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Alcohol-Induced Psychosis

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What is Alcohol-Induced Psychosis?

Alcohol-induced psychosis is used to describe different psychotic conditions resulting from alcohol use. Psychotic conditions are mental disorders characterized by a disconnection from reality.

Healthcare professionals refer to alcohol-induced psychosis as a secondary psychosis because it results from a medical condition (addiction). A primary psychosis means that a mental health disorder causes symptoms.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), alcohol-induced psychosis causes significant hallucinations or delusions.

Delusions can start during or immediately after alcohol intoxication or withdrawal. To be considered alcohol-induced psychosis, no other psychotic disorder can be responsible for the episode.

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Causes of Alcohol-Induced Psychosis

Alcohol triggers changes in the functions of cells, cell membranes, and organs (including your brain). Therefore, people with an alcohol use disorder can develop hallucinations or delusions. Your auditory system could also be affected, causing these symptoms.

Alcohol-induced psychosis occurs in people who experience: 

  • Acute intoxication (or acute alcohol poisoning)
  • Alcohol withdrawal
  • Chronic alcohol use disorder (AUD)

4 Types of Alcohol-Induced Psychosis

There are four types of alcohol-induced psychosis:

1. Delirium Tremens (DTs) Psychosis

Delirium tremens (DTs) psychosis occurs during alcohol withdrawal syndrome. People will experience delirium within 4 to 7 days of stopping alcohol consumption.

Symptoms of the condition will include:

  • Sensitivity to sensory inputs (lights, sounds, touch, etc.)
  • Disorientation
  • Severe confusion, fear, or agitation
  • Visual and auditory hallucinations
  • Persecutory delusions (the sensation of being chased)
  • High blood pressure, temperature, and pulse 
  • Mood swings

If left untreated, delirium tremens psychosis can become life-threatening. Untreated DTs have a mortality rate of over 25%, while medically treated DTs have a mortality rate of around 5%.

People with this condition require medical support. Sedatives like benzodiazepines may also be necessary.

2. Alcohol Poisoning (Acute Intoxication) Psychosis

Alcohol poisoning psychosis is sometimes called acute intoxication. It occurs after a person consumes a substantial amount of alcohol.

Sometimes, symptoms can occur while the person is intoxicated. Other times they happen when the body is clear of alcohol.

Severe aggression or psychotic reactions for several hours is expected. Often, they won't remember anything (amnesia) following the episode. 

Other factors such as hypoglycemia (low blood sugar) or psychotropic drugs (e.g., stimulants) can increase the risk of developing alcohol poisoning psychosis.   

3. Chronic Alcoholic Hallucinosis

Alcoholic hallucinosis occurs after years of chronic alcohol abuse. It shares some symptoms with delirium tremens psychosis.

For example, psychotic symptoms can include:

  • Vivid, auditory hallucinations 
  • Visual hallucinations 
  • Paranoia
  • Persecutory delusions (the sensation of being chased)
  • Fear
  • Mood swings

Hallucinations are often auditory with alcoholic hallucinosis. Mood disturbances are common as well.

Periods of psychosis last longer among alcoholics, lasting hours, days, or weeks. This extended period makes alcoholic hallucinosis seem like paranoid schizophrenia. However, there has been no genetic connection shown between the two conditions.

4. Alcohol-Induced Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome (WKS) is a thiamine (vitamin B1) deficiency. Excessive long-term alcohol consumption can cause thiamine loss in the body. This leads to brain damage and can cause hallucinations and memory loss. 

Wernicke encephalopathy is the acute version, and symptoms include:

  • General confusion
  • Loss of mental activity
  • Loss of muscle coordination
  • Tremors
  • Strange eye movements
  • Vision changes (double vision)

Korsakoff syndrome is the chronic (long-lasting) version, and symptoms include

  • Memory loss (similar to dementia)
  • Inability to form new memories
  • Hallucinations
  • Delusions

These conditions may present the same symptoms as alcohol-induced psychosis. However, your mental abilities will continue to deteriorate with Wicke-Korsakoff Syndrome.

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Early Warning Signs of Alcohol-Induced Psychosis

Alcohol-induced psychosis can appear either during or after alcohol consumption. Some warning signs of alcohol-induced psychosis include:

  • Difficulties concentrating or thinking with a clear mind
  • Self-care or hygiene suddenly begins to decline
  • Hearing or seeing things that others don’t
  • Intense, aggressive emotions or outbursts

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Can Alcohol Cause Schizophrenia?

Alcohol does not cause schizophrenia. There is no evidence to support that the two conditions have a common genetic basis.

However, alcohol hallucinosis can be quite similar to paranoid schizophrenia. Alcohol and drug use may cause psychosis in those susceptible to developing schizophrenia.

How Serious is Alcohol-Induced Psychosis?

Alcohol-induced psychosis may be life-threatening. It can pose risks for the person suffering from the psychotic episode and those nearby. 

People with the condition can become violent and require physical restraints. Higher rates of suicidal behaviors have been associated with alcohol-induced psychosis. Fortunately, if people receive addiction treatment and stop drinking alcohol, they have a high chance of recovery.

Treatment for Alcohol-Induced Psychosis

Treatment options are available for alcohol-induced psychosis. If you have an alcohol use disorder and a mental health problem, you must seek help for both conditions.

Clinicians will consider different approaches depending on a person’s vital signs. If sedation is necessary, clinicians may administer neuroleptics (antipsychotics). Benzodiazepines, like lorazepam, can be another treatment strategy for alcohol withdrawal symptoms and seizures.

For people with AUD, quitting alcohol is mandatory for their health. Without treatment, they will likely develop a chronic syndrome and recurrent illnesses.

Inpatient and outpatient treatment can help you quit drinking. These programs may provide people with the following:

Summary

  • Alcohol-induced psychosis is a mental condition that causes a disconnection from reality
  • The condition is caused by excessive and long-term alcohol consumption
  • If you have an AUD and a mental health condition, it is essential to seek help for both
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Updated on November 10, 2022
6 sources cited
  1. Masood et al. “Treatment of Alcohol-Induced Psychotic Disorder (Alcoholic Hallucinosis)-A Systematic Review.” OUP Academic, Oxford University Press, 2017.
  2. Stankewicz et al. “Alcohol-Related Psychosis.” StatPearls, U.S. National Library of Medicine, 2020.
  3. What Causes Schizophrenia?” Department of Health, 2019.
  4. Isenberg-Grzeda et al. “Wernicke-Korsakoff-Syndrome: Under-Recognized and Under-Treated.” Psychosomatics, Elsevier, 2012.
  5. Hendricks et al. “Cognitive changes in alcohol-induced psychotic disorder.” BMC Res Notes, 2017.
  6. Khouzam et al. “Alcohol Psychosis.” ScienceDirect, 2020.

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