Dnipro State Medical University

Department of Psychiatry, Narcology and Medical Psychology

Methodical recommendation for student of medical faculty

to clinical lesson
«Psychiatry, narcology, medical psychology, psychologie médicale»
For students IV course

«Mental and behavioural disorders due to use of alcohol »

Author: Shornikov A.V., MD.

Methodical recommendation was aproved
at the methodical meeting
Protocol № __ from __.__.2023
Acting Head of Department__Ogorenko V. V.

Reaffirm “_______”_________________202 р. Protocol №________

Reaffirm “_______”_________________202 р. Protocol №________
Reaffirm “_______”_________________202 р. Protocol №________
Reaffirm “_______”_________________202 р. Protocol №________

Dnipro 2023
 Theme of lesson. Mental and behavioural disorders due to use of alcohol
Course – IV.
Specialty – Medicine.
Number of training hours – 4,0.
Place of employment: Classroom, department of the Hospital.
I. Actuality of the theme: Diseases that are studied in this lesson cause significant
health and social consequences. The problem of alcoholism is one of the major
programs of WHO. A clear upward trend in alcohol abuse and alcoholism was
determined in recent years in many industrialized countries. In general hospitals
significantly increased the number of patients who, in addition to the underlying disease
also suffer from alcoholism. The difficulty of early diagnosis makes the task of
combating with mental and behavioral disorders due to alcohol use is especially urgent
and priority issue of Clinical Psychiatry. Therefore, knowledge of problems of mental
and behavioral disorders due to alcohol use is a must for physicians of all specialties.

II. Specific objectives:

- Know the etiology and pathogenesis of mental and behavioral disorders due to alcohol
use.
- To learn principles of classification of mental and behavioral disorders due to alcohol
use.
- To learn clinical, diagnostic and differential diagnostic signs of mental and behavioral
disorders due to alcohol use.
- Make schemes of treatment, the prevention of mental and behavioral disorders due to
alcohol use.

ІІІ. Goals of personality development (educational goals). Actual aspects:

deontological, ecological, legal, professional responsibility, psychological,
psychotherapeutic, patriotic.
 ІV. Interdisciplinary integration
№ Discipline To know
1. Medical history Main stages of development narcology, public
attitudes towards alcohol consumption
2. Аnatomy Anatomy of the brain
3. Physiology Physiology of the brain
4. Biochemistry Involvement of alcohol in metabolism
5. Pathological anatomy Types of affections of the central and peripheral
nervous system in acute and chronic intoxication
6. Pathological Pathological syndromes of disorders of the central
physiology and peripheral nervous system in acute and chronic
intoxication
7. Pharmacology The principles of treatment of diseases of the
nervous system due to acute and chronic
intoxication. Medications from groups of
tranquilizers, nootropics, diuretics, desensitizing,
anticholinesterase, vitamins

V. Contents of the topic.

From a broad perspective, we can say that addictive or dependence behaviours
include both consumption of alcohol or other psychoactive substances, and gambling,
addiction to computer games, Internet. The principal general feature of these behaviours
consists in increasing the physiological activity of the brain, and thus changing its
functional state. Research data show, that there probably is a biochemical basis for
addictive behaviour, in particular disturbances of the dopamine transmitter metabolism.
A gambling, computer games and similar exciting activities increase the level of
endogenous opiates and some other psychoactive substances.
 In ICD-10 these disturbances are classified in section Fl "Mental and behavioural
disorders caused by consumption of psychoactive substances." In DSM-IV these
disorders are included in sections 291 ("Alcohol induced disorders") and 292
(“Substance-related disorders"). In both classifications attention is focused on
complications (delirium, amnesia, dementia, etc.), and not on addiction as such.
For each psychoactive substance it is necessary to consider the following:
1. Intoxication — the psychological and physical effects of the substance
which disappear when the substance is eliminated;
2. Withdrawal state — symptoms and signs occurring substance is reduced or
stopped;
3. Tolerance — the state in which repeated administration the substance leads
to decreasing effect;
4. Dependence — a syndrome that includes withdrawal states, sometimes
tolerance, and other features such as persistent use despite harmful effects.
Alcohol abuse
Terminology. The term "alcoholism" is used widely in everyday life but has a too
broad meaning. The problem is that the term can refer to excessive consumption of
alcohol, dependence on alcohol, or the damage caused by this practice. For this reason,
it is more useful to employ four terms that are more specific: excessive consumption of
alcohol, problem drinking, alcohol-related disability, and alcohol dependence (in
the Ukrainian psychiatry the term "alcoholism" means only alcohol dependence).
Excessive consumption refers to use that is above the limit at which alcohol is
thought to be harmful.
Problem drinking is drinking that has caused disability but not dependence.
Alcohol dependence is defined below.
Alcohol-related disability refers to any mental, physical, or social harm resulting
from excessive alcohol consumption.
The Consumption of Alcohol
 Alcohol is consumed by many people without harmful effects. So what is a safe
level of alcohol consumption? To understand these levels and to give advice that can be
easily understood, the term "unit" of alcohol can be helpful. A unit of alcohol
corresponds the following measures in which alcohol is usually consumed:
● half a pint of beer;
● a wine glass of wine;
● a sherry glass of sherry or other fortified wine;
● a standard measure of spirits.
These measures are useful but cannot be precise because the lengths of different
beers and wines vary.
In these terms, the safe level of alcohol consumption for men is up to 21 units per
week; for women up to 14 units per week; provided that the whole amount is not taken
on one occasion and that there are occasional drink-free days. (This level is equivalent,
for example, to an average of three half pints of beer a day for a man.) Hazardous levels
are thought to be levels above these limits.
The Causes of Excessive Consumption
Several factors affect the likelihood that a person will consume excessive amounts
of alcohol.
Consumption in the community. The higher the average consumption in a
community, the greater the number of people who are likely to drink more alcohol than
the safe amount.
Age and sex. The heaviest drinkers are among young men in their late teens and
early twenties. It is a matter of concern that increasing drinking problems have been
identified among 15-16 year olds. Fewer women than men abuse alcohol, but rates in
women are rising more quickly than in men so that the differences between the sexes
are becoming less marked.
Occupation. The rates of excessive consumption of alcohol are much increased
among people in occupations that provide easy access to alcohol, for example barmen,
brewery workers, and kitchen porters.
Genetic factors. Excessive drinking runs in families, but this could result from
social factors. Genetic influences are suggested by some twin studies though the
evidence is conflicting. A genetic cause is also suggested by the finding that the rate of
problem drinking is greater among children of an alcoholic parent who have been
adopted by non-alcoholic substitute parents than among adopted children of other
biological parents.
Personality factors are suggested by clinical experience, for it is common to find
alcohol problems associated with a pervading sense of inferiority, self-indulgent
tendencies, and readiness to anxiety.
The Epidemiology of Alcohol Abuse
Reliable epidemiological data are difficult to obtain because people tend to be
evasive about the amount they drink and the consequences of their drinking. However,
other relevant information can be obtained from three sources: first from records of the
national consumption of alcohol, second from records of people admitted to hospital
with alcohol problems, and third from deaths from cirrhosis of the liver (of which
alcohol is a major cause). All three sources are imprecise, but each has shown a trend
towards a substantial increase of alcohol abuse.
Alcohol-Related Disabilities
Continued excessive drinking of alcohol can lead to physical, psychiatric, and
social disability. This damage can occur whether or not the person has become
dependent on alcohol, though very high levels of consumption are likely to cause both
damage and dependency.
We should add, that the impact of alcohol on the organism depends not only on the
amount of alcoholic beverages consumed, but also on their quality. Home-made wine is
often more sour and can irritate the stomach, and spirits can contain toxic substances.
Moreover, alcoholics sometimes consume alcohol-containing substances not designed
for internal use, like technical spirits, because they are cheaper or easily available.
 Physical Effects of Alcohol Abuse
Excessive consumption of alcohol may lead to physical damage in several ways:
●a direct toxic effect on certain tissues, notably the brain and liver;
●associated poor diet leading to deficiency of protein and B vitamins;
●an increased risk of accidents, particularly head injury;
●associated general neglect leading to increased susceptibility to infection.
Medical Effects of Excessive Use of Alcohol
Alimentary Neurological Others
Gastritis and peptic ulcer Peripheral neuropathy Anemia
Oesophageal varices Dementia Episodic hypoglycemia
Acute and chronic pancreatitis Cerebral degeneration Haemochromatosis
Hepatitis and cirrhosis Epilepsy Cardiomyopathy
Myopathy
Obesity

Alimentary disorders, notably gastritis and peptic ulcer, damage to the liver,
oesophageal varices and carcinoma, and acute or chronic pancreatitis, are common.
Damage to the liver includes fatty infiltration, hepatitis, cirrhosis, and hepatoma.
Disorders of the nervous system include peripheral neuropathy, dementia,
cerebellar degeneration, and epilepsy, as well as several less common effects on the
optic nerve, pons, and corpus callosum.
Other physical disorders include anaemia, episodic hypoglycemia,
haemochromatosis, cardiomyopathy, and myopathy.
Effects on the fetus. When a pregnant woman drinks excessively, the fetus may
suffer damage and the child may be born with a syndrome of facial abnormality, low
weight, low intelligence, and overactivity.
Neuro-Psychiatric Disorders. Alcohol-related psychiatric disabilities fall into
four groups: abnormal forms of intoxication, withdrawal phenomena, toxic or
nutritional disorders, and associated psychiatric disorders.
Neuropsychiatry Effects of Excessive Use of Alcohol:
Intoxication states
Memory blackouts
Idiosyncratic intoxication
Withdrawal states
Delirium tremens
Toxic and nutritional states (organic bran damage)
Korsakov’s syndrome
Wernicke’s encephalopathy
Alcoholic dementia
Associated states
Depressive disorder
Anxiety symptoms
Suicide and deliberate self-harm
Personality change
Pathological jealousy
Sexual dysfunction
Transient hallucinations
Alcoholic hallucinations

Abnormal Forms of Intoxication. As well as the familiar picture of drunkenness,

two syndromes occur in people who abuse alcohol persistently. Memory blackouts are
losses of memory of events that occurred during a period of intoxication. Such episodes
can occur after a single episode of heavy drinking in people who do not habitually
abuse alcohol. When these episodes occur regularly they indicate frequent heavy
drinking; when they are prolonged, affecting the greater part of a day or whole days,
they indicate sustained excessive drinking.
 Idiosyncratic intoxication (or pathological drunkenness) is a marked change of
behaviour occurring within minutes of taking alcohol in amounts that would not induce
drunkenness in most people. Often the behaviour is aggressive. Such cases may occur
after a further small intake of alcohol in a person who already has a raised blood alcohol
level from unadmitted drinking.
Withdrawal phenomena. Withdrawal phenomena will be described under
dependency.
Toxic and nutritional conditions. In these cases alcohol causes organic brain
damage with the development of organic psychiatric syndromes. There are three
neuro-psychiatric disorders of this kind: Korsakov's syndrome, Wernicke's
encephalopathy, and alcoholic dementia.
Alcoholic dementia can arise after prolonged abuse of alcohol. Intellectual
impairment is often associated with enlarged ventricles and widened cerebral sulci seen
on a CT scan.
Associated Psychiatric Disorders
Depressive disorder can be induced by prolonged abuse of alcohol, but depressed
patients sometimes drink excessively to relieve their symptoms and so care needs to be
taken to find out the sequence of changes.
Anxiety symptoms occur commonly, particularly during periods of partial
withdrawal of alcohol. However, some patients with an anxiety disorder from other
causes drink to relieve anxiety.
Suicidal behaviour and deliberate self-harm are more frequent among people
who abuse alcohol than among other people of the same age. Estimates of the
proportion of alcoholics who eventually kill themselves vary from 6 to 20 per cent.
Suicidal attempts in alcohol consumers are often impulsive and they use violent
methods, like hanging themselves or jumping of high places etc.
Personality change in excessive drinkers often includes self-centredness, lack of
concern for others, and a decline in standards of conduct, particularly honesty and
responsibility.
Pathological jealousy is an infrequent but serious complication of chronic alcohol
abuse. Non-delusional suspiciousness of the sexual partner is more common than
delusions.
Sexual dysfunction is common, usually as erectile dysfunction or delayed
ejaculation. The causes include the direct effects of alcohol and a generally impaired
relationship with the sexual partner as a result of heavy drinking.
Transient hallucinations of vision or hearing are reported by some heavy
drinkers; they generally occur during withdrawal, but without all the features of
delirium tremens or alcoholic hallucinosis.
Alcoholic hallucinosis is a rare condition characterised by distressing auditory
hallucinations, usually of voices uttering threats, occurring in clear consciousness.
Some patients argue aloud with the voices; others feel compelled to follow instructions
from them. Delusional misinterpretations may follow, often of a persecutory kind, so
that the clinical picture can resemble schizophrenia. The condition can arise while the
person is still drinking heavily or when intake has been reduced. It lasts up to a few
weeks.
Social Damage
Excessive drinking can cause serious social damage, for example marital and
family problems including violence to the spouse, emotional and conduct problems in
the children, poor performance at work, and unemployment. There are important
associations between alcohol abuse and road accidents. Excessive drinking is also
associated with crime, mainly petty offences, but also with fraud, sexual offences, and
crimes of violence including murder.
Alcohol Dependence (Alcoholism)
Excessive drinking can lead to psychological and physical dependence on alcohol.
The term alcoholism (or chronic alcoholism) in Ukrainian psychiatry is used only for
the states of dependence (addiction). Alcoholism belongs to the group of addictive
disorders and is classified under the heading of "Mental and Behavioural Disorders
Caused by Psychoactive Substances Abuse." Alcoholism is experienced clinically as a
group of three syndromes (changed reactivity, psychological dependence and physical
dependence). It develops gradually, and its course consists of three stages.
The Alcohol Dependence Syndromes
1. The feeling of being compelled to drink. The dependent drinker is unsure
that he can stop drinking once started. If he tries to give up alcohol, he experiences a
craving for it. At the first stage the drive towards alcohol is obsessive (the patient keeps
thinking about it), at the second and third stages it is compulsive — the patient can not
stop drinking, and keeps on until he/she is stopped by some external circumstance (ex.
having no more liqueur). Patients gradually loose quantitative control (they drink too
much), then qualitative and situational control (consume any substance containing
alcohol irrespective of the situation).
2. Primacy of drinking over other activities. For the dependent drinker
alcohol takes priority over everything else, including health, family, home, career, and
social life.
3. Altered tolerance to alcohol. The dependent drinker becomes able to drink
quantities of alcohol that would incapacitate a normal drinker. Alcoholics also lose the
defence reflex towards alcohol. Since they can "hold his drink", they may persuade
themselves that alcohol is no problem to them. In fact increasing tolerance is an
important sign of increasing dependence. In the third stage of dependence, tolerance
falls and the dependent drinker becomes incapacitated after only a few drinks.
4. Repeated withdrawal symptoms. Withdrawal symptoms appear
characteristically on waking, after a fall in blood alcohol concentration during sleep.
The earliest and commonest feature is acute tremulousness affecting the hands, legs and
trunk ("the shakes"), The sufferer may be unable to sit still, hold a cup steady, or do up
buttons. He is also agitated and easily startled. Nausea, retching, and sweating are
frequent.
 As withdrawal progresses, patients may develop misperceptions and
hallucinations. Objects appear distorted in shape or shadows seem to move;
disorganised voices or shouting may be heard. Later there may be epileptic seizures,
and finally after about 48 hours delirium tremens may develop.
Symptoms of Alcochol Withdrawal
a. Tremulousness
b. Agitation
c. Nausea
d. Sweating
e. Misperception
f. Hallucinations
5. Relief drinking. Since they can stave off withdrawal symptoms only by
further drinking, many dependent drinkers take a drink on waking. With increasing need
to stave off withdrawal symptoms during the day, the drinker typically becomes
secretive about the amount consumed, hiding bottles or carrying them in a pocket.
Rough cider and cheap wines may be drunk regularly to obtain the most alcohol for the
least money.
6. Stereotyped pattern of drinking. Whereas the ordinary drinker varies his
intake from day to day, the dependent person drinks at regular intervals to relieve or
avoid withdrawal symptoms.
7. Reinstatement after abstinence. After a period of abstinence, a severely
dependent person who drinks again is likely to relapse quickly and totally, returning to
his old drinking pattern within a few days.
Delirium Tremens.
Delirium tremens is a severe form of withdrawal syndrome and an alcohol
psychosis, which occurs when alcohol is withdrawn after prolonged periods of
excessive drinking. The features are as follows:
1. Those seen in any delirium: confused state of consciousness, disorientation
in time and place, impairment of recent memory, illusions and hallucinations,
fearfulness, and agitation.
2. Special features including gross tremor of the hands (which gives the
condition its name), autonomic disturbance (sweating, tachycardia, raised blood
pressure, dilation of the pupils), and marked insomnia. There may also be fever.
3. Hallucinations which are characteristically true, visual and often frightening,
involving people or animals. Auditory and tactile hallucinations also occur. The patients
see water flowing down the walls, big numbers of rats, snakes, or insects, monsters or
villains attacking; sometimes complex hallucinations occur.
4. Dehydration and electrolyte disturbance are characteristic. Blood testing
shows leucocytosis, a raised erythrocyte sedimentation rate, and impaired liver function.
Delirium tremens usually lasts for 3-4 days. As in other kinds of delirium, the
symptoms are characteristically worse at night. The condition often ends in deep and
prolonged sleep, from which the person awakes with no symptoms and little or no
memory of the period of delirium.
The Disease of Alcoholism
Alcoholism is regarded as a disease in the countries of the former Soviet Union
(Ukraine, Russia, etc.). This terminology initially was used in arguments against the
idea that alcohol abuse and its effects are a form of moral failure, and for the idea that
people with these problems should receive help from doctors. By regarding it as a
disease, alcoholism could be included among the proper concerns of doctors. However,
in the Western states (USA, England and others) specialists think that it is more logical
to regard excessive use of alcohol as a form of behaviour that can cause mental or
physical disorders.
Recognition of the Problem Drinker
Treatment is much more difficult in the late than in the early stages of abuse, and
so it is important that neither excessive use of alcohol nor problem drinking should go
unrecognized. General practitioners are well placed to identify these problems. Hospital
doctors are also well placed because drinking problems can be detected in 10-30 per
cent of patients in general hospitals.
Every patient should be asked how much alcohol he drinks per week. Problem
drinking should be sought particularly carefully among the following at risk groups:
those with medical or psychiatric conditions that can be caused by alcohol, those with
marital or sexual problems or problems with children, particularly when there is
violence, and those with difficulties at work, trouble with the law, or financial problems.
Identifying the Problem Drinker
Be suspicious in cases of:
medical or psychiatric conditions possibly caused by alcohol
marital or sexual problems
trouble with the law
repeated absences or poor record at work
problems with the patient's children
Ask screening questions (and/or CAGE or MAST)
Ask about symptoms of alcohol dependence.
Physical examination for alcohol-related medical conditions
Further investigations
Alcohol diary
Laboratory tests.

The medical conditions that raise suspicion include gastritis, peptic ulcer, liver
disease, peripheral neuropathy, seizures, particularly those starting in middle life.
Psychiatric conditions include anxiety, depression, erratic moods, poor concentration,
memory impairment, and sexual dysfunction.
Some excessive drinkers give misleading answers, and so in appropriate cases it is
good clinical practice to ask four questions that are particularly likely to be
informative.
 ●Have you ever felt you ought to Cut down your drinking?
●Have people Annoyed you by criticising your drinking?
●Have you ever felt Guilty about your drinking?
●Have you ever had a drink first thing in the morning as an "Eye-Opener"?
A mnemonic for these questions is CAGE, derived from the initial letters of the
words Cut, Annoyed, Guilty, and Eye-opener. Two or more positive replies identify
problem drinkers; one positive reply is an indication for further enquiry about the
person's drinking.
Some patients respond more honestly to written questions than to an interview. A
widely used screening questionnaire is the Michigan Alcohol Screening Test (MAST).
There are two versions. The shorter version, which is self-rated, is shown below; a score
of five points or more indicates alcohol abuse.
Screening questions should be followed by more detailed enquiries.
How much alcohol is drunk on a typical "drinking day?" (Start by asking about the
amount drunk in the second half of the day, before asking about morning drinking.)
How does the person feel after going without alcohol for a day or two? How does the
person feel on waking? Questions should be asked about performance at work and in
family life, and about any legal problems.
Finally, laboratory tests can be used. The most direct measure is blood alcohol
concentration, although this does not distinguish between a single recent episode of
heavy drinking and chronic abuse.
Urate concentrations are raised in about half of all heavy drinkers, but as screening
tests they are useful only for men since they are poor discriminators in women.
The Treatment Of The Problem Drinker
The Value of the Assessment Interview. A thorough enquiry into drinking habits
and related problems is not only a way of detecting the problem drinker, but is also a
first step in treatment because it helps the patient to recognize the extent and
seriousness of his problem.
 The Treatment Plan. Treatment begins with a review of the extent of the drinking,
the evidence for dependence, the effects of the patient's excessive drinking, and the
probable consequences if it continues. Any urgently needed medical treatment is
arranged and a decision is made about withdrawal. The patient should be involved in
formulating the treatment plan, and if possible the partner should take part. Specific and
attainable goals should be let and the patient given responsibility for reaching them.
These goals should include control of drinking, collaboration with treatment for any
associated medical condition, and resolution of problems in the family, at work, and
with the law. These initial goals should be short term and achievable.
Treatment Plan for a Problem Drinker
Review with the patient
extent of drinking
evidence for dependence
alcohol related disabilities
Arrange withdrawal of alcohol
Treat urgent medical or psychiatric illness
Set attainable goals for
control of drinking (Abstinence if there is evidence of dependence)
treatment of medical disabilities
resolution of interpersonal problems
dealing with practical difficulties (finance, employment, the law)
establishing new interests
Plan longer term help
Individual or group counseling
AA meetings
Help for the family

Abstinence Versus Controlled Drinking. It is important to decide whether to aim

for total or partial abstinence from alcohol. The traditional advice is that a person with
alcohol dependence should not drink alcohol again because of the high risk of relapse.
Not all dependent patients will accept this goal; they either refuse treatment or report
abstinence while continuing to drink alcohol. Even so, abstinence remains the most
appropriate goal for people with alcohol dependence. For those who drink excessively
but are not dependent on alcohol, the appropriate goal can be the reduction of drinking
to a safe level provided that the person (1) has not incurred serious physical
consequences of drinking which require abstinence, (2) is not in a job (such as lorry
driving) that carries a risk to others, and (3) is not pregnant. The target can be the usual
safe limits of 21 units per week for men and 14 for women.
Treatment for Special Groups
Withdrawal From Alcohol. When the amount of alcohol taken has been large,
and particularly when there is a dependence syndrome, the patient may develop
delirium tremens or seizures if he stops drinking suddenly.
Since dependent patients are unlikely to succeed in reducing alcohol gradually, it is
usually best to stop the alcohol, replace it with a drug that will prevent delirium tremens
or fits, and then withdraw this drug gradually. Chlormethiazole, Сhlordiazepoxide, and
Diazepam are the drugs used most often.
Psychological Treatment. Psychological treatment has three main aims: (1) to
sustain the patient's motivation; (2) to help the patient to avoid relapse; (3) to relieve
any psychological problems that have contributed to the development of the alcohol
abuse.
Medication to Maintain Abstinence. Disulfiram (Antabuse) and Сitrated calcium
carbamide (Abstem) are used occasionally in specialist practice as deterrents to
impulsive drinking. It is not recommended that either drug be used by non-specialists.
Treatment with either drug carries the risks of occasional cardiac irregularities or
rare cardiovascular collapse. Therefore the drug should not be started until at least 12
hours after the last ingestion of alcohol. These drugs also have unpleasant side-effects,
including a persistent metallic taste in the mouth, gastrointestinal symptoms, dermatitis,
urinary frequency, impotence, peripheral neuropathy, and toxic confusional states.
Prevention of Alcohol Problems
Several social measures might help to prevent excessive drinking by reducing the
general level of alcohol consumption in the population. It is not certain how effective
they are in achieving this aim.
1. Control of advertising of alcoholic drinks has been proposed particularly of
advertising targeted on young people.
2. Controlling the sale of alcohol by limiting sales in shops might be effective.
Health education seems desirable since the best control on drinking is self-control.
Customs and moral beliefs are important determinants of alcohol use, but it has not yet
been proved that any form of classroom or media education can alter drinking habits.
VІ. Plan and organizational structure of lesson.
1. Organizational moment - 3 minutes
2. Checking the entry level of knowledge - 35 minutes.
3. Instruction on the material of the lesson - 40 minutes.
4. Independent work of students - 70 minutes.
5. Checking the mastering of the topic - 30 minutes.
6. Homework - 2 minutes.

VII. Material for the methodical provision of employment.

List of control questions:
1. Effect of alcohol on the higher nervous activity of person.
2. Simple alcoholic intoxication, its extent, individual characteristics, diagnosis.
3. Pathological alcoholic intoxication, diagnosis, forensic psychiatric expertise.
4. Alcoholism and its criteria, dependence syndrome in alcoholism.
5. Diagnostics of alcohol withdrawal syndrome and aid.
6. Stages of alcoholism, especially the degradation of the individual.
 7. Metalchohol acute psychoses: diagnosis of primary symptoms, prevention and
treatment.
8. Protracted metalcoholic psychosis.
9. Alcoholic encephalopathy.
10. Principles of treatment of alcoholic psychoses.
11. Organization of substance abuse treatment.
12. Methods of treatment of alcoholism.
13. Prevention of alcoholism and its recurrence.
VII.1. Control material for the preparatory phase of the lesson: questions,
tasks, test tasks.
VII.2 Methodical support materials for the main stage of employment:
professional algorithms (indicative maps) for the training of skills and
practical skills, educational tasks.
VII.3. Control material for the final stage: tasks, tasks, tests.
1. What is this tolerance:
A. symptoms and signs occurring substance is reduced or stopped;
B. the state in which repeated administration the substance leads to decreasing
effect;
C. a syndrome that includes withdrawal states, sometimes tolerance, and other
features such as persistent use despite harmful effects
D. the psychological and physical effects of the substance which disappear when
the substance is eliminated;
E.
2. Neurological complications from long-term alcohol use include:
A. Peripheral neuropathy
B. Dementia
C. Cerebral degeneration
D. Epilepsy
 E. all answers are right.
3. The patient drank alcohol for 2 weeks every day, yesterday he ran out of
money and could not buy himself a drink. He did not sleep all night, now he is anxious,
restless, has high blood pressure, sweats, hands are shaking. Select the condition the
patient is currently in:
A. Alcochol withdrawal
B. Dementia
C. Cerebral degeneration
D. Epilepsy
E. all answers are right.
Answers: 1- B, 2- E, 3- A.
VII.4 Material of methodical provision of self-preparation of students:
approximate sheets for the organization of independent work of students with
educational literature.

VIII. List of literature:

Basic:
1. Psychiatry. Course of lectures / V.S. Bitensky, T.M. Chernova, P.I. Goryachev
etc.; Ed. by V.S. Bitensky. – Odessa: Odessa State Medical University, 2005. –
336p.
2. Child Psychiatry [Textbook]/ G.M. Kojina, V.D. Mishiev, V.І. Korostiy etc.; Ed.
By G.M. Kojina, V.D. Mishiev. – Kiev: VСV «Medicine», 2014. – 376p.
3. Essentials of general psychopathology / V.L. Gavenko, G.A. Samardakova,
V.M. Sinayko etc.; Ed. by V.L. Gavenko. – Kharkov: Region-inform, 2004. –
148p.
4. Handbook of the family doctor in psychosomatics questions / N.О. Maruta, V.І.
Korostiy, G.M. Kojina etc. – Kiev: «Zdorov’a», 2012. – 384p.
Additional:
5. Dictionary-Guide for Psychiatric Terms [Tutorial] / G.М.Кojina, G.A.
Samardakova, V.І. Кorostiy etc. - FAP Sheinina E.V., 2012. – 176p.
6. Organic mental disorders due to somatic diseases: cognitive and emotional
disorders. / G.М.Кojina, І.А. Grigorova, V.І. Korostiy etc. - Kharkov: Rarities
of Ukraine, 2012. – 120p.
7. Cognitive and emotional disturbances due to somatic diseases in persons of
working age / G.М.Кojina, І.А. Grigorova, V.І. Korostiy etc. - Kharkov: Rarities
of Ukraine, 2011. – 80p.
8. General organic diseases of the brain. [Tutorial] / V.L. Gavenko, G.М.Кojina,
V.І. Korostiy etc. - Kharkov, NTUHPI, 2008. – 228p.
9. Coпcise Oxford Textbook of Psychiatry. М. Gelder, D. Gath, R. Мауои. -
Oxford; New York; Tokyo; Oxford University Press, 1994.
10.Bhatia, М.S. Dictionary of Psychiatry, Psychology and Neurology. CBS
Publishers and Distributors, New Delhi, 1994.
11.Bhatia, М.S. Essential of Psychiatry. CBS Publishers and Distributors, 11, Dаrуа
Ganj, New Delhi, 1994.
12.Gelder, М. Gath D. and Мауоn R. Oxford Textbook of Psychiatry. Oxford
University Press, Oxford, 1994.
13.Kaplan H.I., Sadock B.J., Сrеbb J.A. Synopsis of Psychiatry. VIII Ed. Williams
and Wilkins, 1998.
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