1. By : dr.noor Alcohol& related mental disorders By: Dr.Noor

2. Points to be covered : History. Metabolism of alcohol. Alcohol dependence. Intoxication. Withdrawal. Effects of alcohol.

3. History of alcohol : Egyptians =“hek” Romans. Americans _ Europe ?? In 1920 congress law. 1993 limited use while driving a car!!!

4. 51% of adults currently are alcohol abusers!! 10 % of women& 20% of men =abusers 3-5% of women&10% of men = Dependence !!

5. Metabolism: 10% by stomach & 90% by small intestine. Passive diffusion. Peak concentration is reached in 30 to 90 min Effects of : Food. Drugs: asprin,ulcer meds. Differences in sex !

6. Distribution to all body fluids, including blood brain barrier, placenta “in pregnant lady. B.A.C = to measure rather than the amount ingested.

7. 95% by liver, through oxidation & 5% only by lung. Rate of metabolism is 15 mg\dl per hour. Enzymes involved are : ADH aldehyde dehydrogenase

9. Alcohol dependence : Need large amount. In ability to cut down. Amnestic periods. With serious physical illness. Social & occupational functioning.

10. DSM-VI criteria for Alcohol Dependence * maladaptive pattern of substance use, by 3 or more of the following in the same 12 months period : **-Tolerance, either marked increase in amount for the desired effect or reduce effect with same amount used. **- Withdrawal **- Taken in larger amounts and in longer periods than intended. **- Unsuccessful efforts to cut down or control the use. **- A great deal of time is spent in obtaining, using or recovering from the substance. **- Important life activities are given up because of the substance use. **- Use is continued despite knowledge of having a problem.

11. Subtypes of dependence : Type A & B. Others :-early stage problem -affiliative drinkers. -schizoid isolated drinkers. Type 1 & 2 male limited drinkers (psychological > physical )

12. Alcohol intoxication: Its not a trivial problem! Legal intoxication = 0,1%_0,15% At 0,20% == motor area in brain dep. At 0,3% == confusion At 0,4_0,5 == coma & death.

13. DSM-VI criteria for Alcohol Intoxication : A)- Recent ingestion of alcohol. B) - Significant maladaptive behavioral or psychological changes. C)- One or more of the following : - slurred speech - in coordination - unsteady gait - nystagmus - impaired attention - stupor or coma. D)- Are not due to a general medical condition or other mental disorder.

14. Alcohol withdrawal : A) - Cessation or reduction in heavy alcohol use. B)-two or more of the following( several hours – few days ): - autonomic hyperactivity - increased hand tremor - insomnia - nausea or vomiting - transient hallucinations or illusions - psychomotor agitation - anxiety - grand mal seizures C) - Impairment in function. D)- Not due to a general medical condition or mental disorder.

15. Jitters = = = in 6-8 hrs. Perceptual ===in 8-12 hrs Seizures === in 12- 24 hrs D.T= == in 72 hrs up to 1 week !

16. Delirium tremens ( DT’s): Medical emergency Mortality 20% Can appear up to 1 st week & can start from 3d day. Autonomic hyperactivity.

17. The best Treatment for DT’s is prevention. Benzodiazepine Systemic stabilization

18. Effects of alcohol : Physiological : liver, esophgitis, varices,alcoholic hepatitis. Sleep : ease of falling sleep. Other body system : M.I, HTN, cancer

19. Psychiatric comp. Alcohol Induced psychosis Alcohol induced Mood disorder Alcohol induced anxiety disorder Sexual dysfunctioning.