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The Alcohol Dependence: Epidemiology

1. Alcohol consumption

    a.) Expressed as pure alcohol consumption

- This is a true reflection of morbidity alcoholic.
- In France, it consumes 19 liters of pure alcohol per adult over 15 years per year (133 liters of wine + 64 liters of beer + 2.5 liters of hard liquor)
- Charts.





Largest consumers                                                                 Less heavy users

    - 1er: France - 1st: France                                                      - 1er: Japon - 1 Japan
    - 2eme: Portugal - 2nd: Portugal                                             - 2eme: Suède - 2nd: Sweden
    - 3eme: Luxembourg - 3rd: Luxembourg                                  - 3eme: Chili - 3rd: Chile
    - 4eme: Espagne - 4th: Spain                                                 - 4eme: Finlande - 4th: Finland
    - 5eme: Italie - 5th: Italy

    b.) Changes in consumption - tendency to decrease in wine consumption

- Drinking beer and hard liquor increases.
- In Anglo-Saxon is the reverse.

    c.) Global

- Alcohol consumption increases.
- Increase in the level of alcohol.
- The average cost of alcohol decreases.

2. Mortality

    a.) Cirrhosis and neuro-psychiatric

20,000 deaths per year due to alcohol.

    b.) Road accidents + cancer due to alcohol cirrhosis + + neuropsychiatic diseases

50,000 deaths per year.

    c.) Accidents at work + + household accidents suicides

70,000 deaths per year.
In accidents, alcohol is involved in 15% of cases.

    d.) Domestic accidents

Alcohol is involved in 20% of cases.
A man of 25 who sinks into alcoholism has a life expectancy of less than 12 years.

3. Morbidity related to alcohol

- Alcohol is involved in 25% of all diseases.
- The number of heavy drinkers was 4.5 million.

4. The social cost of alcohol

The direct costs related to illness (hospitalizations and visits) + indirect costs (lost productivity) + + work stoppages accidents and crimes = 130 billion francs a year (tax of 6,000 francs per family).

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The Alcohol dependence: Classification

1. Symptomatic forms of alcohol
  
   a.) Abstinent subjects

  • Subjects with no alcohol consumption. This may be a recovering alcoholic.
    b.) Consumer temperate
  • The alcohol is intermittent or regular basis. In any case it is moderate and does not involve any social problem or symptomatic.
    c.) Consumers at risk
  • The alcohol causes a double risk of dependence and alcoolopathies. The goal is to detect early consumers at risk.
    d.) Alcoholics
  • They are often alcohol-dependent. Psychological dependence usually will settle and physical dependence. The boundary is blurred between the alcoholic patients and consumers at risk.
2. Etiological Forms

    a.) Alcoolites: (alcoholism training, alcohol habits, alcohol imitation, primary alcohol)
  • Epidemiology:
This represents between 40 to 50% of alcoholism in humans and it represents 1-5% of female alcoholism.
  • Age of consultation:
About 40 years. Il débute en fin d'adolescence. It begins in late adolescence.

It is the departure of occasional users who will become regular customers. These are people who drink at dinner, wine or beer.Eventually everything is an excuse to drink with friends (never alone, always friendly). Consumption evolves little. It is daily and continuous.

These are people who are very rarely drunk. Tolerance will increase over time. Gradually, the dependency is installed without the knowledge of the subject. The subjects have no guilt.

They usually become aware of their alcohol in organic complications during withdrawal or involuntary or in social or family problems. There is often a substance identical in the family, especially on the father of the subject. These men often an older woman and have many children. Sexuality has long normal subjects but when it will get worse there will be a subject of pathological jealousy over his wife.
  • Evolution:
    - A stop at the beginning of the spontaneous senescence (age).
    - Organic development of complications.
    - Gradual move towards alcoholism.

    b). Alcooloses (alcohol secondary alcohol psychic neurotic alcoholism, alcoholism decompensation)
  • Epidemiology:
 40 to 50% of alcoholism in men and from 60 to 80% of female alcoholism.

  • Age of consultation:
Between 20 and 45. Often young patients with immature relationship difficulties and existential. They use alcohol for the psychotropic effect. They often drink alone, so hidden.

These are people who have little attraction to alcohol and sometimes disgust. Consumption is irregular, paroxysmal. They can stay several months without drinking and stops will become shorter. Over time there is a psychological dependence that will occur and physical dependence. They have a guilt very important with respect to alcohol and they try to fight against alcoholism. These subjects consulted in connection with behavioral disorders (intoxication), suicide attempt, family or business failures.They have few physical problems at the start.
  • Evolution:
This often progresses to severe behavioral problems, sometimes with a psychic evolution possible.

    c.) Somalcoolose: (alcoholism sympytomatic alcoholism perversion, dipsomania)

- Heredity:
- Nothing.
- Sexual problems very common.
- Evolution:

Is indefinite. Il ya un passage possible vers l'alcoolose. There is a possible transition to the alcoolose.

    d.) Clissification DSM3
  • Alcohol abuse
For at least one month must be a pathological use of alcohol (inability to reduce or stop, episode of amnesia, continued use despite interference), or a disability of social or occupational functioning due to alcohol consumption.
  • Dependency syndrome
Alcohol abuse (same criteria) plus an increased tolerance or withdrawal syndrome.

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The Alcohol dependence: Definition

It is a substance that affects the central nervous system

2. Alcohol

It is the absorption by an individual of a beverage containing ethanol.

3. BAC

It is the presence of alcohol in the blood.

4. Alcoholism

- Is an alcoholic, those who consume a daily amount of alcohol than that can metabolize it safe, that is about ¾ of a liter of wine at 10 ° for a 70 kg.

- There are alcohol when there is a loss of freedom to refrain from alcohol or when there are complications of medical, psychological and social.

- It replaces the term alcoholism more often the term syndrome of alcohol dependence.

5. Alcohol subject

This is a subject consumers usual alcoholic substances which undergoes significant alteration of its ability to control consumption or has complications.

6. Alcoolopathies

These are all secondary damage in acute alcohol or especially in chronic alcoholism.

7. Alcohol dependence
   
    a.) Physical (or physiological)
  • Is defined by the appearance of a withdrawal syndrome after cessation of alcohol.
        b.) Psychological (or mental)
    • This corresponds to an impulse to absorb alcohol regularly or repeatedly to derive pleasure or to endure a situation experienced as painful. Alcohol is consumed as a psychotropic drug.
    8. Habit

    It is the fact that a subject that consumes a toxic to feel the effects, will want to consume this poison again to feel the effects again.

    9. Tolerance

    It has the property that the body to feel the effects of a precise dose produced no disease symptoms appear. La tolérance est dynamique, c'est à dire qu'elle s'accroît parallèlement à l'augmentation régulière des doses nécessaires pour que les effets obtenus restent les mêmes. Tolerance is dynamic, ie it increases with increasing doses regularly to ensure that the effects obtained are the same. Après plusieurs années, la tolérance s'effondre souvent de façon définitive. After several years, tolerance often collapses for good.

    10. Weaning

    This is to stop taking toxic in a subject dependent. Le syndrome de sevrage alcoolique est l'ensemble des signes pathologiques survenant à la suite de l'arrêt de l'alcoolisation chez un sujet ayant une alcoolo-dépendance physique. The alcohol withdrawal syndrome is the set of signs of disease that occurs following cessation of alcohol in a person with physical alcohol dependence.

    11. Healing

    This is normally the total disappearance of a disease process and in the field of alcohol dependence it is better not to speak of cure, but stabilization.

    12. Stabilization

    This means that a subject maintains a satisfactory condition of equilibrium with an alcohol-free quality of life as it deems proper.

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    Chronic fatigue syndrome (CFS or ME) [3]

    Treatment

    If the hypothesis of CFS is withheld, it is important that the doctor in an open discussion with the patient explaining the situation, discuss the prognosis and treatment options overflowing.
    On the treatment of CFS is also no consensus and there is a lot of experimenting with drugs, supplements, psychotherapy etc.
    Some common treatments are:


    • Tricyclic antidepressants: in low doses can be helpful for patients with CFS. They are in high doses to patients with a depressed mood by endogenous (ie from the body itself) or reactive factors may cause.
    • Amantadine (Amantan) is a drug that was originally used in Parkinson's disease, and lately also in MS patients also with a strong general fatigue may have suffered.
    Recently it was shown that the product produces antiviral properties, particularly preventive protection against influenza A infections.
    • Calcium channel blockers may be useful for the symptomatic treatment of muscle pains, or 75% of CFS patients.
    • There are some indications that the essential fatty acids linoleic acid and alpha linolenic acid forms of protection against viral infections. Administration of these fatty acids in CFS patients would have a beneficial effect.
    • Because many symptoms of CFS suggest a disordered immune system, one has tested various forms of immunotherapy, including high doses of immunoglobulins.
    • CFS patients are sometimes extremely high doses of vitamins (B12, B6, Vitamin C) and minerals (especially magnesium and zinc) administered on its own initiative or they swallow supplements. The usefulness of this is not scientifically proven, the potential dangers of overdose, however, are clearly demonstrated.
    • Psychotherapy and behavioral therapy. From the behavior makes a distinction between the causal factors of CFS (eg viral infections) and the entertaining factors (eg an irregular rest and activity schedule. In cognitive-behavioral based treatment largely to an improved handling of the sustaining factors that often cause the more severe forms aaneemt CFS. The following topics are addressed in therapy:
    • treatment of the disease and the disabling aspect;
    • seeking to appropriate a lifestyle;
    • the physical and psychosocial rehabilitation;
    • treatment of sleep disorders and emotional problems may present symptoms such as stress or depression.

    In practice, a combination of a causal approach, a symptomatic treatment of the worst symptoms, proper treatment and a supportive accompaniment psychological most to bear fruit. This requires a multidisciplinary approach involving both internists, psychiatrists and neuro-physiotherapists, paramedics, partners and family members a role to play.

    Good psychological guidance is important to the feelings of fear, resentment, dissatisfaction, etc. of the patient to absorb. Besides the physical symptoms he suffers is with anger and powerlessness in relation to the loss of his intellectual capacity, problems at work (long-term illness), lack of understanding of the environment, etc.

    CVS and lifestyle

    Rest and exercise

    As one of a hyperactive immune system characteristics of CFS, the patient usually recommended initially for a period rest. Then much to start with the progressive creation of an exercise schedule, the patient must find its limits and gradually learn to shift. The point is the right balance between effort and rest, and great efforts can trigger a flare to avoid.

    Work and family

    In many cases, the patient should take a long time sick, and / or other working arrangements, like part-time work or home. Unfortunately, not everyone succeeds in it, and see CFS patients are sometimes obliged to work and to make disability to apply.
    The care for the household and any children often weighs heavy. Amsterdam is currently experimenting with a buddy system, similar to the AIDS-buddies buddies with both practical help (cooking, shopping, childcare ...) and emotional support.

    Nutrition

    A healthy, balanced diet is obviously important. An adequate supply of complex carbohydrates is necessary for the hypoglycemieaanvallen who frequent CFS-prevention.
    Highly restrictive diets, such as those in alternative medicine often promoted, have not proven their worth, just as the popular anti-candida diet.
    CFS patients generally do not tolerate alcohol, and in principle will therefore avoid spontaneous.

    Pregnancy

    CFS patients can safely continue taking the pill. During pregnancy most women in a notable improvement in their condition determined. Yet this does not necessarily an incentive for CFS patients to become pregnant: after birth, it follows a tiring postnatal period and later, the care of a child quite burdensome.
    There is no indication that CFS to the fetus can be passed.

    Drive

    The reduced cognitive and visual capacity, driving can be dangerous. insurance should be informed of the health problem.
    Although as yet no "CVS virus could be identified, allowing the possibility that a virus, or even another transient trauma, a chronic reaction of the immune system. This means that the immune system remains constantly active even when the infection is over. Abnormally high doses of immune-activating factors - some indeed can cause fatigue, would result in the bloodstream and lead to chronic exhaustion.

    Moreover Fri recent study has shown that the organ systems in which the patient complains, the majority of the muscles, the immune system, blood system, persistent viruses are found. Pathogenic viruses in healthy individuals are relatively short term (several weeks or months) evacuated, while the viruses in CFS patients a long time, even years after the infection, persist.

    Other theories then go in the direction of endocrine disorders, or search for psychological factors.

    And finally, it remains possible that CFS is caused by a single, as yet unknown factor.

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    Chronic fatigue syndrome (CFS or ME) [2]

    No yuppie disease


    CFS was sometimes used contemptuously "the yuppie disease" because it was thought that she was a young, hardworking, career oriented people hit. It is now evident:
    • that most patients between 20 and 50 years old, but the disease also occurs in children aged 7 years;
    • that CFS is more common among women (about 1 man 3 women);


    • the disease in all socioeconomic groups of songs, but something more teachers and medical and paramedical professions;
    • that CFS patients often have a very active, busy and quite stressful lives.

    Causes

    About the causes of CFS are different theories, but none provides a conclusive proof.

    • A possible hypothesis is that CFS is caused by a yet-unidentified virus which activates the immune system constantly.
    There are indeed many known viruses during the infection period, a strong fatigue. Of some viruses such as Epstein-Barr virus (better known as mononucleosis or kissing the disease) are known to cause exceptionally a chronic active infection, with persistent fatigue as a result. Correlations between Epstein-Barr and CFS, and between CFS and other known viruses such as Herpes type 6 and HIV and a number of enteroviruses, have been extensively studied, but not a causal link could be established.
    • Although so far no "CVS virus could be identified, allowing the possibility that a virus, or even another transient trauma, a chronic reaction of the immune system. This means that the immune system remains constantly active even when the infection is over. Abnormally high doses of immune-activating factors - some indeed can cause fatigue, would result in the bloodstream and lead to chronic exhaustion.
    Moreover, very recent research has shown that the organ systems in which the patient complains, the most muscles, the immune system, blood system-persistent viruses are found. Pathogenic viruses in healthy individuals are relatively short term (several weeks or months) evacuated, while the viruses in CFS patients a long time, even years after the infection, persist.
    • Other theories go back in the direction of endocrine disorders, or search for psychological factors.
    • And finally, it remains possible that CFS is caused by a single, as yet unknown factor.

    Diagnosis

    There is no test to the diagnosis of CFS can be stated unequivocally.
    The doctor will also be good in the first place to listen to his / her patient, and the complaints he / she sets against the standard criteria (see above).

    The most common symptoms of CFS are:
    • The disease began suddenly, but was usually preceded by an infection (flu-like illness, pharyngitis, gastroenteritis ...);
    even a minimal effort causes extreme fatigue in the muscles (myalgia), which we only slowly recovering. Often they also suffer from involuntary muscle contractions;
    • one can not, or only part-time work;
    • headache
    • cognitive disorders such as concentration and attention problems, memory loss, difficulty speaking (mistake in words). Together these symptoms are a reduction of intellectual potential;
    • Large fluctuations in the fitness condition: one is not tired all day;
    one-to-patient exaggerated physical or intellectual effort may provoke a flare;
    • an overactivity of the autonomic nervous system, eg, frequent urination (heart) palpitations, etc.;
    • flu-like symptoms that occasionally flare up, with sore throat and painful swollen lymph nodes;
    • distorted body with night sweats, cold extremities (fingers, toes ...) and sometimes mild fever and chills;
    • sleep disorders (in the initial phase, sleepiness, and then fall asleep and / or sleep);
    • poor fine motor skills and balance disorders that worsen at night;
    • disorders of the senses to paresthesia (itching and tickling)
    • tinnitus (noise observations) and photophobia (photophobia);
    • pronounced alcohol intolerance;
    • emotional labliteit;
    • atypsiche depression (not a true depression), sometimes with depersonalization (self-alienation) and disorientation;
    • IBS.

    In a second phase, the doctor will try to objectify the complaints by a clinical examination. In most cases, this however, but little result.

    • In some patients, they propose that a-true-atypical strep throat and swollen lymph nodes down.
    • The neurological examination often shows an abnormal Romberg test to (falter and tendency to fall when we closed feet and eyes straight to it) and sometimes involuntary muscle contractions, other neurological signs are only for when the disease was preceded by an infection that also central nervous system is affected.
    • The weakness can be clearly determined by a effort, but not at rest.
    • Blood pressure is usually low.
    • Usually, the clinical examination supplemented by a number of routine investigations such as laboratory tests of blood, an echocardiogram or rhythm examination of the heart (ECG), an EEG (electro-cardiogram), a radiograph of the chest (RX thorax), a spinal puncture, a brain scan, an MR examination of the brains (magnetic resonance) ...

    These and other studies are also useful for other precipitating causes of chronic fatigue (eg MS) to exclude.

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