratory depression, or even death. It is considered a medical emergency. The term is mostly used by healthcare providers. Toxicologists use the term "alcohol intoxication" to discriminate between alcohol and other toxins.
The signs and symptoms of acute alcohol poisoning include:
- severe confusion, unpredictable behavior and stupor
- sudden lapses into and out of unconsciousness or semi-consciousness (with later alcoholic amnesia)
- vomiting while unconscious or semi-conscious
- seizures
- respiratory depression (fewer than eight breaths a minute)
- pale, bluish, cold and clammy skin due to insufficient oxygen
The short-term effects of alcohol (also known formally as ethanol) consumption–due to drinking beer, wine, distilled spirits or other alcoholic beverages–range from a decrease in anxiety and motor skills and euphoria at lower doses to intoxication (drunkenness), stupor, unconsciousness, anterograde amnesia (memory "blackouts"), and central nervous system depression at higher doses. Cell membranes are highly permeable to alcohol, so once alcohol is in the bloodstream it can diffuse into nearly every cell in the body.
The concentration of alcohol in blood is measured via blood alcohol content (BAC). The amount and circumstances of consumption play a large part in determining the extent of intoxication; for example, eating a heavy meal before alcohol consumption causes alcohol to absorb more slowly. The amount of alcohol consumed largely determines the extent of hangovers, although hydration also plays a role. After excessive drinking, stupor and unconsciousness can occur. Extreme levels of consumption can lead to alcohol poisoning and death (a concentration in the blood stream of 0.40% will kill half of those affected). Alcohol may also cause death indirectly, by asphyxiation from vomit.
Alcohol can greatly exacerbate sleep problems. During abstinence, residual disruptions in sleep regularity and sleep patterns are the greatest predictors of relapse.
Investigators have successfully narrowed down the major factors that are associated with musical hallucinations. Evers and Ellgers compiled a significant portion of musical hallucination articles, case studies etc. and were able to categorize five major etiologies:
- Hypoacusis
- Psychiatric disorders
- Focal brain lesion
- Epilepsy
- Intoxication
Alcohol intoxication, also known as drunkenness among other names, is a physiological condition that may result in psychological alterations of consciousness. Drunkenness is induced by the ingestion or consumption of alcohol in a living body. Alcohol intoxication is the result of alcohol entering the bloodstream faster than it can be metabolized by the body. Metabolism results in breaking down the ethanol into non-intoxicating byproducts.
Some effects of alcohol intoxication, such as euphoria and lowered social inhibition, are central to alcohol's desirability as a beverage and its history as one of the world's most widespread recreational drugs. Despite this widespread use and alcohol's legality in most countries, many medical sources tend to describe any level of alcohol intoxication as a form of poisoning due to ethanol's damaging effects on the body in large doses. Some religions consider alcohol intoxication to be a sin.
Symptoms of alcohol intoxication include euphoria, flushed skin, and decreased social inhibition at lower doses, with larger doses producing progressively severe impairments of balance, and decision-making ability as well as nausea or vomiting from alcohol's disruptive effect on the semicircular canals of the inner ear and chemical irritation of the gastric mucosa.
Sufficiently extreme levels of blood-borne alcohol may result in coma or death.