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Alcohol-Induced Hallucinations: Prompt Care IS Key.

BERLIN -- Hallucinations may be considerably more common in the alcohol-dependent population than is generally believed, according to a small series reported in a poster presentation at the Seventh World Congress of Biological Psychiatry.

Although the condition is unlikely to progress to schizophrenia, it may take a serious course in which symptoms become continuous and persist despite abstinence from alcohol. Given the high prevalence of command hallucinations in this disorder, prompt and aggressive intervention is called for, said Dr. J.M. Anderson of Parkhead Hospital, Glasgow, Scotland.

In what has been called "alcoholic hallucinosis" and "alcohol-induced psychotic disorder with hallucinations," vivid, persistent hallucinations develop, usually after cessation or reduction in heavy alcohol consumption. According to one survey, 7.5% of alcoholics meet criteria for the disorder.

Dr. Anderson described a study undertaken in response to increased reports of perceptual disturbance in recently detoxified alcoholics in East Glasgow, a population where alcohol dependence is known to be particularly severe.

In 1989, 16 of 124 patients with a diagnosis of alcohol dependence were identified with alcoholic hallucinosis: At 13% this represents nearly double the expected prevalence. Eleven patients described their hallucinations, which were associated with intoxication, cessation, and withdrawal from alcohol, as episodci; five patients described their hallucinations as continuous.

Hallucinations were primarily auditory and distinct, usually in the second person, and often identifiable as the voices of neighbors or relatives. In all but one case, they were accusatory, derogatory or obscene, chiefly relating to the patient's past and present lifestyle. Seven patients described command hallucinations; all but one of these had acted on them, in ways that included life-threatening behavior in four.

No patient described the "third-person, running-commentary syle auditory hallucinations commonly associated with schizophrenia," Dr. Anderson said.

There was no difference in duration or amount of alcohol consumed or in severity of dependence in the hallucinating patients, compared with a11 individuals admitted for detoxification during the same period, he said at the meeting sponsored by the World Federation of Societies of Biological Psychiatry.

At follow-up 8 years later, 14 patients could be traced. Two of these were deceased. Of the remaining 12, 5 were abstinent from alcohol and had no psychiatric diagnosis. Five continued to meet criteria for alcoholic hallucinosis. All had had episodic hallucinations originally; in two, they were now continuous. All had reduced the quantity of alcohol consumed, compared with reported use 8 years previously Dr. Anderson said.

Two patients who had been abstinent from alcohol for a number of years now met DSM-IV criteria for schizophrenia. One had a family histoy of the disease. No features of clinica1 history distinguished these patients from the others.

Although the etiology of the condition is unclear, it seems reasoable to postulate a connection with cerebral damage and alcohol withdrawal, Dr. Anderson said.
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Publication:Clinical Psychiatry News
Geographic Code:4EUGE
Date:Oct 1, 2001
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