Overview
Psychosis linked to alcohol can occur when a person is highly intoxicated, withdrawing from alcohol or regularly overusing alcohol. This specific type of psychosis, often referred to as alcohol hallucinosis, is a relatively uncommon result of alcohol use. However, its prevalence can vary based on the criteria used to diagnose it. In cases of alcohol-related psychosis, symptoms typically appear during or just after a period of heavy drinking. These symptoms can look a lot like schizophrenia but it’s important to understand that they are part of a distinct and separate condition. This condition often involves hallucinations, paranoia and fear.
Causes
There are several theories about what causes alcohol-related psychosis, but none fully explain why some people with alcohol use disorder suddenly or repeatedly experience hallucinations. Therefore, we don’t really know what causes alcohol-related psychosis. It likely has something to do with brain chemicals like dopamine and serotonin.
Risk Factors and Frequency
Alcohol-related psychotic disorders are highlighted in a 2015 Dutch review. These disorders are seen in about 0.4% of the general population and 4% of patients with alcohol dependency. These conditions are most commonly seen in men of working age. Some people are more prone to these disorders, such as:
- those who develop an alcohol dependency at an early age,
- individuals with a low socioeconomic status,
- people who are unemployed or rely on their pension, and
- those who live alone.
Among individuals with alcohol use disorder, those whose fathers have had alcohol and mental health issues are more likely to experience alcohol-related psychosis. Research indicates that genes may also play a role in the development of these conditions. Once diagnosed, there is a 68% chance the patient will need to be readmitted, and a 37% chance they will experience other mental health disorders. Patients with an alcohol-related psychosis have a 5% to 30% risk of developing a chronic condition similar to schizophrenia.
Signs and Symptoms
Alcohol-related psychosis is a serious mental health condition. People with this condition can show many different symptoms. However, intense hallucinations or delusions are always present. It’s more severe than what you would expect from alcohol intoxication or withdrawal alone. Caregivers need to watch the patient’s mental state closely, including any lack of emotional expression or reactions to internal feelings. Also, a thorough physical examination is essential to rule out injuries or infections that could be causing changes in mental status.
- Intense hallucinations
- Delusions
- More severe than symptoms related to alcohol intoxication or withdrawal
- Lack of emotional expression
- Reactions to internal feelings
- Possible injuries or infections
Testing
Most people experiencing psychosis for the first time also engage in substance abuse, including alcohol use. So, when doctors evaluate patients for alcohol-related psychosis, they’ll ask about the patient’s history with alcohol use. Sometimes, it’s hard to tell if a person’s psychosis is primarily due to substance use or another factor. This is particularly challenging in emergency situations where it’s often difficult to get a complete history.
A way of differentiating alcohol-induced psychosis is by looking at the patient’s family history. If there’s no family history of psychotic disorders but a known history of alcohol use, this supports a diagnosis of alcohol-related psychosis. This condition must be distinguished from other causes of psychosis, especially schizophrenia. Compared to schizophrenia, patients with alcohol-induced psychosis usually have less education, develop psychosis later in life, experience more depression and anxiety symptoms, and exhibit fewer negative and disorganized symptoms. These patients often have a better understanding of their condition and show better judgment.
Diagnosing substance-induced psychotic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), requires the presence of significant hallucinations or delusions. There has to be evidence that these symptoms appeared during or soon after substance intoxication or withdrawal. The symptoms should not be better explained by a psychotic disorder that’s not related to substance use, and don’t only occur alongside delirium. Furthermore, the psychosis should cause notable distress or interfere with regular activities such as work or social interactions.
A comprehensive physical exam is just as important as the patient’s history. Doctors first assess the patient’s stability, focusing on airway, breathing, and vital signs. The patient’s general appearance also matters; doctors note if the patient appears neglected, shows a lack of emotional response, smells of alcohol, or seems to be reacting to internal stimuli. They also thoroughly check for signs of trauma, especially to the head. Other potential causes for the altered mental state such as infection, trauma, metabolic issues like liver disease, and electrolyte imbalances must be evaluated. Therefore, various tests like a brain CT scan, urinalysis, urine drug screen, lab tests for electrolytes, liver function tests, ammonia levels, and toxicology screening may be necessary.
Treatment
The first step is to stabilize the patient and closely monitor their airway, breathing, and other crucial signs of health. If the patient is experiencing psychosis related to alcohol use, medicines like haloperidol are usually given. If there’s a chance the patient might go through alcohol withdrawal and have seizures, a drug like lorazepam might be used. Some patients may require physical restraints for safety. It’s also necessary to assess patients with alcohol-related psychosis for suicide risk, as this condition can increase suicidal behaviors.
Medicines like ziprasidone and olanzpine, which are different kinds of antipsychotic drugs, can also be used to help calm patients experiencing severe psychosis. Unfortunately, the outlook for alcohol-related psychosis might not be as positive as previously thought. However, if the patient can quit drinking alcohol, they should have a good outlook. If they continue drinking, there’s a high chance the condition can return.
Related Conditions
- Bipolar Disorder Type 1, which is a mental health condition that causes extreme mood swings.
- Mental health problems related to cannabis use.
- Psychiatric disorders linked to cocaine use.
- Delirium, which is a sudden state of confusion.
- Delirium Tremens, a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes.
- Hallucinogen use, which refers to the taking of substances that can cause hallucinations.
- Major disruptive disorder, either a one-time event or recurring, with serious psychotic symptoms, like hallucinations or delusions.
- Schizophrenia, a long-term mental disorder involving a breakdown in the relation between thought, emotion, and behavior.
- Stimulants, which are drugs that speed up the body’s systems.
- Wernicke-Korsakoff syndrome, a brain disorder due to thiamine deficiency often associated with alcohol abuse.
Possible Complications
- Depression
- Suicide
- Major disruptions in social and daily life
