Alcohol Interaction. It has long been recognized that there is an interaction between alcohol and paranoid mechanisms, but the nature and quality of the interaction remains unknown. There is no question that alcohol is used by some paranoid patients to relieve the tension associated with the paranoid condition. The patient is usually prevented by his suspiciousness and fears of contact and closeness from obtaining any of the usual gratifications in his relationships with other people. Nonetheless, there is evidence to suggest that the anxiety-reduction model for the use of alcohol is not very adequate. Tamerin and Mendelson(1969) in an experimental setting have shown that somewhat depressed and inhibited alcoholics experience a considerable increase in their aggressiveness and self-assertiveness—along with indications of irritability, childishness, and a provocative hypermasculine sort of contentiousness which is quite different in quality from their normal personality functioning. This form of pathological aggressiveness and assertiveness may well have been a defense against passive homosexual wishes, which became more active under the release of alcohol. However, we can also suggest that, under the influence of alcohol, preexisting paranoid tendencies are activated. The partial release from superego restraints and self-denigration may easily take the form of externalizations which permit greater degrees of external attack. 相互作用。人们早就认识到，酒精和偏执机制之间存在相互作用，但这种相互作用的性质和质量仍不清楚。毫无疑问，一些偏执患者用酒精来缓解与偏执状态有关的紧张情绪。患者通常被他的多疑和对接触和亲近的恐惧所阻止，无法在与他人的关系中获得任何通常的满足。尽管如此，有证据表明，使用酒精的焦虑减少模型不是很充分。Tamerin和Mendelson(1969)在实验环境中表明，有些抑郁和抑制的酗酒者在他们的攻击性和自我强硬性方面经历了相当大的增加——伴随着易怒、幼稚和挑衅性的超男性化的那种争吵的迹象，这在质量上与他们正常的人格运作完全不同。这种病态的攻击性和强硬性的形式很可能是对被动的同性恋愿望的一种防御，而这种愿望在酒精的释放下变得更加活跃。然而，我们也可以认为，在酒精的影响下，预先存在的偏执倾向被激活。超我约束和自我贬低的部分释放可能很容易采取外化的形式，从而允许更大程度的外部攻击。 Consequently, we must conclude that if alcohol can in some cases serve to relieve the tension of paranoid symptoms, there are also other cases in which it is clear that its use can activate or expose previously latent paranoid tendencies. Thus the influences of the drug must be set in a context of the personality organization and function. This is also true in cases of frank paranoia—even on a psychotic level. Some patients will become more argumentative and aggressive, thus triggering responsive anger in those around them and increasing paranoid suspiciousness and defensiveness. Symptoms of paranoia may thus become more severe and ideas of reference and other delusions may be exacerbated. 因此，我们必须得出这样的结论：如果说酒精在某些情况下可以起到缓解偏执症状的紧张作用，那么在其他情况下，使用酒精显然也会激活或暴露出以前潜伏的偏执倾向。因此，药物的影响必须放在个性组织和功能的背景下分析。在明确的偏执症——甚至是精神病水平的情况下也是如此。有些患者会变得更加好辩论和具有攻击性，从而引发周围人的反应性愤怒，增加偏执的猜疑和防御性。偏执症的症状可能因此变得更加严重，牵连观念和其他妄想可能会加重。 However, even psychotic patients may find some diminution in the impact of persecutory delusions and hallucinations through the use of alcohol. This usually is the case when patients have consumed enough of the drug to diminish their usual degree of hyperalertness and attention concentration. Here too, it is noteworthy that some patients are very wary of the use of alcohol or even other drugs on the grounds that it will diminish their defensive alertness and hyperacuteness—thus leaving them vulnerable to attack. This pattern of thinking is often seen in paranoid patients who refuse to take medications recommended by the physician—or if they do not refuse the medications, will simply neglect to take them. Management of medications, where indicated in paranoid patients, is usually a difficult process. It is worth noting that acute paranoid symptoms may be exacerbated in susceptible persons with only a small quantity of alcohol consumption. 然而，即使是精神病患者也会发现，通过酒精的使用，迫害性妄想和幻觉的影响有所减弱。通常情况下，当患者摄入的药物足以降低其通常的超敏性和注意力集中程度时，就会出现这种情况。这里也值得注意的是，有些病人对使用酒精甚至其他药物非常谨慎，理由是酒精会降低他们的防御性警觉性和超敏性，从而使他们容易受到攻击。这种思维模式经常出现在偏执患者身上，他们拒绝服用医生推荐的药物——或者如果他们不拒绝服药，就会直接忽视服药。在偏执患者有药物治疗指征的情况下，对药物的管理通常是一个困难的过程。值得注意的是，仅少量饮酒的易感者，急性偏执症状可能会加重。 Pathological States. There are several toxic states that are associated with the use of alcohol. The first of these is delirium tremens, which may be due to direct toxic effects of the alcohol in the metabolism of the central nervous system, but is usually regarded clinically as an acute withdrawal syndrome. It usually follows the end of a bout of alcoholic drinking by several days and is rather sudden in onset. The delirium is accompanied by impairment of intellectual and perceptual functions. There is generally partial amnesia with confusion, disorientation, and impairments of attention, perception, and comprehension. The patient may be able to carry on a discussion with his physician, but consciousness is generally partially impaired. Hallucinations are frequent accompaniments of the syndrome—usually visual, but may also be auditory. These are generally vivid and may be frightening to the patient. The hallucinations may be amusing or entertaining, but often have a bizarre and extremely frightening quality—the patient may see monsters or spiders or scorpions or snakes, or other frightening things. The patient may feel that his life is threatened and in panic try to escape from these horribly threatening things. 病理状态。 有几种中毒状态与使用酒精有关。首先是震颤性谵妄，可能是由于酒精在中枢神经系统代谢中的直接毒性作用，但临床上通常认为是一种急性戒断综合征。它通常在一次饮酒结束后数天出现，发病相当突然。谵妄伴随着智力和知觉功能的损害。一般有部分失忆，伴有精神错乱、定向力障碍、注意力、知觉和理解力障碍。患者可与医生进行讨论，但意识一般部分受损。幻觉是本综合征经常伴随的症状——通常是视觉的，但也可能是听觉的。这些幻觉通常是生动的，可能会让病人感到害怕。幻觉可能是有趣的或娱乐性的，但往往具有怪异和极其可怕的性质——病人可能会看到怪物、蜘蛛、蝎子或蛇，或其他可怕的东西。病人可能觉得自己的生命受到威胁，惊慌失措地试图逃离这些可怕的威胁性事物。 There is also a specific paranoid state which is related to the use of alcohol, alcoholic paranoia, but this is generally regarded as a basically paranoid condition which is simply unveiled by the use of alcohol. The defenses against the paranoid process are probably weakened and the paranoid symptomatology then becomes more manifest. Such individuals usually show a lifelong pattern of personality disturbance. Usually the paranoid characteristics are relatively well compensated and latent, but under the influence of alcohol, the patient undergoes a psychotic decompensation and the paranoid traits become more florid and delusional (Thompson, 1959). 还有一种特殊的偏执状态是与饮酒有关的，即酒精性偏执，但一般认为这是一种基本的偏执状态，只是因饮酒而揭发。对偏执过程中的防御可能会被削弱，然后偏执症状表现就会更加明显。这类人通常表现出终生的人格障碍模式。通常偏执特征是比较好的补偿和潜伏，但在酒精的影响下，患者会发生精神失代偿，偏执特征变得更加花哨和妄想（Thompson，1959）。 Another syndrome which is characteristically related to the use of alcohol is the so-called alcoholic hallucinosis. This syndrome is usually more severe and frequently more markedly paranoid as to its symptomatology than states of pathological intoxication. Such patients are usually felt to be basically schizophrenic, with the symptomatology being exacerbated by the toxic effects of alcohol. The alcoholic hallucinosis is usually accompanied by terrifying auditory hallucination, while the patient maintains a relatively clear sensorium. This contrasts the syndrome to delirium tremens in which the patient experiences primarily visual hallucinations together with a clouded state of consciousness. The hallucinations often take the form of superego accusations against the patient—often of a sexual nature. 另一种与饮酒有关的综合症是所谓的酒精性幻觉症。这种综合症通常比病理中毒状态更严重，而且在症状上往往更明显地表现为偏执。这类患者通常被认为基本上是精神分裂症，症状因酒精的毒性作用而加重。酒精性幻觉通常伴随着可怕的听觉幻觉，而患者却保持着相对清晰的感觉。这与震颤谵妄形成了鲜明的对比，在震颤谵妄中，患者主要体验到视觉幻觉和意识模糊的状态。幻觉的形式往往是超我对病人的指控——通常是性方面的。 It is interesting to note that patients who are afflicted by alcoholic hallucinosis rarely merge into what is known as the Korsakoff syndrome. While Korsakoff patients often go through states of severe agitation and delirium in the early acute phase, in the "burnt-out" phase, there is no indication of psychotic symptoms, such as hallucinations or delusions. In the advanced stages of Korsakoff syndrome, the patient will confabulate—that is, he will make up a story or recount imaginary events as a way of filling in the extensive memory gaps that are part of the syndrome; but these confabulations do not have the same quality as psychotic delusions. Thus, while the Korsakoff syndrome is often referred to as a "psychosis," it is clear that it is a condition that is secondary to the deterioration of cognitive—specifically memory—functions and it is not a psychosis in the usual sense. Moreover, Korsakoff patients rarely show signs of paranoia. Cases in which confabulation is associated with paranoid ideation in the invented material seem to represent the expression of premorbid paranoid personality organization (Berlyne,1972). Consequently the hallucinosis is probably more correctly regarded as a symptomatology based on a schizophrenic process which is exacerbated or unveiled by the effects of alcohol on the central nervous system, rather than as a specific syndrome caused by the toxic effects of alcohol or its withdrawal. 有意思的是，受酒精性幻觉影响的病人很少会合并成所谓的科萨科夫综合症。虽然科萨科夫综合症患者在早期的急性期经常会出现严重的躁动和谵妄状态，但在 "烧坏 "阶段，并没有出现精神症状，如幻觉或妄想。在柯萨科夫综合症的晚期阶段，病人会胡言乱语——即他会编造一个故事或叙述想象中的事件，以此来填补广泛的记忆空白，这也是综合症的一部分；但这些胡言乱语并不具备精神病性妄想的性质。因此，虽然科萨科夫综合征经常被称为 "精神病"，但很明显，这是一种继发于认知--特别是记忆--功能恶化的病症，它不是通常意义上的精神病。此外，柯萨科夫患者很少有偏执症的表现。那些在编造的材料中，胡言乱语与偏执思维有关的病例，似乎代表了先天性偏执型人格组织的表现（Berlyne,1972）。因此，幻觉可能更正确地被认为是一种基于精神分裂症过程的症状学，这个过程因酒精对中枢神经系统的影响而加重或揭发，而不是由酒精的毒性作用或其戒断引起的一种特殊综合征。 Finally it should be noted that alcohol has a definite effect on the activation of certain epileptic syndromes (Ervin,1967). This is true of a variety of epileptic disorders, but is particularly associated with psychomotorlike seizures. Such patients often are susceptible to alcoholic blackouts and the unleashing of violent behavior under the influence of epileptic discharges activated by the influence of alcohol. 最后应该指出，酒精对某些癫痫综合症的激活有明确的影响(Ervin,1967)。这对各种癫痫病都是如此，但与精神运动型癫痫发作特别相关。这类病人往往容易在酒精影响下激活的癫痫性放电的影响下出现酒精性昏迷和暴力行为的释放。