Pharmacopsychiatry 2007; 40(6): 291-292
DOI: 10.1055/s-2007-992144
Letter

© Georg Thieme Verlag KG Stuttgart · New York

Neuroleptic Treatment of Alcohol Hallucinosis: Case Series

M. Soyka 1,2 , B. Täschner 2 , N. Clausius 2
  • 1Psychiatric Hospital Meiringen, Meiringen, Switzerland
  • 2Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
Further Information

Publication History

received 15.05.2007 revised 17.07.2007

accepted 23.07.2007

Publication Date:
21 November 2007 (online)

Chronic alcohol consumption can cause psychotic disorders, most commonly with hallucinatory features. In the older psychiatric literature, this schizophrenia-like syndrome was called alcohol hallucinosis. Patients suffer from predominantly auditory but also visual hallucinations and delusions of persecution. The psychosis usually has a rapid onset. In contrast to alcohol delirium, the sensorium is clear and withdrawal symptoms are weak or absent. Alcohol psychosis is considered to be rather rare [20] [21], although there are no exact estimates of prevalence. The prognosis is usually good, but 10-20% of patients with alcohol psychosis develop a chronic schizophrenia-like syndrome [8]. In these cases, differential diagnosis between alcohol hallucinosis and schizophrenia can be difficult [12]. The pathophysiology of alcohol psychosis is not clear [14] [16]. There is no evidence that alcohol psychosis and schizophrenia have a common genetic basis [7]. An impaired dopaminergic neurotransmission and hyperdopaminergic state may play a role [3] [6] but this has not been shown in alcohol hallucinosis [17]. Recent PET findings indicate a hypofunction of the thalamus in patients with alcohol psychosis, which may resolve upon clinical improvement [11] [17] [18].

No studies have been performed on the pharmacotherapy of alcohol psychosis and there is no established therapy. A few case series have been published [1] [5] [10] [13] [15]. We performed a retrospective chart analysis to study the effects of neuroleptic treatment in patients with alcohol hallucinosis.

References

  • 1 Aliyev NA, Aliyev ZN. Application of glycine in acute alcohol hallucinosis.  Human Psychopharmacol. 2005;  20 591-594
  • 2 Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie/AMDP .Das AMDP-System: Manual zur Dokumentation psychiatrischer Befunde. 5th revised edn. Göttingen, Bern, Berlin, Heidelberg, New York, Hogrefe 2005
  • 3 Borg S, Kvande H, Valverius P. Clinical conditions and central dopamine metabolism in alcoholics during acute withdrawal under treatment with different pharmacological agents.  Psychopharmacology. 1986;  88 12
  • 4 Caton CLM, Drake RE, Hasin D, Dominguez B, Shrout PE, Samet S, Schanzer B. Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses.  Arch Gen Psychiatry. 2005;  62 137-145
  • 5 De Millas W, Haasen C. Treatment of alcohol hallucinosis with risperidone.  Am J Addict. 2007;  16 249-250
  • 6 Fadda F, Mosca E, Colombo G, Gessa GL. Effects of spontaneous ingestion of ethanol on brain dopamine metabolism.  Life Sci. 1989;  44 281
  • 7 Glass IB. Alcohol hallucinosis: a psychiatric enigma - 1. the development of an idea.  Br J Addiction. 1989;  84 29-41
  • 8 Glass IB. Alcohol hallucinosis: a psychiatric enigma - 2. the follow-up studies.  Br J Addict. 1989;  84 151-164
  • 9 Guy W, Ban TA. The AMDP-SYSTEM. Manual for the Assessment and Documentation of Psychopathology. Berlin, Heidelberg, New York, Springer 1982
  • 10 Hermann D, Heinz A, Croissant B, Mann K. Provoked recurrence of alcohol hallucinosis - remission with additive amisulpride medication. A case report.  Pharmacopsychiatry. 2004;  37 90-92
  • 11 Kitabayashi Y, Narumoto J, Shibata K, Ueda H, Fukui K. Neuropsychiatric background of alcohol hallucinosis: a SPECT study.  J Neuropsychiatry Clin Neurosci. 2007;  19 85
  • 12 Soyka M. Psychopathological characteristics in alcohol hallucinosis and paranoid schizophrenia.  Acta Psychiatrica Scandinavica. 1990;  81 255-259
  • 13 Soyka M, Botschev C, Völcker A. Neuroleptic treatment in alcohol hallucinosis: no evidence for increased seizure risk.  J Clin Psychopharmacol. 1992;  12 66-67
  • 14 Soyka M. Pathophysiologic mechanisms possibly involved in the development of alcohol hallucinosis.  Addiction. 1995;  90 289-290
  • 15 Soyka M, Wegner U, Moeller H-J. Risperidone in treatment-refractory chronic alcohol hallucinosis.  Pharmacopsychiatry. 1997;  30 135-136
  • 16 Soyka M Dresel S, Horak M, Rüther T, Tatsch K. PET and SPECT findings in alcohol hallucinosis: Case report and super-brief review of the pathophysiology of this syndrome.  World J Biol Psychiatry. 2000;  1 215-218
  • 17 Soyka M, Zetzsche T, Dresel S, Tatsch K. FDG-PET and IBZM-SPECT suggest reduced thalamic activity but no dopaminergic dysfunction in chronic alcohol hallucinosis.  J Neuropsychiatry Clin Neurosci. 2000;  12 287-288
  • 18 Soyka M, Koch W, Tatsch K. Thalamic hypofunction in alcohol hallucinosis: FDG PET findings.  Psychiatry Res Neuroimaging. 2005;  30 259-262
  • 19 Surawicz FG. Alcoholic hallucinosis: a missed diagnosis.  Can J Psychiatry. 1980;  25 57-63
  • 20 Tsuang JW, Irwin MR, Smith TL, Schuckit MA. Characteristics of men with alcohol hallucinosis.  Addiction. 1994;  89 73-78
  • 21 Victor M, Adams RD. Effects of alcohol on the nervous system.  Res Pub Assoc Res Nerv Ment Dis. 1953;  32 526

Correspondence

Prof. Dr. M. SoykaMD 

Psychiatric Hospital Meiringen

P.O. Box 612

3860 Meiringen

Switzerland

Phone: +41/033/972 82 95

Fax: +41/033/972 82 91

Email: michael.soyka@pm-klinik.ch