Acute alcoholic psychosis (delirium)

#10

*! Patient K., 32 years old, locksmith of a motor-building plant, was taken to the emergency room of the narcological hospital by a special team. He was delivered from a city hospital with a diagnosis of "alcoholic psychosis? Condition after alcohol intoxication, toxic hepatitis, colitis, intoxication nephropathy." According to ambulance workers, the patient was excited, ran around the wards, tried to jump out the window.
In the emergency room - lies motionless with fixed hands, shakes his head. The speech is quiet, muttering. He does not answer questions, does not respond to external stimuli. On the part of the somatic sphere - skin integument is pale, with a yellowish tint, lips are baked, bluish. The breathing is shallow, uneven. Heart sounds are muffled, barely listening. The sclera of the eyes is injected, with small hemorrhages. Corneal reflexes saved. The reaction of the pupils to the light is sluggish. Temperature - 38.2 C. Hell - 85/40 mm Hg, pulse 108 beats. in minutes., filiform, arrhythmic.
Select Estimated Diagnosis:
Alcohol Mussitic Delirium

#eleven

*! Patient M., 42 years old, was admitted to the emergency room of the narcological hospital. According to his wife, it is known that the patient has been abusing alcohol for a long time, in the last 5 years there have appeared binges up to 3-5 days. On the eve before entering the hospital, he drank with relatives. During a drink a quarrel arose, was beaten by relatives, lost consciousness.
On the second day, the patient’s mental state changed sharply: he called surrounding people with fictitious names, said that he was at work, couldn’t stay in place, constantly tried to go somewhere, followed instructions with compulsion, saw a lot of flies, cobwebs, flashes around him fire. Under the influence of treatment, this condition was stopped.
Later, while in the department for a month, he remained dull, was somewhat euphoric. He was poorly versed in the situation, could not find his ward, his bed, did not recognize the doctor. At the same time, he accurately indicated the names of his relatives, correctly named the dates, talked about his work. Was examined by a neurologist, without stating neurological symptoms.
Assess the current status of the patient:
Korsakovsky amnestic syndrome

#12

*! The doctor of the ambulance team fixes the patient with tremor, dilated pupils, runny nose, frequent sneezing, coughing and profuse lacrimation. The patient is anxious, anxious, trying to massage the muscles of the limbs, complains of drawing pains in the joints of the limbs, upset stool, insomnia. When viewed in the area of ​​the elbow bends along the veins, numerous seals and minor hemorrhages in the places.
Select your proposed diagnosis:
Withdrawal Syndrome

#thirteen

*! Patient M., 46 years old, suffers from insomnia during the last year. As prescribed by doctors, he took sleeping pills periodically, then constantly. Within 3 months, the dose of drugs increased, but without a noticeable improvement. As the patient himself admits, without taking sleeping pills, he feels "psychological discomfort", since they bring a sensation of a surge of energy, activity, working capacity increase. I did not notice how the dose of sleeping pills increased, but without a sleeping pill. I decided to quit taking sleeping pills, but the next day the patient had unexplained anxiety, fear. Trembling in the extremities, muscle twitching, general weakness, dizziness, nausea, vomiting appeared, the perception of surrounding objects and space was disturbed. Blood pressure increased, although when getting out of bed there was a sharp drop in blood pressure. Later 2 convulsive seizures developed.
Select a Prospective Diagnosis:
Barbituric Addiction

#14

*! The doctor of the ambulance team fixes the patient with tremor, dilated pupils, runny nose, frequent sneezing, coughing and profuse lacrimation. The patient is anxious, anxious, trying to massage the muscles of the limbs, complains of drawing pains in the joints of the limbs, upset stool, insomnia. When viewed in the area of ​​the elbow bends along the veins, numerous seals and minor hemorrhages in the places.
Select your proposed diagnosis:
Withdrawal Syndrome

#fifteen

*! The patient says that when the drug is administered intravenously, it starts to smell violets, which disappears at the end of the injection. Then it begins to “acutely” perceive the environment: colors, smells, shapes of objects, which is accompanied by intolerance to bright colors and loud sounds. The patient's coordination is disturbed, movements are awkward, often falls, so he tries to use drugs in dark rooms in a lying position. In the future, there is a feeling of joy, indescribable happiness, "high", a feeling that he can do everything. There is the ability to see, with closed eyes, their travels to various countries, flights into space. This condition lasts no more than 15-20 minutes.
Identify your drug:
Ephedron

#sixteen

*! Patient K., 28 years old, was delivered to the hospital. The day before hospitalization, he returned from a long business trip - he works on a rotational basis at an oil drilling rig. Upon arrival, I decided to celebrate the arrival with friends. Half an hour after the start of the feast, the patient suddenly became tense, anxious, “turned off the conversation”, did not answer questions. Then he unexpectedly declared that he would be killed now and ran out into the street, onto the carriageway. At the same time, he didn’t notice the cars moving toward him, "he ran to wherever he looked," aimlessly, not taking the road apart. In this state, he was caught by a specialized psychiatric team.
Give a preliminary diagnosis:
Pathological intoxication

# 17

*! Patient M., 45 years old, was taken to the narcological department by a special ambulance team. From the anamnesis it is known that heredity is not burdened. He has been abusing alcohol for the past 20 years. Drinks from 25 years old, first drank with friends on holidays, in the future, to "relax." Over the past 7-8 years, binges have been noted. He is registered with a narcologist with a diagnosis of D: Mental and behavioral disorders due to alcohol abuse. Addiction Syndrome. ” 4 days before admission to the hospital, I felt anxiety, disturbed sleep, when I tried to fall asleep, I saw awesome images of animals. The next day, being in the supermarket I saw snakes, cockroaches, which began to chase him and crawl along it. He dismissed them, fled home, and at home he saw armed people in the room who were aiming at him. The daughter, seeing this state of her father called an ambulance. What drugs are indicated for the relief of psychomotor agitation in this patient?

Chlorpromazine

#eighteen

*! Patient N., 25 years old. He turned to the emergency room on his own, accompanied by relatives. He reported that he uses drugs. Facial expression is suffering. He complains of physical weakness, malaise, superficial sleep with frequent awakenings, chills, pain in the joints and muscles of the arms, legs, back, lower back, and abdomen. The patient is anxious, the pupils are dilated, symptoms of rhinorrhea, lacrimation, frequent loose stools, tenesmus are noted. In the mental status is oriented comprehensively. Anxious, mood background with severe dysphoria. Deceptions of perception and qualitative disturbances in thinking are not detected. Asks for help to alleviate his condition. What drugs are indicated for this patient in the first place?

Naloxone

#nineteen

*! Patient S., 22 years old, being in a somatic hospital, was found in a toilet on the floor. Not available for contact, bluish skin, severe acrocyanosis of the nasolabial triangle, pulse is not palpable, breathing is not heard, on the ulnar vein there is a trace of fresh intravenous injection to the left. What drug should be administered to the patient immediately?

Naloxone

#twenty

*! Patient M., 55 years old. Abuses alcohol 25 years. He became sober 20 years ago, in the last 10 years - binges up to 15 days. To date, he switched to surrogates, fortified wines. The daily tolerance decreased to 200.0 - 300.0 ml., During the day he drinks fractionally, in small portions. Attitudes towards family and work have changed — indifference and selfishness have appeared. For many years, a conflict with his wife due to alcohol abuse, 4 years ago he began to notice that his wife often leaves home, changed her attitude towards him. He persistently began to find out where she was, if she didn’t come on time. His wife's answers did not satisfy him, he stopped believing her. He began to suspect that she was cheating on him, and began to follow her. There were frequent quarrels at home. His wife was crying, the patient believed that this confirms his suspicions. He demanded confessions from her, found evidence of her infidelity - in the evening the bed was not made up not like in the morning, found suspicious spots on linen. During quarrels he threatened his wife with reprisal. An ax was hung on the wall at home in the hope of intimidating his wife. Recently, he came to the conclusion that he was cheating on him with all his colleagues. In mental status at the time of the examination: he is comprehensively oriented, talks in detail about his wife’s behavior, unshakably convinced that his wife is cheating on him. In order not to kill her and not be responsible for this, he considers it necessary to get a divorce. He considers himself to be healthy, and his wife and her lovers put him in the hospital in order to “debauch”. After much persuasion, he agreed to heal the "nerves." In the department, the behavior is calm, orderly. On dates with his wife, if no one is watching, she demands confessions from her, insults her, and threatens reprisal. What therapy is the most indicated for this patient in the first place?