Alcohol-related psychosis is a
secondary psychosis with predominant hallucinations occurring in many
alcohol-related conditions, including acute intoxication, withdrawal,
after a major decrease in alcohol consumption, and alcohol idiosyncratic
intoxication. Alcohol is a neurotoxin that affects the brain in a
complex manner through prolonged exposure and repeated withdrawal,
resulting in significant morbidity and mortality. Alcohol-related
psychosis is often an indication of chronic alcoholism; thus, it is
associated with medical, neurological, and psychosocial complications.
Alcohol-related psychosis spontaneously clears with discontinuation of alcohol use and may resume during repeated alcohol exposure. Although distinguishing alcohol-related psychosis from schizophrenia through clinical presentation often is difficult, it is generally accepted that alcohol-related psychosis remits with abstinence, unlike schizophrenia. If persistent psychosis develops, diagnostic confusion can result. Comorbid psychotic disorders, eg, schizophrenia and bipolar affective disorder, may exist, resulting in the psychosis being attributed to the wrong etiology.
Some characteristics that may help differentiate alcohol-induce psychosis from schizophrenia, are that alcohol-induced psychosis shows a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment.[1]
Alcohol idiosyncratic intoxication is an unusual condition that occurs when a small amount of alcohol produces intoxication that results in aggression, impaired consciousness, prolonged sleep, transient hallucinations, illusions, and delusions. These episodes occur rapidly, can last from only a few minutes to hours, and are followed by amnesia. Alcohol idiosyncratic intoxication often occurs in elderly persons and those with impaired impulse control.
Unlike alcoholism, alcohol-related psychosis lacks the in-depth research needed to understand its pathophysiology, demographics, characteristics, and treatment. This article will attempt to provide as much possible information for adequate knowledge of alcohol-related psychosis and the most up-to-date treatment.
At 5 pm you are asked to consult on a 44-year-old Caucasian female who is 2 days postsurgical hysterectomy. She is complaining of rabbits running across the room and demands the nurses stop intruding "every minute of every hour." She is tremulous, disoriented to time and place, and irritable. A review of her lab data shows an elevated GGT and slightly elevated LFTs. White blood cell count is normal. Urinalysis is normal and blood alcohol level is 0.01. Her medications, which were held prior to the surgery included acamprosate 666 mg tid and clonazepam 1 mg 4 times a day. Her sister later informs the nursing staff that this woman is usually on her fourth Manhattan by this hour of the day.
Alcohol-related psychosis spontaneously clears with discontinuation of alcohol use and may resume during repeated alcohol exposure. Although distinguishing alcohol-related psychosis from schizophrenia through clinical presentation often is difficult, it is generally accepted that alcohol-related psychosis remits with abstinence, unlike schizophrenia. If persistent psychosis develops, diagnostic confusion can result. Comorbid psychotic disorders, eg, schizophrenia and bipolar affective disorder, may exist, resulting in the psychosis being attributed to the wrong etiology.
Some characteristics that may help differentiate alcohol-induce psychosis from schizophrenia, are that alcohol-induced psychosis shows a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment.[1]
Alcohol idiosyncratic intoxication is an unusual condition that occurs when a small amount of alcohol produces intoxication that results in aggression, impaired consciousness, prolonged sleep, transient hallucinations, illusions, and delusions. These episodes occur rapidly, can last from only a few minutes to hours, and are followed by amnesia. Alcohol idiosyncratic intoxication often occurs in elderly persons and those with impaired impulse control.
Unlike alcoholism, alcohol-related psychosis lacks the in-depth research needed to understand its pathophysiology, demographics, characteristics, and treatment. This article will attempt to provide as much possible information for adequate knowledge of alcohol-related psychosis and the most up-to-date treatment.
Case study
A 37-year-old Caucasian male infantryman stationed in Iraq arrived at a field hospital complaining that his superior officer placed poisonous ants in his helmet. His face is covered with excoriations from persistent scratching. On further examination, he is stuporous and has mildly slurred speech, tremor, and mint odor to his breath. Later his troop leader mentioned that his Humvee was littered with empty bottles of mouth wash, and that the man has been reprimanded for falling asleep at his post. After a night of rest, he discussed his excessive use of mouthwash in place of alcohol, which is the only available form of alcohol in Iraq.At 5 pm you are asked to consult on a 44-year-old Caucasian female who is 2 days postsurgical hysterectomy. She is complaining of rabbits running across the room and demands the nurses stop intruding "every minute of every hour." She is tremulous, disoriented to time and place, and irritable. A review of her lab data shows an elevated GGT and slightly elevated LFTs. White blood cell count is normal. Urinalysis is normal and blood alcohol level is 0.01. Her medications, which were held prior to the surgery included acamprosate 666 mg tid and clonazepam 1 mg 4 times a day. Her sister later informs the nursing staff that this woman is usually on her fourth Manhattan by this hour of the day.
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