Alcoholic hallucinosis

Temporary hallucinations and delusion were found in 43% of alcohol dependence cases. Alcoholic hallucinosis is usually accompanied by vivid hallucinations, and can be found in individuals between 40 – 50 years of age, who have been using alcohol for over 10 years. Has a higher prevalence amongst male population. Disease occurs shortly after stopping an excessive intake of alcohol or reducing the intake amount. Auditory hallucinations can occur as if heard from a third person and can be persecutory and terrifying. These hallucinations can be intermittent or continuous; can be instant or last for days. Cognitive functions are usually unaffected, and reality testing is disrupted in accordance to hallucinations. A rare case of alcohol hallucinosis is presented in this paper. The patient is a 58 years old male. He finished primary school and has no other education. He has 30 years of alcohol consumption history. The patient, willing to give up alcohol consumption, was referred to our hospital’s “Alcohol and Substance Addiction Treatment Center” (AMATEM), and was presented with increasing inability to sleep, nervousness, and lately hearing voices when there is nobody around especially when he does not take alcohol or drink less than usual. Psychiatric examination, following his admission, showed that he looked older than his actual age and has a decreased self-care. His mood was anxious and affect was in accordance with his mood. Examining his perception revealed his auditory hallucinations to be of an insulting nature; telling him that he is worthless, that he is being ignored, and rejecting his wishes. The patient had a clear consciousness and was cooperative, and he was well oriented towards people, places and time. He had a normal attention and adequate insight and judgment. His complete blood count was normal except a slight increase in GGT level [GGT: 71 U/L (12-64)]. His treatment consisted of diazepam 60 mg/day for detoxification, folic acid and vitamin B supplements, and olanzapine 10 mg/day for the psychotic symptoms. Detoxification treatment stopped gradually and on the 19th day of the treatment perceptual disturbances disappeared. The patient was discharged with clinical recovery on the 21st day of his admission. Outpatient follow-ups were arranged. Delirium due to the general medical condition was excluded due to the normality of patient’s lab work results. Delirium Tremens excluded that the patient’s consciousness was clear, his orientation and attention was adequate and his clinical course was not şuctuating. Schizophrenia was excluded atypical onset age, correlation between the onset of psychotic symptoms and the time he stopped alcohol use, and discontinuity in the course of disorder. The clinical picture evaluated as ‘alcohol-induced psychotic disorder’ according to DSM-5. In our patient, auditory hallucinations have completely disappeared after 19 days. Alcoholic hallucinosis is a rare disorder, its pathophysiology has not yet been discovered completely, and it needs a careful differential diagnosis. Patients usually respond well to the treatment, and patients should be informed, that a relapse in alcohol consumption also greatly increases the risk of a recurrence.