Acute Alcoholic Hallucinosis: A Review.

Acute alcoholic hallucinosis is a psychotic disorder characterized by a predominance of auditory hallucinations with delusions and affective symptoms in the clinical picture. Classically, it develops as part of the alcohol withdrawal syndrome. The prevalence of acute alcoholic hallucinosis ranks second among alcohol-related psychoses after alcohol delirium. The study aimed to systematize the scientific data on the history of alcoholic hallucinosis, its pathogenesis, clinical presentation, and treatment approaches. A literature search was performed in PubMed, Scopus, Google Scholar, and eLibrary. The following words and combinations were used as search strings: (alcoholic hallucinosis OR alcoholic psychosis OR alcohol-related psychosis OR alcohol-induced psychosis OR alcohol-induced psychotic disorder OR complicated alcohol withdrawal syndrome) NOT (animal OR rat OR mouse). The relevant information concerning the history of acute alcoholic hallucinosis, its pathogenesis, clinical picture, and treatment approaches was systematized and summarized. This review presents relevant findings regarding acute alcoholic hallucinosis. Limitations of the review include the use of heterogeneous and mostly descriptive studies and studies on small cohorts of patients.

Phenomenology and Course of Alcoholic Hallucinosis.

Objective: The objective of the study was to examine the correlates, phenomenology, and short-term treatment response to benzodiazepines and antipsychotics in an inpatient sample with alcohol-induced psychotic disorder, predominant hallucinations i.e., F10.52. Methods: We reviewed the charts of the patients admitted in a tertiary care addiction treatment center between 2010 and 2016 with the diagnosis of alcoholic hallucinosis. Results: Among 6,493 patients admitted with alcohol dependence during the study period, 61 patients (0.9%) had alcoholic hallucinosis. Among them, 41 (67.2%) had alcoholic hallucinosis in the past; 26 (42.6%) had a family history of psychosis. Only auditory hallucinations were found in 46 patients (75.4%), only visual hallucinations in 3 patients (5%), and both auditory and visual hallucinations in 12 (19.7%). Thirty-four (55.7%) had delusions, which were secondary to hallucinations. Suicidality which includes suicidal ideas and attempts was noted in 12 (19.7%) patients. Fifty-three (86.9%) patients had hallucinations exclusively during alcohol withdrawal, while 8 (13.1%) had them during withdrawal as well as while consuming alcohol. At the end of six months, 13.1% of the patients had an independent psychotic disorder diagnosed. The primary mode of management was treatment with only benzodiazepines (n = 37, 60.7%) or benzodiazepines and antipsychotics (n = 24, 39.3%). The reasons for starting antipsychotics were the presence of florid psychotic symptoms (26.2%) and incomplete symptom resolution with benzodiazepines (9.8%). The median duration of response was four days, with 25th to 75th quartile range at two to seven days. Conclusions: Alcoholic hallucinosis is an acute short-lasting psychotic disorder which lasts for less than a week when treated. Suicidality is high in this group, which needs attention. Benzodiazepines as part of withdrawal management may be sufficient for a majority of cases. Antipsychotics may be required in selected cases. A high degree of recurrence and morbidity indicates a need to intervene early with an abstinence-oriented management goal.

The effect of beverage type on alcoholic psychoses rate in Russia.

AIMS: To test the hypothesis of beverage-specific effect in Russia on the incidence rate of alcoholic psychoses (a known indicator of a population's alcohol-related problems). METHODS: Time series analytical modeling techniques (ARIMA) were used to examine the relation between the sales of different alcoholic beverages (vodka, wine, beer) and alcoholic psychoses incidence rate between 1970 and 2013. RESULTS: The analysis suggests that of the three beverages vodka alone was associated with alcoholic psychoses incidence rate. The estimated effect of vodka sales on the alcohol psychoses rate is statistically significant: a 1 l per person per year increase in vodka sales would result in a 23.4% increase in the alcoholic psychoses incidence rate. CONCLUSION: The incidence of alcoholic psychoses is more responsive to changes in vodka sales per capita than wine or beer sales.

[Alcohol-induced psychotic disorder: a systematic literature review]. / Psychotische stoornis door alcohol: een systematisch literatuuroverzicht.

BACKGROUND: From the second half of the 19th century eminent psychiatrists began referring to alcohol-induced psychotic disorder (AIPD) as a specific alcoholic psychosis. Over the last decades interest in AIPD seems to have declined: the last review dates form 1989. AIM: To review the recent literature on AIPD, revive interest in the disorder, evaluate the current scientific evidence and assess its clinical value. METHOD: We performed a Medline search based on the following terms: 'Psychoses, Alcoholic' [Mesh] OR 'alcohol induced psychotic disorder' OR 'alcoholic hallucinosis' OR 'alcohol hallucinosis'. Our search was restricted to articles written in English or Dutch and published between 1-1-1988 and 31-1-2013. RESULTS: We found 164 papers, from which we selected 21 for further discussion. The quality of the papers selected was variable, most of the papers being the result of clinical research. The most important findings referred to epidemiology: 0.4% lifetime prevalence in the general population, 4.0% in patients with alcohol dependence. We found only limited evidence of psychopathological differentiation between delirium and primary psychotic disorder. Correct diagnosis of AIPD is important because of the implications regarding the length and nature of the treatment: short or long course of antipsychotics, referral to a substance-abuse unit. CONCLUSION: AIPD has survived as a clinical entity. However, scientific evidence of this is limited. Further research is needed because it is vitally important that the patient receives the most appropriate treatment.

Alcohol-induced psychotic disorder: a review.

While alcohol-induced psychotic disorder (AIPD) is well recognised, relatively little is known about the condition. We undertook a review of the literature to identify studies on the epidemiology, clinical manifestations, underlying neurobiology and treatment of AIPD. Few prospective studies have been conducted on AIPD. Recent advances have focussed on epidemiological, phenomenological, neuro-imaging, treatment and outcome issues. Current evidence suggests AIPD can be clinically distinguished from alcohol-withdrawal delirium and schizophrenia. The disorder may be more common than previously recognised depending on the inclusion criteria applied. AIPD is associated with high co-morbidity with other psychiatric disorders, high re-hospitalization and mortality rates and suicidal behaviour. Concurrent dysregulation of several neurotransmitter systems may be involved in the pathogenesis of hallucinations in alcohol dependence, and neuro-imaging studies suggest perfusion abnormalities to various brain regions. Antipsychotic treatment remains the preferred treatment for AIPD. The prognosis appears less favourable than previously believed, yet usually good when abstinence can be maintained.

[Alcohol and psychiatric disorders]. / Alkohol a zaburzenia psychiczne.

Alcohol dependence and abuse is one of the most costly health problems in the world from both a social and an economic point of view. It is a widespread problem, focusing attention not only psychiatrists but also doctors of other specialties. Patterns of drinking appear to be changing throughout the world, with more women and young people drinking heavily. Even risky drinking is a potential health risk, while chronic alcohol abuse contribute to the serious physical and mental complications. Alcohol used disorders associated with alcohol-induced brain damage include: withdrawal state, delirium tremens, alcoholic hallucinosis, alcoholic paranoia, Korsakoffs psychosis, alcoholic dementia, alcoholic depression. On the other hand, mental disorders as panic disorder, social anxiety disorder, agoraphobia, depression, bipolar disorder, schizophrenia, personality disorder most frequently comorbid with alcohol abuse or they trigger alcohol.

[Psychotic experiences in the course of alcohol withdrawal symptoms: locus of control among patients with and without delirium and analysis of subjective experiences in delirium]. / Doznania psychotyczne w przebiegu alkoholowych zespolów abstynencyjnych: porównanie lokalizacji poczucia kontroli u osób z majaczeniem i bez majaczenia oraz analiza doznan w zespolach majaczeniowych.

AIM: The comparison of the locus of control in groups of patients hospitalised due to alcohol withdrawal with and without delirium and analysis of psychotic experiences of patients with delirium. METHODS: 25 patients with alcohol withdrawal with delirium and 25 without delirium took part in the study. They filled-in the Internal-External (I-E) Locus of Control Scale by Rotter; Multidimensional Health Locus of Control (MHLC) scale; the group with delirium also did the Psychopathological Symptoms Inventory, by Bizon et al. RESULTS: The mean score in I-E Locus of Control Scale in the group with delirium was more external than in the group without delirium (M = 13.28; SD = 2.762 versus M = 11.64; SD = 2.612; t(48) = -2.157; p = 0.036). Group with delirium had also lower mean score in the dimension of internal control in MHLC, than the group without delirium (M = 24.8; SD = 6.149 versus M = 26.8; SD = 4.648; t(48) = 1.99; p = 0.04). There were no statistically significant differences between the groups in the other subscales. The auditory and visual hallucinations were most common among patients with delirium (84%, 80% respectively, as well as delusions of taking part in not existing events (92%) and persecutory delusions (80%). Psychotic experiences influenced behaviour in nearly 50% of the cases. CONCLUSIONS: A more external locus of control may be one of the factors contributing to the development of alcohol delirium. The content of psychotic experiences seems to have impact on the behaviour of many patients with alcohol delirium.

Alcohol-induced psychotic disorder and delirium in the general population.

BACKGROUND: Epidemiological data on alcohol-induced psychotic disorder and delirium (alcohol-induced psychotic syndrome, AIPS) are scarce. AIMS: To investigate the epidemiology of AIPS, the risk factors for developing AIPS among people with alcohol dependence, and mortality associated with alcohol dependence with or without AIPS, in a sample drawn from the general population of Finland. METHOD: A general population sample of 8028 persons were interviewed with the Composite International Diagnostic Interview and screened for psychotic disorders using multiple sources. Best-estimate diagnoses of psychotic disorders were made using the Structured Clinical Interview for DSM-IV Axis I Disorders and case notes. Data on hospital reatments and deaths were collected from national registers. RESULTS: The lifetime prevalence was 0.5% for AIPS and was highest (1.8%) among men of working age. Younger age at onset of alcohol dependence, low socioeconomic status, father's mental health or alcohol problems and multiple hospital treatments were associated with increased risk of AIPS. Participants with a history of AIPS had considerable medical comorbidity, and 37% of them died during the 8-year follow-up. CONCLUSIONS: Alcohol-induced psychotic disorder is a severe mental disorder with poor outcome.

[The interrelationship of alcoholic psychoses and lethal alcohol intoxications with population cash income].

The analysis of dependence of alcoholic psychoses and lethal alcohol intoxications from the portion of poor population all over 87 regions of the Russian Federation revealed the decrease in alcoholism morbidity up to 70.7%. Thereby, the poorer is the territory the higher is the indexes of morbidity and mortality because of alcoholism.

Homicide and alcoholic psychoses in Belarus, 1970-2005.

BACKGROUND: The association between alcohol and homicide is well documented. Research evidence suggests an important role for cultural and social context in the alcohol-homicide association. PURPOSE: To estimate the aggregate level effect of alcohol consumption on homicide rate in the former Soviet Slavic republic of Belarus. METHODS: Trends in homicide and alcoholic psychoses morbidity rate from 1970 to 2005 in Belarus were analyzed employing ARIMA analysis in order to assess the bivariate relationship between the two time series. RESULTS: The results of time series analysis suggest a close relationship between homicide and alcoholic psychoses rate at zero lag. CONCLUSION: This study replicates the previous findings that suggested a close link between alcohol and homicide at the aggregate level. The outcome of the present findings suggests that alcohol is responsible for the fluctuation in homicide rate over time in the former Soviet republic of Belarus. This study also supports the hypothesis that homicide and alcohol are closely connected in the prevailing culture with its intoxication-oriented drinking pattern.

[Modeling of an influence of indicators of social stress on demographic processes in regions of the Russian Federation]. / Modelirovanie vliianiia indikatorov sotsial'nogo stressa na demograficheskie protsessy v regionakh Rossiiskoi Federatsii.

AIM: To assess an impact of indicators of social stress on demographic processes in regions of the Russian Federation using statistical methods. MATERIAL AND METHODS: The data of Rosstat «Regions of Russia¼ and «Health care in Russia¼ were used as information base. Indicators of about 80 subjects of the Russian Federation (without autonomous areas) for the ten-year period (2005-2014) have been created in the form of the database consisting of the following blocks: medico-demographic situation, level of economic development of the territory and wellbeing of the population, development of social infrastructure, ecological and climatic conditions, scientific researches and innovations. In total, there were about 70 indicators. Panel data for 80 regions of Russia in 10 years, which combine both indicators of spatial type (cross-section data), and information on temporary ranks (time-series data), were used. Various models of regression according to the panel data have been realized: the integrated model of regression (pooled model), regression model with the fixed effects (fixed effect model), regression model with random effects (random effect model). RESULTS AND CONCLUSION: Main demographic indicators (life expectancy, birth rate, mortality from the external reasons) are to a great extent connected with socio-economic factors. Social tension (social stress) caused by transition to market economy plays an important role. The integral assessment of the impact of the average per capita monetary income, incidence of alcoholism and alcoholic psychoses, criminality, sales volume of alcoholic beverages per capita and marriage relations on demographic indicators is presented. Results of modeling allow to define the priority directions in the field of development of mental health and psychotherapeutic services in the regions of the Russian Federation.

[Incidence of alcoholic psychoses, mortality from alcoholic poisonings and diseases of the liver and in Russia].

Authors studied the influence of availability of beer on mortality from alcoholic poisonings, diseases of a liver and incidence of alcoholic psychoses in Russia during 1995-2011. Time series analysis was performed using the method of ARIMA. There were no significant associations between the availability of beer and levels of mortality and morbidity.

Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis.

BACKGROUND: Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards. OBJECTIVES: To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators). METHOD: Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries. RESULTS: Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14-20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence. CONCLUSION: The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).

Delirium tremens in a nine-year-old child.

The authors report a case of delirium tremens in a 9-year-old American Indian boy, who was later found to have been drinking steadily for 3 years prior to his emergency admission for agitation and delirium. The authors suggest that the use of alcohol by children is an activity that may be more common than most physicians realize.

Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort.

OBJECTIVE: The purpose of the study was to examine the quantitative risk of criminal behavior associated with specific mental disorders. METHOD: An unselected 1966 birth cohort (N = 12,058) in Northern Finland was prospectively studied until the end of 1992. The investigation started during the mothers' pregnancy, and the data on the subjects' family characteristics, mental and physical development, living habits, psychiatric morbidity, and criminal records were gathered at various times. RESULTS: The prevalence of offenses was the highest among males with alcohol-induced psychoses and male schizophrenic subjects with coexisting alcohol abuse, and more than half of the schizophrenic offenders also had problems with alcohol. Eleven (7%) of the 165 subjects who committed violent crimes were diagnosed as psychotic. Male schizophrenic subjects had a moderately high risk for violent offenses, but the risk for other types of crimes was not elevated significantly. Odds ratios for criminal behavior were adjusted according to the socioeconomic status of the childhood family and were the same as or slightly lower than the crude odds ratios for all disorders except schizophrenia and mood disorders with psychotic features. CONCLUSIONS: The results indicate that the risk of criminal behavior was significantly higher among subjects with psychotic disorders, even though the socioeconomic status of the childhood family was controlled. The higher risk for violent behavior was associated especially with alcohol-induced psychoses and with schizophrenia with coexisting substances abuse. The results suggest that schizophrenia without substance abuse may also be associated with a higher risk of offenses, but this finding is tentative and requires further investigation.

Regional variation in alcoholism rates in Britain: the effect of provision and use of services.

The range of variation in Scottish and English psychiatric admission rates for alcoholism is represented by the Highlands, Tayside and Kent. When other medical and psychiatric services, notably psychiatric extramural services, are taken into account, the considerable variation almost disappears. With the background of recently reported similar average alcohol consumption in England and Scotland, these results are discussed with respect to variations in geography, admission policy and provision of services.

Some demographic and diagnostic characteristics of a geriatric population in a state geriatric facility.

Data are presented on some of the chief characteristics of a sample of 276 patients (152 women and 124 men) in a long-term state psychiatry facility, who had previously undergone intensive psychiatric treatment. For the women the average age ws 81.6 years, and for the men 75.8 years. The women had slightly more schizophrenia, manic depressive illnesses and cerebrovascular syndromes. The men had distinctly more CNS syphilis and alcoholic dementia. Initially, patients with schizophrenia had been admitted at ages ranging from 15 to 99 years, and those with manic depressive illness at ages ranging from 20 to 70 years. For cerebrovascular syndromes, admissions were concentrated in the age range of 70-90 for women and 65-85 for men. For CNS syphilis, the admissions (for men) were concentrated in the age range of 50-70, and for alcoholic dementia in the age range of 60-80. Length of stay was extremely long for schizophrenic and manic depressive illness and relatively short for cerebrovascular syndromes. However, for the majority of the cerebrovascular patients, the length of stay was at least five years for the men and at least ten years for the women.

Hospitalization and alcohol-related morbidity within three years after screening in middle-aged men.

All men living in Malmö who were born in 1926-1929 were invited for a health screening examination which included, among many other things, measurement of gamma-glutamyltransferase (GGT). They were followed up and within three years after the screening 963 of 4571 men had been hospitalized. They had 17158 hospital days or almost 6 days per individual each year. The impact of alcohol on the admissions was analysed both according to the International Classifications of Diseases and a new design where all the diagnoses were grouped and coded in conditions which were judged to be alcohol-related, potentially alcohol-influenced and non-alcohol-related. Of the total days in hospital, alcohol psychosis and alcoholism accounted for 13.6 per cent. Altogether 29.2% of the days were caused by alcohol-related and potentially alcohol-influenced conditions. GGT values at the screening investigation were significantly increased in 25% of the hospitalized men. Alcohol-related admissions were seven times as many in men with GGT values in the highest quintile compared with those who had values in the lowest quintile.