Alcohol psychosis: what is it, symptoms and treatment, prognosis

What is alcoholic psychosis?

Alcoholic psychosis (or metal alcohol psychosis) Is a secondary psychosis that occurs in acute intoxication, alcohol withdrawal, as well as in patients with chronic alcoholic disorder (alcoholism). The specific diagnosis associated with alcoholic psychosis is also known as alcoholic hallucinosis. This is a relatively rare consequence of alcohol consumption. However, it may be more common than commonly believed, depending on the inclusion criteria used for diagnosis. In alcoholic psychosis, symptoms of psychosis appear during or shortly after heavy drinking. Clinically, alcohol-related psychosis is similar to schizophreniabut has been found to be a unique and independent state. It is characterized by hallucinations, paranoia, and fear.

Sign and symptoms

Alcohol psychosis is associated with a variety of symptoms. Although some symptoms and signs may occur when a person is in a state of alcoholic intoxication or in a state of abstinence, what distinguishes alcoholic psychosis is how serious symptoms. When someone has this condition, the symptoms are noticeable and often severe.

• Anxiety or paranoia: Paranoia is when you feel intense fear or distrust of others. You can believe that people are trying to harm you even when they are not. Worry is when you are more worried than others. Both symptoms are associated with alcohol psychosis, although anxiety is also associated with alcohol in general.
• Hallucinations - this is when you hear, see or feel what is not. About 95% of patients with alcoholic psychosis have hallucinations. Most have more than one type of hallucination.
• Delusions Is when you believe something is true, even if it is false. Even if someone tries to prove to you that what you think is false, you still believe it. Misconceptions occur in 51% of patients with alcoholic psychosis. Delirium can occur along with other symptoms such as hallucinations.
• Dissociation Is when you feel disconnected from yourself. You may not even be aware that this is happening. An example of dissociation might be that you are somewhere and don't know how you got there, or don't remember an important event.
• Depersonalization - this is when you feel that the world around you is unreal. You may have an out-of-body experience or feel detached from the world around you.
• Suicidal thoughts or actions: suicide and alcohol use are closely related. Unfortunately, 22% of suicides happen when a person is drunk. People who struggle with alcoholism have a suicide rate 10 times higher than others. In addition, 40% of people who have been helped to cope with alcoholism have tried to commit suicide at least once.

Causes

There are many hypotheses describing the etiology of alcohol-related psychosis, but none of them can completely explain the development of acute or chronic hallucinations in some patients with use disorder alcohol. Consequently, the exact etiology of alcoholic psychosis is unknown. It is likely associated with dopamine, serotonin, and other neurotransmitters.

Epidemiology

A 2015 Dutch literature review on alcohol-related psychotic disorders found that lifetime prevalence of this disorder in the general population is 0.4%, and among patients with alcoholic addiction — 4%. The incidence is highest in men of working age. Alcohol-related psychoses are also more common in 1.) patients who became alcohol-dependent at a younger age age, 2.) people with low socioeconomic status, 3.) people who are unemployed or retired, and 4.) lonely.

Twin studies also suggest a genetic predisposition to the development of alcoholic psychosis. If you are diagnosed with alcohol-related psychosis, there is a 68% chance of readmission and 37% of comorbidities with other mental disorders. In patients with alcoholic psychosis, the risk of developing chronic schizophrenia-like syndrome ranges from 5% to 30%.

Pathophysiology

The pathophysiology of alcoholic psychoses is unclear. There are several hypotheses. Some studies suggest that an increase in central dopaminergic activity and changes in dopamine receptors may be associated with hallucinations in patients with alcoholic disorder. However, serotonin can also be involved. Other studies show that amino acid abnormalities can lead to a decrease in serotonin in the brain and an increase in dopamine activity, which leads to hallucinations. Elevated beta-carbolines and impaired hearing are also associated with alcohol-induced psychosis. Studies using neuroimaging have shown that perfusion disorders in various areas of the brain may be associated with hallucinations in alcohol dependence.

Diagnostics

- History and physics.

As with any form of psychosis, patients with alcoholic psychosis can have a wide variety of symptoms. However, the presence of significant hallucinations or delusions should be evident. The psychosis is more serious than what can potentially be attributed to alcohol intoxication or withdrawal. Particular attention should be paid to mental status, including flat affect or reactions to internal stimuli. In addition, a good physical examination is necessary to identify possible trauma or infectious causes of mental status change.

- Analyzes.

Most patients presenting with psychosis for the first time have some form of substance abuse. A detailed history is important in evaluating alcoholic psychosis. In particular, it is imperative to determine the patient's drinking history. It can be difficult to determine whether a patient's psychotic symptoms are related to the primary psychotic disorder or to the use of psychoactive substances, including alcohol. This can be especially difficult in the emergency department, where a history is often missing. The absence of a family history of psychotic disorder in a patient with a clear history of alcohol use does not support a diagnosis of alcohol-related psychosis. Alcohol-related psychosis must be differentiated from other causes of psychosis and, in particular, from schizophrenia. Compared to schizophrenia, patients with alcohol-related psychosis tend to have significantly lower levels of education, the onset of psychosis at an older age, more pronounced depressive and anxiety symptoms and less negative and disorganized symptoms. Patients with alcoholic psychosis are also usually better discerning and judicious.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that for diagnosis substance use disorder requires significant hallucinations or delirium. There must be evidence that the hallucinations or delusions started during or shortly after intoxication or withdrawal of psychoactive substances, or the substance used is known to cause disorder. Symptoms are no better explained by a psychotic disorder unrelated to substance use. Psychosis does not occur only when delirium. Symptoms cause clinically significant disturbance or difficulty in normal activities such as work or social interaction.

A detailed physical examination is also important. Patient stability should first be assessed, including airway patency, breathing and vital signs. Particular attention should be paid to the general appearance, including if the patient is unkempt, has a flat affect, smells like alcohol, or seems to be responding to internal stimuli. In addition, the patient should be carefully examined for any signs of trauma, especially head trauma. Other causes of mental status change should also be evaluated, including infection, trauma, metabolic causes such as liver disease and electrolyte disturbances. Hence, a computed tomography scan of the brain may be shown, general urine analysis, urine drug testing, laboratory assessments, including electrolytes, liver function tests, ammonia, and toxicology screening.

Treatment

The priority is to stabilize the patient's condition with close attention to airway, breathing and vital signs. If a patient requires sedation due to alcohol-related psychosis, antipsychotics such as haloperidol are considered first-line treatments. Benzodiazepines such as lorazepam are used if there is concern about alcohol withdrawal and epilepsy. Some atypical antipsychotics, such as ziprasidone and olanspin, are also used to calm patients with acute psychosis. Some patients may require the use of physical protective equipment to protect the patient as well as staff. Patients with alcohol psychosis should also be evaluated for suicidality.

Forecast

The prognosis for alcohol-related psychosis is less favorable than earlier studies suggested. However, if the patient can abstain from alcohol, the prognosis is good. If patients cannot stop drinking alcohol, the risk of relapse is high.

An estimated 10-20% of all psychosis cases become permanent.

Complications

• Depression;
• Suicide;
• Serious psychosocial disorder.