Serotonin Reuptake Inhibitor Provoked Recurrence of Alcohol Hallucinosis - Remission with Additive Amisulpride Medication

Introduction

We describe a case of alcohol hallucinosis that had been treatment refractory for several neuroleptics but was finally successfully treated with a combination of the two atypical neuroleptics risperidone and amisulpride. At first our patient showed symptom relief after treatment with risperidone. Hallucinations reappeared under a combination of risperidone with the selective serotonin reuptake inhibitor (SSRI) sertraline, and a full remission was reached after combining two atypical neuroleptics. In this case-report some interesting aspects of the receptor status, the recurrence of alcohol hallucinosis triggered by sertraline, and pharmacokinetic aspects during treatment will be discussed.

According to ICD-10, alcohol hallucinosis or alcohol-related psychotic disorder is characterized by hallucinations (typically auditory), misidentification, delusions, psychomotor disturbances, and an abnormal affect. It occurs during or immediately (within 2 weeks) after alcohol abuse. Symptoms are similar to schizophrenia and a distinction can be difficult [16].

Alcohol hallucinosis is a relatively rare psychiatric disorder. Tsuang et al. [17] reported a rate of 7.5 % out of 643 treated alcoholics that fulfilled ICD-10 and DSM-III-R criteria for alcoholic hallucinosis. Mild perceptual distortions or hallucinations associated with alcohol withdrawal were excluded. In general, the outcome of the disorder is good and hallucinations disappear rapidly when alcohol abstinence is maintained. The rate of persisting hallucinations independent from further alcohol intake was estimated to be approximately 10-20 % [3]. Traditional neuroleptics (e. g., haloperidol) are the usual treatment for persistent hallucinations [12] [13], but there have been no controlled clinical trials so far; however, flupenthixol has been shown to be associated with an increased relapse rate among non-psychotic alcoholics [18], and alcohol relapse may be the highest risk factor for the reoccurrence of psychosis in alcohol hallucinosis. So far, only one case has been reported in which the atypical neuroleptic risperidone successfully abolished auditory hallucinations that previously did not respond to haloperidol treatment [12].

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