Neuroleptic Treatment of Alcohol Hallucinosis: Case Series

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.

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