By Murali, MRCPsych, MBBS, DPM, PGDip in Medical Ethics and Law; Vanathi Kennedy, MRCPsych; and Samina Zaman, MRCPsych
From “Directions in Psychiatry,” Volume 33, 2013, #3, pp209-219 Posted on November 19, 2014 | By thedapaway
Alcohol is one of the most commonly used psychoactive substances. Problems related to alcohol misuse by major public health concern. It has been estimated that alcoholism is the third major cause of death in the world, even without including a number of unreported alcohol-related deaths.
Although alcohol has been used for recreational and religious reasons for a number of years, evidence of its use in the Neolithic Period (c. 10, 000 BC) was acquired by the discovery of Stone Age beer mugs.
There are two schools of thought regarding the genesis of alcoholism: (1) social learning theory, and (2) the disease models of alcoholism. Social learning theory suggests that alcoholism is a learned behavior from which the individuals can relearn and correct themselves with the help of behavioral therapy.
The disease model suggests that susceptibility of an individual to addiction is decided by genetic, neurobiological, or psychopathological causes. However, researchers have claimed that a combination of number of factors leads to the occurrence of alcohol problems.
NEUROLOGIC OCCASIONS OF ALCOHOL MISUSE:
Alcohol-induced neurologic complications can be subdivided into three major categories:
1. Acute intoxication
2. Withdrawal syndrome
3. Various neurological disorders secondary to chronic alcohol abuse
Table 1: Adverse Physical Effects of Alcohol Misuse.
- Neurotoxicity
- Alcohol dependence syndrome
- Alcohol withdrawal syndrome
- Seizures
- Cognitive deterioration leading to Korsakoff’s psychosis, Wernicke’s encephalopathy, and Wernicke-Korsakoff syndrome
- Progressive cerebellar degeneration
- Acute confusion state
- Peripheral neuropathy
- Autonomic neuropathy
ALCOHOL DEPENDENCE SYNDROME:
Alcohol dependence is a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance, or class of substances, takes on a much higher priority for a given individual and other behaviors that once had greater value.
ALCOHOL WITHDRAWAL SYNDROME:
The Himmel Bach concept has been proposed by most studies as an agreed mechanism of tolerance and withdrawal. Himmel Bach suggested that the acute effects of alcohol disturb the normal neuo-chemical equilibrium of the brain; however, if alcohol continues to be in the system on a regular basis, the body tends to develop a neurochemical adaptation to alcohol, which is called “tolerance.” This adaptation, which is developed to maintain homeostasis, is disturbed when an alternate route system and leads to “withdrawal symptoms.”
WERNICKE-KORSAKOFF SYNDROME:
Until the 19th century, there was little awareness of the neurological competitions about call, except for alcoholic rock. On observing three patients with a classical clinical trial of ataxia, confusion and ophthalmoplegia, Carl Wernicke defined a clinical syndrome, termed Wernicke’s encephalopathy. Later, Russian physician Korsakoff described an illness with profound memory disturbance along with polyneuritis. It was decided that these two conditions were a continuum of the same illness with the same etiology: Thiamine and B-12 deficiency. This condition is most often found in chronic alcoholism. This is a very serious condition, however prompt recognition and treatment with intravenous thiamine can lead to a complete resolution of the condition and prevent its progression to Korsakoff syndrome.
PELLAGRA:
this is a condition caused by vitamin B three (niacin) deficiency or common with chronic alcoholics. It is characterized by dermatitis, diarrhea, and dementia.
PROGRESSIVE CEREBELLAR DEGENERATION:
Chronic alcoholism is the most common cause of progressive cerebellar degeneration. Alcohol, with its direct toxic effects along with thiamine deficiency, causes degeneration and significant loss of Purkinjean cells in the cerebellar cortex, the anterior ends of the superior parts of the vermis and cerebellar hemispheres.
ALCOHOLIC NEUROPATHY:
Peripheral neuropathy manifests as a “glove and stocking” in distribution and is also associated with an alcohol-induced nutritional deficiency, which can be treated with supplementation and abstinence.
RESPIRATORY COMPLICATIONS:
Heavy and chronic alcohol use has been related to a number of respiratory problems and can cause a mortality rate 10% higher than in nonalcoholic individuals with respiratory problems. Alcohol increases respiratory infections by diminishing pulmonary defense mechanisms. The likelihood of COPD, aspiration pneumonia, acute respiratory distress syndrome is higher. Alcohol’s immuno-suppressant effect, from poor nutrition and alcohol-related liver problems, also contribute to respiratory complications.
REPRODUCTIVE SYSTEM:
Heavy alcohol consumption has a significant deleterious effect on both female and male reproductive systems.
FETAL ALCOHOL SYNDROME:
Alcohol is now considered teratogenic, and reports recommend complete abstinence from alcohol during pregnancy. Acetaldehyde has a direct neurotoxic effect on the neural networks of the fetus, especially if alcohol is consumed in the first trimester. It leads to a range of permanent mental, physical, and neurobehavioral birth defects. FAS is a leading cause of mental retardation in the Western world. Children present with growth deficiency, craniofacial abnormalities, developmental disabilities, and susceptibility to disease in adult life.
ALCOHOLIC LIVER DISEASE:
The consumption of alcohol results in a spectrum of liver diseases, including acute disorders, such as fatty liver, alcoholic hepatitis, and more chronic conditions, such as cirrhosis. It is estimated that nearly 100% of those with a history of heavy alcohol use will develop some form of alcoholic liver disease and about 20% develop cirrhosis. Cirrhosis-related deaths are an important measure of heavy alcohol use within the population. The exact mechanism of liver damage remains unclear.
The majority of heavy drinkers will develop changes consistent with a fatty liver. This is one of the earliest changes to occur and is often asymptomatic. This is usually a benign condition, with the changes reversing on cessation of alcohol you.
Alcoholic cirrhosis is associated with significant morbidity and mortality. It is characterized by fibrosis and scar tissue that replaces normal parenchyma. Micro-nodular and mixed pattern cirrhosis is a main form associated with chronic alcohol misuse. These changes can result in oral hypertension and are associated with an increased risk of hepatocellular carcinoma. Up to a third of deaths in patients with alcoholic cirrhosis are related to hepatocellular carcinoma. The most important aspect of management and alcoholic liver disease is widely acknowledged to be abstinence for alcohol. Complete abstinence has been shown to improve life expectancy at all stages of alcoholic liver disease.
CARDIOVASCULAR SYSTEM:
Alcohol misuse has been associated with a number of effects on the cardiovascular system, including hypertension, arrhythmias, and cardiomyopathy.
