When it takes a turn for the worse….

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Alcohol is a staple in many people’s lives from the occasional glass of wine to self-medicating with alcohol to soothe mental, emotional or physical problems. The main component, but not always the largest part, of alcoholic beverages is ethanol. Ethanol is able to cross the blood brain barrier to give its user’s a desirable effect. Alcohol exerts its effect by altering the different levels of neurotransmitters (NT) throughout the brain. Alcohol affects the level of GABA, an inhibitory neurotransmitter, glutamate, an excitatory neurotransmitter, as well as dopamine. Alcohol increases the amount of GABA in the brain which causes a lot of the physical symptoms such as slow/sluggish movements and slurred speech. Glutamate is decreased as a result of alcohol consumption which essentially results in a psychological slow down. The cerebral cortex is the main area where thought processing and consciousness are affected with alcohol consumption. The effect on this area causes the consumer to be less inhibited, and unable to adequately process the information from our various senses. The addictive aspect of alcohol may be caused by the increase of dopamine levels in the brain’s reward center, essentially the interaction between the nucleus accumbens, amygdala and ventral medial prefrontal cortex and the ventral tegmental area. The reward system associates a pleasurable feeling with the consumption of alcohol, leaving the consumer to want to experience that feeling again. Other affected regions are the cerebellum, which helps with balance and coordination, the hypothalamus and pituitary glands, which control hormone release, and the medulla which handles breathing, consciousness and body temperature. The medulla is what induces sleepiness after alcohol consumption. Acting on these regions are also different NT and their receptors, for example nicotinic receptors, CB1 cannabinoid receptors, voltage gated calcium ions, and calcium activated potassium channels.

When the consumption of alcohol becomes too constant various disorders can occur, examples are: alcoholism and Wernicke-Korsakoff syndrome, which occurs when there is a lack of thiamine due to alcohol deficiency. Alcohol consumption can also lead to what is termed as alcohol-related psychosis (ARP). Alcohol, although a producer of addictive effects, is a neurotoxin that through repeated exposure, as well as repeated withdrawal, can have damaging effects on the brain. ARP results in psychological, neurological, and medical problems with symptoms resembling schizophrenic symptoms. Due to its nature, ARP may often be misdiagnosed as schizophrenia because its effects can remain, even after stopping alcohol consumption. The accepted differentiating factor between ARP and schizophrenia is through abstinence from alcohol the symptoms of ARP will decrease, and eventually dissipate. Another differentiating factor is with ARP there is a later onset of psychosis, anxiety, and a higher level of depression. With ARP there are fewer negative and disorganized symptoms as well as less functional impairment, and there is better insight and judgment. In a study 97% of participants had hallucinations, 53% had delusions in addiction to hallucinations during alcohol induced psychosis episodes. Research on ARP is minimal compared to alcoholism in general, so there is no full conclusive understanding of why it occurs, and why it is usually treated by removing alcohol from the user’s system. In some users a result of ARP is comorbid mental health disorders, or the real development of schizophrenia or non-specific psychosis. (Perala et al) ARP is treated in the same fashion alcoholism is because the most effective solution is removing alcohol from the user’s system which includes hospital care, rehab etc.

But, that is hard for users due to the addictive aspect, and the dangerous withdrawal symptoms that may lead to death.  The interesting aspect is what is it about alcohol that causes some users to have psychosis symptoms?  Users who over consume alcohol need to be warned that they may be getting more than they bargain for.

Perala, J., Lonnqvist, J., Suvisaari, J., Koskinen, S., Latvala, A., Viertio, S., et al. (2010). Alcohol-induced psychotic disorder and delirium in the general population. The British Journal of Psychiatry, 197(3), 200-206.

ALCOHOL’S DAMAGING EFFECTS ON THE BRAIN. (n.d.). National Institute of Health. Retrieved March 13, 2014, from http://pubs.niaaa.nih.gov/publications/aa63/aa63.htm

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One thought on “When it takes a turn for the worse….

  1. I have never even heard of ARP, I assumed that the only problem that people ever experienced with alcohol was alcoholism and the other problems related to it such as depression. Is anyone able to develop ARP with consistent exposure to alcohol, or does it have a large genetic predisposition aspect to it as well? And do alcoholism and ARP often go together, because it seems to me that the main way that ARP would be experienced would be when there is consistent high exposure to alcohol. I suppose it could be something that happens occasionally to someone who has weekly very large doses of alcohol but little in between. Also what is the incidence of ARP? Is it low compared to alcoholism or relatively comparable, I am just surprised that I have never heard of it. It’s rather scary that something that can cause schizophrenic symptoms is so widely used and accepted as doing little harm.

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