Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

5. Alcohol 89individual with a history of alcoholism are early clues suggestive of alcoholinducedpersisting dementia.Alcohol-Induced Anxiety, Affective, or Psychotic DisorderIf symptoms of an anxiety disorder, affective disorder (depressive, manic, ormixed), or psychotic disorder (hallucinations or delusions) develop during orwithin 1 month of intoxication or withdrawal, an alcohol-induced anxiety,affective, or psychotic disorder may be diagnosed. If the patient has insight thathallucinations are alcohol-induced, an alcohol-induced psychotic disorder isnot diagnosed. The anxiety and affective symptoms must exceed the usual presentationof such symptoms as they commonly occur during intoxication orwithdrawal (DSM-IV).These disorders must be distinguished from comorbid psychiatric disorders(see section on comorbidity). A careful history eliciting the onset and thecourse of symptoms during abstinence or reexposure to alcohol will help distinguishalcohol-induced syndromes from psychiatric comorbidity.Alcohol-Induced Sleep DisorderAlcohol consumed at bedtime may decrease the time required to fall asleep buttypically disrupts the second half of the sleep cycle, resulting in subsequent daytimefatigue and sleepiness. Even a moderate dose of alcohol consumed within6 hours prior to bedtime can increase wakefulness during the second half ofsleep (Vitiello, 1997). Alcohol use prior to bedtime will also aggravate obstructivesleep apnea, and heavy drinkers or those with alcoholism are at increasedrisk for sleep apnea. Patients with severe obstructive sleep apnea are at a fivefoldincreased risk for fatigue-related traffic crashes if they consume two or moredrinks per day compared to obstructive sleep apnea patients who consume littleor no alcohol (Bassetti & Aldrich, 1996).In alcoholics, heavy drinking eventually leads to increased time requiredto fall asleep, frequent awakenings, and a decrease in subjective quality of sleep.Slow-wave sleep is interrupted, and during periods of withdrawal there is pronouncedinsomnia and increased rapid eye movement (REM) sleep. Followingwithdrawal from alcohol, sleep patterns may be abnormal, even following yearsof abstinence.Alcohol-Induced Sexual DysfunctionSexual dysfunction refers to impairment in sexual desire, arousal, or orgasm, orpresence of pain associated with intercourse as a result of alcohol use. Alcoholinducedsexual dysfunction differs from a primary sexual disorder in thatimprovement would be expected with abstinence from alcohol.