[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 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.

[Risk factors for alcoholic psychosis in patients with eating disorders].

The aim of the study was to reveal risk factors for development of alcoholic psychosis in patients with eating disorders. Ten inpatients with anorexia nervosa and bulimia nervosa abusing alcohol for 1-4 years have been examined. Delirium tremens was diagnosed in 5 patients in the first few days of staying in the hospital, other 5 patients were included in the control group. Factors precipitating delirium tremens were low body mass index, water-electrolytic imbalance, severe dehydration caused by vomiting and hypoglycemia. A careful choice of doses of psychotropic drugs taking into account concomitant somatic-endocrine disturbances, the degree of electrolytic imbalance and thorough alcoholic anamnesis is important at the earlier stage of treatment.

Estimates of harm associated with changes in Swedish alcohol policy: results from past and present estimates.

AIMS: (i) To compare actual developments of alcohol-related harm in Sweden with estimates derived prior to major policy changes in 1995 and (ii) to estimate the effects on consumption and alcohol-related harm of reducing alcohol prices in Sweden. DESIGN: Alcohol effect parameters expressing the strength of the relationship between overall alcohol consumption and different alcohol-related harms were obtained from ARIMA (Auto Regressive Integrated Moving Average) time-series analyses. MEASUREMENTS: Measures of Swedish alcohol-related mortality (liver cirrhosis, alcoholic psychosis, alcoholism and alcohol poisoning), accident mortality, suicide, homicide, assaults and sickness absence from 1950 to 1995. FINDINGS: Previous estimates of alcohol-related harm based on changes in alcohol consumption for the period 1994-2002 for Sweden were, in some cases (e.g. violent assaults and accidents), relatively close to the actual harm levels, whereas in other cases (e.g. homicides, alcohol-related mortality and suicide) they diverged from observed harm levels. A tax cut by 40% on spirits and by 15% on wine is estimated to increase total per capita alcohol consumption by 0.35 litre. This increase is estimated to cause 289 additional deaths, 1627 additional assaults and 1.6 million additional sickness absence days. CONCLUSIONS: The estimates of future changes in harm based upon even relatively modest increases in alcohol consumption produce considerable negative effects, with large economic consequences for the Swedish economy. The additional alcohol-related deaths, for instance, amount to more than half the number of yearly traffic fatalities in Sweden.

Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders.

BACKGROUND: Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced. AIMS: To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each. METHOD: Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared interms of cost, burden averted and efficiency of current and optimal treatment. We then calculated the burden unavertable given current knowledge. The unit of health gain was a reduction in the years lived with disability (YLDs). RESULTS: Summing across all disorders, current treatment averted 13% of the burden, at an average cost of 30,000 Australian dollars per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of 18,000 Australian dollars per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at 16,000 Australian dollars per YLD gained. Sixty per cent of the burden of mental disorders was deemed to be unavertable. CONCLUSIONS: The efficiency of treatment varied more than tenfold across disorders. Although coverage of some of the more efficient treatments should be extended, other factors justify continued use of less-efficient treatments for some disorders.

[Alcohol-related admissions to a psychiatric departments]. / Alkoholbetingede indlaeggelser på psykiatrisk afdeling.

The purpose of this investigation was to find out the number of hospitalizations of alcoholics in a department of psychiatry throughout one year. Further, some characteristics of the patients were noted. The information was gathered from case sheets of patients who had been hospitalized in the period 01.10.96-30.09.97, and who were given a F10.x diagnosis from the ICD-10 system. The investigation showed that about one fifth of the patients hospitalized in the department were alcoholics. Fore more than half of these patients, the reason for hospitalization was for treatment that according to guidelines should have been given in an outpatient setting. The study confirms that there is a need for facilities for inpatient treatment for alcoholics, and that offering outpatient detoxification is not sufficient.

Substance abuse and emergency psychiatry.

Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other Axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.

B Vitamin deficiency and neuropsychiatric syndromes in alcohol misuse.

Alcohol misuse and alcohol withdrawal are associated with a variety of neuropsychiatric syndromes, some of which are associated with significant morbidity and mortality. B vitamin deficiency is known to contribute to the aetiology of a number of these syndromes, and B vitamin supplementation thus plays a significant part in prophylaxis and treatment. In particular, the Wernicke Korsakoff syndrome (WKS). due to thiamine deficiency, is a common condition in association with alcohol misuse, and is associated with high morbidity and mortality. Nicotinamide deficiency may result in a rarer condition, alcoholic pellagra encephalopathy, which often has a similar clinical presentation to WKS. This review considers the role of B vitamins in the aetiology and treatment of neuropsychiatric syndromes associated with alcohol misuse, with particular emphasis on WKS.

Improvement in alcoholics measured using the General Health Questionnaire.

Over a 1-year study period all patients admitted to the department of psychiatry in a general hospital were asked to complete the General Health Questionnaire at admission, discharge, and first polyclinic (outpatient) follow-up contact. Seventeen per cent of admissions were alcoholics. Alcoholics improved rapidly after admission to the psychiatric department. This improvement was comparable to that of all the (psychiatric) patients admitted and continued after discharge.

[Acute intestinal infections and chronic alcoholism]. / Ostrye kishechnye infektsii i khronicheskii alkogolizm.

153 chronic alcoholics were given treatment against food poisoning. 55 of them developed withdrawal syndrome, 98 had alcoholic psychosis including 88 with delirium tremens. The acute intestinal infection in these alcoholics was managed with rehydration using polyionic crystalloid solutions under controlled diuresis. Previous relief of central excitation contributed much to a positive treatment outcome.

[Patients with frequent hospitalizations: their clinical characteristics]. / Bol'nye s chastymi gospitalizatsiiami: klinicheskaia kharakteristika.

A clinical trial covered 69 schizophrenics subjects to frequent rehospitalizations because the patients' need in repeated inpatient treatment. The author points out, that frequent hospitalizations form psychological hospital dependence.

[Main involvement of the central nervous system in alcoholism]. / Principales atteintes du système nerveux central dans l'alcoolisme.

The effects of alcohol on the central nervous system can be subdivided into three main categories: the effects of acute intoxication (drunkenness, acute encephalopathy, stroke), the effects of tolerance and ethanol withdrawal (delirium tremens, seizures) and the delayed manifestations of chronic alcohol consumption (cerebellar degeneration, Wernicke's encephalopathy, dementia).

[Experience with the compulsory treatment of patients with pulmonary tuberculosis and alcoholism]. / Opyt prinuditel'nogo lecheniia bol'nykh tuberkulezom legkikh i alkogolizmom.

Patients with alcoholism and tuberculosis suffer most frequently of alcoholism stage II. Tuberculosis effects unfavourably the course of alcoholism. Most frequently acute alcohol psychoses appear in patients with pulmonary tuberculosis showing a severe and prolonged course. Alcoholism effects the process of treatment of tuberculosis: healing of cavernosis is noted in 9.8%, abacillation--in 11.5%. Compulsory treatment of patients with alcoholism and tuberculosis should be carried out in large antitubercular clinics with special wards for these purposes. Decisions should be made by courts. In narcological clinics special wards for the treatment of the above mentioned patients should be singled out.