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.

Healthcare Utilisation, Morbidities and Alcohol Use Monitoring Prior to Alcoholic Psychosis Diagnosis.

AIMS: The aim of this study was to describe healthcare utilisation, morbidities and monitoring of alcohol use in patients prior to a diagnosis of alcoholic psychosis in order to inform the early identification of patients at risk. METHODS: Using linked general practice and hospitalisation data in England (April 1997 to June 2014), we identified 1731 individuals (≥18 years) with a clinical recorded diagnosis of alcoholic psychosis and 17,310 matched controls without the disorder, we examined all prior general practitioner (family doctor) visits, hospitalisations, medically recorded morbidities and alcohol assessment/interventions records. Poisson regression models were used to compare rates of healthcare utilisation in people with alcoholic psychosis to those without. Logistic regression models were used to evaluate the association between alcoholic psychosis and prior morbidities. RESULTS: Patients with alcoholic psychosis showed increased levels of healthcare utilisation at least 5 years prior to their diagnosis. The most common reasons for prior healthcare visits were seizures and injuries and there was >4-fold higher rate of seizures, unintentional injuries and self-harm incidents among these patients up to 10 years prior to diagnosis, compared to the control population. A high proportion (78%) of patients had their alcohol consumption recorded, 50% had a record of heavy drinking but only one in five had any evidence of receiving an alcohol-related intervention. CONCLUSION: Patients present more often with seizures and injuries than the general population several years prior to a diagnosis of alcoholic psychosis. These visits represent opportunities for preventive action and imply that we may be missing opportunities to intervene.

You're the Flight Surgeon.

Levy B. You're the flight surgeon: alcohol-induced psychosis. Aerosp Med Hum Perform. 2018; 89(10):933-935.

Treatment of Alcohol-Induced Psychotic Disorder (Alcoholic Hallucinosis)-A Systematic Review.

AIMS: To evaluate the effectiveness of evidence based treatments for alcohol-induced psychotic disorder (AIPD) as described by ICD-10 and DSM-5, a condition that is distinct from schizophrenia and has a close relationship with alcohol withdrawal states. METHOD: Systematic review using PRISMA guidelines. RESULTS: Of 6205 abstracts found, fifteen studies and ten case reports met criteria and were examined. Larger studies examined the use of first-generation antipsychotic drugs, reporting full or partial remission in most patients. Newer case reports report similar results using second generation antipsychotic drugs. Novel treatments, such as those acting on GABA receptors reported low numbers of patients in remission. Some large studies report the successful use of standard alcohol withdrawal treatments. CONCLUSION: The findings of our systematic review are inconclusive. There was significant heterogeneity between and within studies. Significant publication bias is likely. Randomized control trials of more carefully delineated samples would produce evidence of greater clinical utility, for example, on differential effectiveness of antipsychotics and optimal length of standard alcohol withdrawal treatments. AIPD patients who show poor treatment responses should be studied in greater depth. SHORT SUMMARY: This systematic review of alcohol-induced psychotic disorder treatment found 15 studies and 10 case reports of relevance. Older studies of first-generation antipsychotics reported full or partial remission in most patients, as did newer studies with second-generation antipsychotics. Novel drugs reported low remission rates. Standard alcohol withdrawal treatments were successful.

Effects of alcohol on the offender's sanity-Issues of criminal law and psychiatry in light of findings of research.

The present report is the result of research on the causes of insanity or issuing opinions about the causes of insanity or diminished sanity perpetrators in criminal proceedings conducted in Poland (CEE). Research has shown the impact that has, in fact, use or abuse of alcohol and other alcoholic diseases on the status of the accused in criminal proceedings. This publication presents not only the results but also the basic regulations - valid in Poland and in other European countries - with respect to the responsibility of the perpetrators insane, with diminished sanity and being in a state of inebriation at the time of committing a criminal act.

[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.

Updating toxic psychosis into 21st-century Canadian: Bouchard-Lebrun v. R.

For centuries, Anglo-Saxon common law tradition has tended to limit voluntary intoxication as a defense on both mens rea (so-called diminished capacity defenses) and insanity. A new decision by the Supreme Court of Canada has clarified for Canadian jurisdictions whether voluntary substance-induced psychosis is a mental disorder for the purposes of determining insanity. In the United States, there is still considerable variation with regard to this question in such settled-insanity cases. This article is a review of Anglo-Saxon, American, and Canadian jurisprudence with regard to intoxication defenses on both mens rea and insanity. The factual and appellate history of Bouchard-Lebrun v. R. and a discussion of the Supreme Court's reasoning and the implications for future forensic practice follow. Potential pitfalls for forensic evaluators are explored, including the lack of scientific evidence available to detect individuals who, while appearing to present with a drug-induced psychosis, prove over time to have an endogenous psychotic illness.

Substance-induced psychotic disorders: 13-year data from a de-addiction centre and their clinical implications.

The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Alcohol use and mismatch negativity in young patients with psychotic disorder.

Mismatch negativity (MMN) is a neurophysiological indicator of the brain's ability to extract relevant information from an irrelevant background. MMN has been described as a reliable biomarker of schizophrenia and more recently it has found to be impaired in the early stages of psychosis. In addition, drugs (including alcohol) that block glutamate's N-methyl-D-aspartate receptor have been shown to reduce MMN. This study aims to determine whether risky alcohol consumption in young patients with psychotic disorder further impacts or changes their MMN response. Patients with high-alcohol use were found to show reduced temporal MMN amplitudes compared with patients with low-alcohol use and controls. In contrast, early psychosis patients with low-alcohol use showed reduced fronto-central MMN amplitudes compared with controls; whereas patients with high-alcohol use showed an intermediate response at these sites. Correlational analysis revealed distinct patterns of association between MMN and alcohol use in patients with early psychosis compared with controls. This study shows that early psychosis outpatients who engaged in risky drinking have decreased temporal MMN amplitudes, compared with their peers. This may reflect an additive effect of N-methyl-D-aspartate receptor hypofunction and high-alcohol consumption.

Deterioro cognitivo asociado al consumo de diferentes sustancias psicoactivas / Cognitive deterioration associated with the use of different psychoactive substances

Introducción. El estudio de los déficits neuropsicológicos asociados al consumo de sustancias tóxicas ha cobrado gran relevancia en los últimos años debido a las graves repercusiones de salud física y psicológica de los consumidores. Metodología. En el presente trabajo se evaluaron los posibles déficits de memoria y el deterioro de las funciones ejecutivas, en una muestra de 54 sujetos que se encuentran realizando un tratamiento de desintoxicación y deshabituación. Para ello se aplicaron diversos test neuro-psicológicos (la Escala de Memoria de Wechsler, Wisconsin Card SortingTest, Test de Stroop, Test de fluidez verbal y el Test de Construcción de Senderos). Resultados. reflejaron la presencia de un mayor déficit en la memoria de trabajo en sujetos con una mayor duración de consumo de alcohol y/o cannabis. Los sujetos con un consumo prolongado de cannabis reflejaban también mayores carencias en la memoria inmediata mostrando más conservada la memoria demorada, así como una peor capacidad a la interferencia, es decir, muestran una menor inhibición a las respuestas automáticas. También se observa que poseen una atención alterante disminuida, necesitando más tiempo para realizar actividades que requieren un pensamiento lógico y secuencial. El estudio también reflejó la importancia de la duración del consumo como una variable significativa en el aumento de los déficits de memoria. Conclusiones. El tiempo y tipo de consumo son determinantes en el deterioro cerebral producido por las drogas (AU)

Introduction. The study of the neuropsychological deficits associated with substance abuse has become highly relevant in recent years due to the serious impact they have on the physical and mental health of users. Methodology. The possible memory deficits and deterioration of executive functions were studied in a sample of 54 subjects undergoing drug detoxification and rehabilitation. Several neuropsychological tests were applied (Wechsler Memory Scale, Wisconsin Card Sorting Test, Stroop Test, Verbal Fluency Test and the Trail-Making Test). Results. Subjects with a more prolonged history of alcohol and/or cannabis use had a greater deficit in working memory. Subjects with prolonged cannabis use also showed greater deficiencies in immediate, or short term, memory and better conserved long-term memory, as well as less interference capacity, i.e., less inhibition of automatic responses. They also had impaired alternating attention and needed more time to execute activities that required logical and sequential thought. The study also reflected the importance of duration of use as a significant variable in the increase in memory deficits. Conclusions. The duration and type of substance abuse are determinants in drug-induced cerebral deterioration (AU)

[Current peculiarities of alcoholic psychosis].

The follow-up study of alcoholic psychoses in male patients admitted to a clinical department of a psychiatric hospital in 2005-2007 was carried out. Patients with alcoholic psychoses made up from 15 to 30% of all patients. The number of psychosis had seasonal variations with the elevations in spring and autumn, peaks in January, lune and October. Alcoholic delirium morbidity made up from 69 to 82% of the total number of alcoholic psychoses, alcoholic hallucinosis varied from 14 to 27%. Other forms were presented by single cases. In alcoholic delirium hallucinations had brighter, sated character. The most specific were visual hallucinations in the form of zoohallucinations, hallucinations of an oral cavity ("sensation of threads, hair etc"). The most often observable characters were "extraneous people, animal, demons". In alcoholic hallucinosis, verbal contrast hallucinations, making comment hallucinations, visual illusions were most frequent. The family history of mental disorders and alcoholism was noted in 30% of patients with alcoholic psychosis. The probability of occurrence of alcoholic psychoses depended on the quality of consumed drinks. The presence of a cranial-brain injury in the anamnesis considerably aggravated the disease forecast and increased the risk of seizure syndrome.

[Rethinking criminal responsibility: practical application of operational diagnosis and gnostic into expert testimony].

There had been argument concerning the difference between the agnostic approach and the gnostic approach to the psychiatric perspective of criminal responsibility until the landmark ruling by the 3rd court of the Japanese Supreme Court in 1984. The decision upheld the gnostic approach and affirmed that the defendant's criminal responsibility should be based on such factors as psychopathology, motive, modus operandi, situation surrounding the crime, and pre-morbid personality, as long as the offense was not directly motivated by the delusion or hallucination. The gnostic explanation includes so many various factors that the psychiatric testimony cannot easily be objective, while agnostic experts can find a conclusion about criminal responsibility only by psychiatric diagnosis. To establish a standard, the authors summarized the means of determination of criminal responsibility. The authors also discussed various topics related to criminal responsibility including Asperger's syndrome, illicit drug intoxication, and prescribed drug intoxication.

Rehabilitation during alcohol detoxication in comorbid neuropsychiatric patients.

For this study, we evaluated the effectiveness of a cognitive training program in improving cognitive function in patients with alcoholism comorbid with another neuropsychiatric disorder and going through the subacute phase of detoxication. We employed a randomized clinical trial design in which 20 subjects were assigned to a five-session cognitive rehabilitation program and 20 subjects were assigned to an attention placebo control condition. All subjects received a battery of cognitive tests for reasoning, attention, and visual-spatial abilities. These tests were repeated at the completion of the study. The training consisted of a number of component tasks designed to improve attention, speed of information processing, perceptual analysis, and visual-spatial cognition. We plotted performance on training results across sessions to detect evidence of learning effects. Comparisons of the cognitive tests revealed greater improvement in the training as compared to the attention placebo group on measures of attention and conceptual flexibility. We concluded that the training produced significant improvement over and above natural recovery during detoxication.

[Psychopathology of self-consciousness in acute alcoholic hallucinosis].

To study self-consciousness changes in initial, manifesting and final stages of acute alcoholic hallucinosis, 60 patients have been examined. In 51 of them, the disease developed on the background of pseudo-dipsomania or constant hard drinking and in 9--of abstinent state. Initial stage of acute alcoholic hallucinosis was characterized by negative type of self-consciousness reaction. In manifesting stage the following variants of self-consciousness were detected: disturbation (vital, somatophysical, autopsychic), suppression (harmonic, dissociated), depersonalization and hyperactivity. In final stage, there were disactualization, nosognosia (adequate-, hypo- and hypernosognosia, anosognosia), partial and total reintegration of self-consciousness. These disorders of self-consciousness appear to be of prognostic and diagnostic value.

Altered NMDA glutamate receptor antagonist response in individuals with a family vulnerability to alcoholism.

OBJECTIVE: A family history of alcoholism is a risk factor for the development of ethanol dependence. Ethanol is an antagonist of the N-methyl-d-aspartate (NMDA) glutamate receptor, and alterations in NMDA receptor function are thought to be involved in ethanol abuse and dependence. The purpose of this study was to determine in healthy individuals with no ethanol dependence whether response to the NMDA receptor antagonist ketamine would differentiate those with a family history of ethanol dependence from those without such a family history. METHOD: Healthy subjects between the ages of 21 and 30 received 40-minute intravenous infusions of saline, low-dose ketamine (0.1 mg/kg), and high-dose ketamine (0.5 mg/kg) on three separate test days in a randomized order under double-blind conditions. The healthy individuals with at least one first-degree relative and another first- or second-degree relative with ethanol dependence (N=16) were compared with those who had no family history of ethanol dependence in any first- or second-degree relative (N=29). Outcome measures included the Brief Psychiatric Rating Scale, Clinician-Administered Dissociative States Scale, verbal fluency, Hopkins Verbal Learning Test, a biphasic alcohol effects scale, visual analog scales of mood states, and ketamine levels. RESULTS: During ketamine infusion, individuals with a family history of ethanol dependence showed an attenuated response in terms of perceptual alterations and dysphoric mood relative to those without such a family history. CONCLUSIONS: These data suggest that alterations in NMDA receptor function may contribute to subjective response to ethanol and therefore also to the risk of developing alcoholism.