DELIRIUM TREMENS

An acute psychotic reaction occurring in chronic alcoholics following a prolonged drinking bout. The disturbance may also occur after a sudden withdrawal of alcohol or in connection with head injury or infection incurred during a period of abstinence.The cause of the delirium is probably a combination of physiological and psychological factors. It is believed to result from an emotional crisis produced by the fears, anxieties, and tensions associated with excessive drinking, plus metabolic disturbances due to impairment of liver function, acidosis, dehydration, and nutritional deficiency. The condition rarely occurs before the age of thirty, and follows at least a three- or four-year history of alcoholism.The delirium is generally preceded by a period of restlessness, irritability, aversion to food, and disturbed sleep with nightmares. During the DTs, the patient experiences several types of symptoms: (1) mental confusion and disorientation: he fails to recognize relatives, mistakes the doctor for an old friend or the hospital for a jail; (2) terrifying hallucinations: the wallpaper comes to life with menacing creatures; imaginary insects crawl over his skin; a foul-smelling gas makes him gasp for breath; (3) extreme suggestibility: he imagines he sees any animals mentioned to him, and uses any suggested way of trying to destroy them; (4) coarse tremors (deliriums tremens) of the hands, tongue, and lips; (5) rapid or irregular pulse, perspiration, fever, and coated tongue.The acute symptoms last from three to ten days and are followed by deep and prolonged sleep. Treatment includes confinement to bed, gradual withdrawal of alcohol, constant supervision and reassurance to avoid injury or suicide, tranquilizing drugs, high enemas, vitamins, enriched soft diet, and large amounts of orange juice and milk. In spite of precautions, the death rate averages 10 per cent due to complications such as heart failure, pneumonia, or liver disease.In cases where there is a predisposition to psychosis, a persistent mental illness may be precipitated by the alcoholic episode. But most frequently the patient recovers from the delirium and has only the vaguest memory of what occurred. He is usually apologetic and remorseful for the trouble he has caused, but in all likelihood will resume his drinking and return to the hospital with another delirious attack within a few months. See ACUTE ALCOHOLIC HALLUCINOSIS, DELIRIUM, ALCOHOLIC ADDICTION.Illustrative Case: DELIRIUM TREMENS:The patient was brought forcibly to the psychiatric ward of a general hospital when he fired his shotgun at 3:30 A.M. while “trying to repel an invasion of cockroaches.” On admission he was confused and disoriented and had terrifying hallucinations involving “millions and millions” of invading cockroaches. He leaped from his bed and cowered in terror against the wall, screaming for help and kicking and hitting frantically at his imaginary assailants. When an attendant came to his aid, he screamed for him to get back out of danger or he would be killed too. Before the attendant could reach him he dived headlong on his head, apparently trying to kill himself.The patient’s delirium lasted for a period of three and a half days, after which he returned to a state of apparent normality, apologized profusely for the trouble he had caused everyone, stated he would never touch another drop, and was discharged. However, on his way home he stopped at a bar, had too much to drink, and on emerging from the bar collapsed on the street. This time he sobered up in jail, again apologized for the trouble he had caused, was extremely remorseful, and was released with a small fine. His subsequent career is unknown. (Coleman, 1964).