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  2. 2. 2 1. PSYCHOLOGICAL AND SOCIAL PROBLEMS PSYCHOLOGICAL EFFECTS Alcohol first affects the central nervous system and excessive and prolonged interference can cause brain damage. It is popularly believed that alcohol increases arousal, but many actually depresses brain centers. The feeling of excitement precisely because the depressed some brain centers reduce tensions and inhibitions and the person experiences feelings of sociability expanded or euphoria. Therefore it is said that alcohol "anesthesia, internal auditing." However, if the alcohol concentration exceeds certain levels in the blood interferes with higher mental processes that visual perception is distorted; motor coordination; balance; speech and vision also suffer heavy damage. Heavy amounts of alcohol reduce body aches and pains and induce sleep. But continuous use irritates the stomach lining even to develop ulcers. Additionally tends to accumulate fat in the liver, interfering with its operation. In chronic alcoholics are raised serious brain disorders, liver (cirrhosis) and cardiovascular (increased blood pressure and thus the risk of a heart attack). Even, there is evidence that alcohol increases the level of triglycerides (saturated fat or vegetable in the arteries) and with it the risks of a heart attack. Finally, as is well known, alcohol causes physical addiction and psychological dependence. SOCIAL EFFECTS
  3. 3. 3 Excessive alcohol consumption is one of the most common causes social transgressions such as rape and fights, practice means sex without protection, work and family abandonment. It global links with 50% of deaths in traffic accidents and 30% of homicides and arrests police. Alcoholics have, as a social group, one of the percentages higher marital separation and divorce. However, in Studies in the country has found that about half the people who manage to drink alcoholic maintain a long time.9 marital bond, 11-13 Many authors have studied the dynamics of family home origins of the alcoholic and its coincidence with the point called "non- transitory family crisis" (divorce, chronic illness or death in one or both parents, hostility excessive violence, the estimated loss to the drinking, neglect of children, legal situations, events dishonorable, bad relationships, etc.). This conditioning situation is considered a learning disorder in a specific population of children has been called "children with inability to learn "normal intelligence, not present the characteristic profile of mental retardation and in which invoking a cognitive deficit specific to the learning.1 ,15-18 The results of other authors show that no significant differences between controls and severe alcoholic children of alcoholics and antisocial or depressed or positive family history of alcoholism. By Therefore, they conclude that the overall mental development is not associated with alcoholism in parents. This raises the possibility of later problems in these areas can reflect more specific cognitive processes or the impact of family and behavioral problems among these children. 2. NEUROIMAGING AND NEUROLOGICAL CONSEQUENCES
  4. 4. 4 It will analyze the acute and chronic alcoholism separately because each has different neurological and imaging.  ACUTE INTOXICATION From the morphological point of view, as long as there is no pathology neurological trauma or prior, the only finding in MRI studies is cerebral edema (40% of cases). The significant findings obtained in PET and functional tests SPCC1, showing the presence of a significant decrease glucose metabolism at the level of cerebral cortex, cerebellar cortex, basal ganglia and corpus callosum, which appears to be responsible for the clinical manifestations mayoríade call drunkenness. This alteration is presented in 100% of cases, with any type of liquor and, even with a apparently low and harmless consumption (Figure 5.1). In the alcoholic withdrawal phase in the state after the phase intoxication (hangover, hangovers, raw, mouse) changes are observed functional alteration of glucose metabolism limited to the mescencéfalo and temporal lobes, this could explain the presence of convulsive confusional some pictures that appear during this phase of syndrome.  CHRONIC INTOXICATION With the use and abuse of ethyl alcohol and alterations may occur neurological syndromes, many of them with neuroimaging findings defined. The most common are:
  5. 5. 5  Wernicke encephalopathy.- It is caused by thiamine deficiency and occurs with high frequency in alcoholic patients. It manifests clinically by ataxia, oculomotor abnormalities in the muscles and signs compatible with encephalopathy. Is a frequent underdiagnosed, because usually health professionals not think of it and are not familiar with this type of diseases. The test of choice for brain MRI confirmed is where you can observe in the S0% of cases, periventricular lesions and hypertensive hypothalamus in the cuts of T2, with obvious loss of volume (atrophy) the mamillary bodies (Figure 5.2) and demyelinating-type lesions (which remind the small vessel artery disease] known as cerebral microangiopathy or leukoaraiosis) located at the level of the bodies mammillary, dorsomedial thalamic nuclei, locus ceruleus, the substance periaqueductal gray, oculomotor nuclei and the vestibular nuclei. These lesions may explain some of the neurological manifestations of this entity (Figure 5.3).  Korsakoff syndrome.- It occurs in 80% of cases of encephalopathy Wemicke, especially in the recovery phase. It is characterized by presence of
  6. 6. 6 significant memory deficits in both anterograde and retrograde, accompanied by apathy, without altered mental status and preservation of other intellectual abilities. The brain MRI is also in this case the initial examination, which allows differential diagnosis with other neurological and psychiatric, with findings similar to those described in encephalopathy Wernicke. Functional studies of the type SPECT and PET may show decreased cerebral blood flow and metabolism in frontal, cingulate and precuneus.  CHRONIC ALCOHOLISM Neurological disorders associated with chronic alcoholism are related with nutritional deficiency, with the toxic effects of alcohol per se and their metabolites, liver disease, and head trauma, all which are very frequent in this type of pacientes.El cardinal finding on MRI is the loss of brain volume especially at the expense of the white matter, reduced in 6-17% of normal type associated with compensatory ventriculomegaly (Figure 5.4). These findings are not conclusive and can be seen in other types of abnormalities. In functional studies of PBT is a marked hypometabolism front.  MYELINOLYSIS CENTRAL PONTIC.- Is an alteration of the white matter of the protuberance, due usually a rapid correction of hyponatremia observed in many chronic alcoholics, malnourished, dehydrated, and vomiting frequent. From the clinical point of view often manifested by spastic cuadriparesla accompanied by alterations in consciousness. You should always be a differential diagnosis with multiple sclerosis, and multi-infarct dementia brainstem encephalitis. Histopathological studies show demyelination of axons, seen as hyperintensities in T2 cuts of MRI, not only in pons, but also in the striatum, thalamus and cerebellum.
  7. 7. 7  MARCHIAFAVA BIGNAMI DISEASE. - It is rare in our environment. It occurs in people consuming routine red wine and is characterized by necrosis of the corpus callosum and substance supratentorial white surrounding, accompanied by gliosis in the third layer cerebral cortex. May be associated with Wernicke syndrome, and demonstrate clinically as dementia syndrome, with alterations in gait, generalized spasticity, dysarthria, and a disconnection syndrome interhemispheric. Choice tests to corroborate this diagnosis is the MRI (which necrosis shown above) and SPECT which defines the poor flow blood involved areas (Figure 5.3). It is significant that the notes the persistence of morphological changes seen on MRI, although clinical improvement of patients. 3. NEUROLOGICAL CONDITIONS ASSOCIATED The convulsive syndrome is perhaps the most common condition that is associated chronic alcoholism. In this case if the disease should be defined prior convulsive worse by alcohol consumption, or if it is produced by its long- term effects. The same can think of dementia syndromes, disease type Alzheimer's or multi- infarct dementia, in which diagnosis should be made differential, because chronic alcoholism can by itself, cause crazy pictures or accelerate the normal brain aging. Patients with alcohol intoxication usually have head injuries that often go unnoticed by the patient and family, but sequelae that can leave and worsen cerebral contusion inherent in the chronic manifestations of ethanol abuse. Special mention should neurotoxicity caused by ethanol SNC during development, which leads to major malformations defects in children born to alcoholic mothers. EFFECTS OF ALCOHOL ON THE DIGESTIVE SYSTEM
  8. 8. 8 Gastric distress are due to mucosal erosions produced by ethanol. Heartburn will be greater if they are mixed or combined different beverages, as gastric irritation should be drunk all the components.  Increases gastric acid production that generates irritation and inflammation in the stomach wall so that in the long term, there may be ulcers, bleeding and perforation of the gastric wall.  Stomach cancer has been linked to alcohol abuse. It also causes cancer of the larynx, esophagus and pancreas.  Causes esophagitis, an inflammation of the esophagus, and bleeding esophageal varices Mallory-Weiss tears.  It can cause acute pancreatitis, a severe inflammatory disease of the pancreas, risking death.  May cause chronic pancreatitis, characterized by an intense constant pain.  Other possible changes include type II diabetes and peritonitis.  The liver is the organ responsible for metabolizing alcohol, which is transformed by liver enzymes after first acetaldehyde and acetate and other compounds. This process is slow and is not exempt from damage (depolarized acetaldehyde proteins, oxidized lipids, consume vitamin B and damages the tissues).  By irritating the liver cell may occur alcoholic hepatitis due to cellular destruction and tissue inflammation. Over time, evolving liver (fatty liver or steatosis) to adapt to metabolic overload, but could later hepatitis and cirrhosis of the liver, resulting in cell death and degeneration of the organ. This serious disease can degenerate eventually cause liver cancer and death.  Other signs of altered hepatic jaundice, a yellowing that takes the skin and sclera, and edema, accumulation of fluid in the extremities.  Alters the function of the kidney, reducing the levels of antidiuretic hormone, causing dehydration and drinking water from other organs like the brain, which produces headache.  Alcohol provides abundant calories (7 kcal per gram of alcohol) with little nutritional value. It nourishes but suppresses the appetite, food substitutes
  9. 9. 9 for other more comprehensive and ultimately can lead to malnutrition. This is compounded by inhibiting the absorption of some vitamins and minerals. EFFECTS ON THE GENITOURINARY SYSTEM: Reduction of male hormones by the action of alcohol on the testis and pituitary Reduction of blood into the corpora cavernous due to early atherosclerosis, which causes deformities at birth and severe disruption of intelligence or
  10. 10. 10 behavior in less severe cases (fetus alcoholic). Bladder disorders. Bladder`s Cancer. Sexual Dysfunction LIVER EFFECTS: It is one of the organs most affected by alcohol use, since it is responsible to clean the toxin from the blood. The liver goes affected after many years of drinking and alcoholic liver disease occurs. The damage can range from inflammation to a degenerative disease such as cirrhosis, where the liver cells die and are replaced by fibrous tissue, making it impossible for normal operation. Alcoholism and hepatitis B are primarily responsible for the degeneration of the liver. 4. ALCOHOLISM AND DEPRESSION Depression is a disease that is frequently associated with alcoholism and, above all, the relapse of alcoholics. Whether dysthymia, chronic depression, neurotic, with its ups and downs, or depression that can occur in the first months of abstinence, depression reactive to painful events, the various presentations of major depression, depressive episodes disorders bipolar, etc.. all forms of depression should be taken into account when thinking about preventing relapse of alcoholic patients. 36% of alcoholic patients suffer from depression as a disease quite common, in some cases induced by addiction and other feeding back the same, creating a vicious circle difficult to break.Because it is common to see the alcoholic patient is depressed and feels guilty about the loss of affection, family, work, social, economic, etc. that it causes addiction, which leads to increased consumption of alcoholic beverages in order to mitigate the painful feelings, but achieving the opposite result from that intended because it will generate new faults and major depression. The morbidity of alcoholism and depression is more common in women than in men. Alcoholic patients with depression have much more relapses of their disease than patients who do not. This difference, which manifests itself in the short term, is most evident in the medium and, moreover, in the long
  11. 11. 11 term. Therefore, it can be argued that the association of depression in alcoholic patients aggravates and worsens prognosis of their addiction and therefore should always be treated. 5. FETAL HARM It is well known that alcohol freely crosses the placental barrier and reaches the fetus. Everyone knows that excessive consumption of alcohol by the mother can adversely affect the fetus, but less is known that consumption of small to moderate doses of alcohol can also lead to dangerous consequences. The ingestion of small amounts of alcohol, as 30 ml per day, the child can express an underweight and has been observed an increased risk of spontaneous abortion with intakes of alcohol as insignificant as 30 ml per week and increases , similarly, the probability that the child has significant defects in shape and characterized as the Fetal Alcohol Syndrome (FAS) (the clinical picture and see details below), however, have not yet reached the clinical picture of the syndrome fetal alcohol, the fetus may experience any of these symptoms in isolation. Fetal alcohol syndrome alcohol syndrome in the fetus with each and every one of the conditions that includes the clinical picture, broadly speaking, is: -Dysmorphology or facial deformities. - Prenatal growth deficit (before birth) - Malformation of the central nervous system, including mental retardation Another cause that can affect the baby's development: - There may be dehydration in the mother (no liquids), and that generally, the alcoholic does not usually take other drinks). - The hormonal system of a mother who drinks alcohol is affected, especially in the functioning of the placenta, causing the transport of nutrients, oxygen, and waste is not adequate. - Changes also occur in the brain of the fetus, because alcohol affects almost all cells, primarily those of a baby is forming in the womb of the mother.
  12. 12. 12 - Alcohol destroys brain cells (nerve cell does not regenerate), especially affecting the formation or malformation of the baby's neurons CONCLUSIONS Depression is a disease that is frequently associated with alcoholism, that the association is more common in women than in men, and also that it has a highly negative effect on the evolution of alcoholic patients, increasing the relapse of their disease and clouding the outlook of it. It follows the conclusion that implementing actions and designing strategies to combat depression associated with alcoholism can improve the prognosis of this disease Effects of Alcohol on the Nervous System • Consumption of alcohol gradually depresses brain function, first affecting the emotions (mood swings), thought processes and trial.If you keep your intake of alcohol, motor control becomes impaired, causing slurred speech, slower reactions and loss of balance. • Alters the action of neurotransmitters, it changes its structure and function. This produces multiple effects: decreased alertness, impaired reflexes, and vision changes, loss of muscle coordination, tremors and hallucinations. Decreases self-control, affect memory, concentration and motor function.
  13. 13. 13 • The combination of these effects is because of multiple accidents and traffic, which each year claim the lives of millions of people around the world. • Alcohol damages brain cells and peripheral nerves permanently. • The decline in vitamin B1 produced by alcohol can lead to Wernicke-Korsakoff disease, which causes disturbances of feelings, thoughts and memory of the person. The affected confuse reality with their inventions. • Produce sleep disorders. • People with drinking problems are isolated from their social environment, often suffer crisis in the family (arguments, divorce, abandonment) and employment (job loss), which leads to depression and sometimes suicide.