Auditory hallucinations resulting from chronic alcohol abuse constitute alcoholic hallucinosis which emerges either during heavy drinking phases or follows these periods (1). The symptoms of alcoholic hallucinosis differ from delirium tremens because the patient retains a clear sensorium but can present mild confusion. Visual and cognitive alterations do not manifest in alcoholic hallucinosis. A hallucinatory episode will persist from several hours up to several months before potentially evolving into a schizophrenic psychotic condition (2).

Claude Marcel introduced the initial description of the condition in 1847 through the medical term folie d’Ivoire which he differentiated from delirium tremens (3). Through his research he detailed how alcoholic patients experienced frightening hallucinations combined with delusions across multiple cases which did not lead to deficits in their orientation or cognitive functioning. According to the International Classification of Diseases 10 (ICD-10) the condition exists as Alcohol-Induced Psychotic Disorder, Predominantly Hallucinatory Type through which affected individuals present with acoustic verbal hallucinations and delusions together with mood changes while remaining aware (4).

Clinical significance of Alcoholic hallucinosis emerges because its symptoms merge with psychiatric illnesses which include both primary psychotic disorders alongside delirium tremens. The main difference between alcoholic hallucinosis and its comparable conditions is its persistent symptom course together with minimal body movements and auditory rather than visual hallucinations (5). People possessing psychotic disorders in their family tree show higher chances of developing prolonged psychotic symptoms because of extended alcohol exposure (6).

This case focuses on alcoholic hallucinosis clinical manifestations while separating them from delirium tremens and psychotic disorders alongside the need for post-treatment monitoring.

The emergency staff at the tertiary care hospital received a 25-year-old married male who came from a rural area and belonged to a lower socio-economic group. Despite his normal sensorium the patient demonstrated prominent suspicion about unrealistic threats from others. The symptoms appeared two months prior to his arrival. The patient received no favorable outcomes from consulting a faith healer previously. The patient developed hand tremors alongside sleep disturbances throughout his past seven days which led him to seek psychiatric evaluation.

History of Present Illness

The patient maintained alcohol use disorder for seven years yet increased his daily alcohol drinking to four years ago. Country liquor consumption had risen progressively from three to four regular measures reaching 750 mL each day. He had his last drinking episode seven days before but drank only half a quarter of alcoholic content. His previous abstinent periods brought on withdrawal symptoms that included sleep disturbances along with trembling in his body.

During the last nine years the patient consumed tobacco on a daily basis. His ten-year-long chronic suspiciousness toward his wife regarding her loyalty spanned the entire duration of their marriage. His continuous mistrust toward his wife triggered sporadic instances during which he became abusive and aggressive toward her.

Family History

The patient inherited both alcohol dependence along with psychotic disorders from his family members. Psychotic features appeared within multiple first-degree relatives from his maternal side which implies an inherited proclivity to develop psychiatric disorders.

Psychiatric Assessment

During his psychiatric assessment the individual exhibited fearful behavior accompanied by a distressed state of emotional being. His psychotic condition featured persecutory delusions together with audio hallucinations which included familiar voices in second and third person. Auditory figures delivered both demanding and insulting messages to him. Up to a minor degree his physical motion displayed an increase. The evaluation of the patientʼs bodily condition revealed no notable findings.

Management and Treatment

Medical staff admitted the patient into the psychiatric hospital for clinical examination and treatment. Initial treatment included:

An immediate intramuscular injection of Lorazepam at 4 mg served to treat sudden withdrawal symptoms and agitation.

Administration of tablet Chlordiazepoxide started at 100 mg daily in divided doses before the clinician reduced the dosage to 25 mg once per day. This strategy controlled withdrawal symptoms.

The psychiatry ward provided the patient with Tablet Olanzapine (5 mg) at night to improve psychotic symptoms.

The staff provided Vitamin B-Complex through injection to counter potential nutritional deficiencies from alcohol use.

Upon hospital admission staff measured his Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-Ar) score which showed 11 points corresponding to mild-to-moderate withdrawal symptoms. During hospitalization the patient succeeded in improving his physical withdrawal symptoms while becoming less prone to auditory hallucinations. Doctors used serial mental status examinations to detect the slow reduction in both how frequently and intensely the patient heard voices.

Follow-Up and Prognosis

Medical assessment requires clear recognition of alcoholic hallucinosis different from delirium tremens. The patient's symptoms lasted more than two months so the diagnosis of delirium tremens became less probable. His medical background of psychotic disorders increases his predisposition to develop primary psychotic disorders. Extended patient monitoring is vital to establish if symptoms fully disappear or remain because this indicates the development of a permanent psychotic disorder. The healthcare provider explained to the patient about dangerous alcohol use risks then suggested ongoing psychiatric treatment with strategies for avoiding a relapse.

The psychiatric condition called alcoholic hallucinosis expresses through clear consciousness as it affects individuals with chronic alcohol use disorder to produce auditory hallucinations and delusions with mood disturbances (1). Clinical decision-making requires professionals to distinguish alcoholic hallucinosis symptoms from those of delirium tremens along with primary psychotic disorders. The symptoms endured for longer than the expected three to four days of delirium tremens therefore support alcoholic hallucinosis as the correct diagnosis (2).

People with delirium tremens show changes in their mental state together with extreme nervous system reactions and visible mental images that appear in the 48 to 72 hours following alcohol withdrawal (3). The primary symptoms of alcoholic hallucinosis involve auditory hallucinations which appear alongside normal mental state awareness and reduced autonomic abnormalities (4). A CIWA-Ar assessment showing 11 points indicated mild withdrawal manifestations which strengthened the diagnosis of alcoholic hallucinosis versus delirium tremens.

A diagnosis of alcoholic hallucinosis recovery takes place from several weeks to multiple months yet certain patients may develop schizophrenia-like persistent psychotic disorder (5). The patient's documented psychotic disorders in family members makes them more susceptible to enduring psychotic symptoms according to research (6). The research conducted by Perälä et al showed alcoholic individuals with psychotic disorder features developed schizophrenia-spectrum disorders more often than those without psychotic features (7). Such findings demand prolonged psychiatric monitoring to properly support these patients.

Medical experts have not identified precise mechanisms behind alcoholic hallucinosis yet studies reveal that dopaminergic dysfunction together with glutamatergic excitotoxicity develops from long-term alcohol intake followed by withdrawal (8). Research using neuroimaging techniques reveals that severe alcoholism eventually causes brain alterations within the prefrontal cortex and limbic system which might produce psychotic manifestations (9). A patient's genetic makeup becomes an additional challenge to diagnosis when they have a family background of both alcohol dependence disorder and psychotic tendencies.

The treatment plan for alcoholic hallucinosis requires medications to handle withdrawal discomfort as well as antipsychotic drugs for psychotic symptoms and programs to stop relapse in the long term (10). The medical staff relied on benzodiazepine drugs like lorazepam and chlordiazepoxide to manage withdrawal symptoms and chose olanzapine to help reduce psychotic symptoms. Medical research indicates olanzapine and risperidone present beneficial treatment approaches because they minimize the chance of worsening withdrawal symptoms compared to traditional antipsychotic drugs (11).

People who want to protect themselves from both mental health relapse and psychotic episodes must carry out long-lasting alcohol abstinence. Research supports integrated psychiatric and addiction management using cognitive behavioral therapy (CBT), motivational interviewing and the pharmacological supports naltrexone and acamprosate to prevent relapses (12).

Doctor B continues to demonstrate the need to properly differentiate between alcoholic hallucinosis and delirium tremens together with primary psychotic disorders. A diagnosis was made through three essential indicators of extensive symptom period together with maintained mental awareness alongside the main auditory auditory symptoms. Regular psychiatric care throughout years is vital for patients with psychotic disorders in their families because it helps detect any development of persistent psychotic illnesses. Successful outcomes for patients with alcoholic hallucinosis require immediate intervention together with ongoing psychiatric monitoring and continued alcohol sobriety.

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