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What is Alcohol-Induced Psychosis?

Alcohol-induced psychosis occurs in individuals who experience: 

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

Healthcare professionals refer to alcohol-induced psychosis as a secondary psychosis. This means that substance abuse is associated with psychosis symptoms. Primary psychosis means that a mental health (psychotic) disorder such as schizophrenia causes symptoms. 

According to the DSM-5, someone diagnosed with alcohol-induced psychotic disorder experiences significant hallucinations or delusions. These delusions start during or immediately after alcohol intoxication or withdrawal. In addition, no other psychotic disorder can be responsible for the psychotic episode. 

Causes of Alcohol-Induced Psychosis 

Alcohol is a chemical compound that interacts with many neurotransmitters (such as serotonin) and receptors (such as dopamine). These are found throughout the body and brain.

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.

Quitting drinking through healthy means and with support will help people who experience psychosis.

A Dutch literature review published in 2015 observed that 4% of people with alcohol dependence experienced an alcohol-related psychotic disorder. Only 0.4% of the general population experienced the disorder. The highest rate is in working-age men.

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Types and Symptoms of Alcohol-Induced Psychosis

Alcohol-induced psychosis refers to delusions or hallucinations that result from heavy drinking. They cannot be the result of any other pre-existing mental health condition. There are three types of alcohol-induced psychosis:

Delirium Tremens (Alcohol Withdrawal) Psychosis

Delirium tremens psychosis occurs during alcohol withdrawal syndrome. Individuals will begin to 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

Individuals with this condition require medical support. A supervised program can help them detox. Sedatives like benzodiazepines may also be necessary. If left untreated, delirium tremens psychosis can become life-threatening. 

Alcohol Poisoning (Acute Intoxication) Psychosis

Alcohol poisoning psychosis is sometimes called acute intoxication. It occurs after an individual consumes a very large amount of alcohol. Sometimes, symptoms can occur while the person is intoxicated. Other times they occur when the body is clear of alcohol.

People can experience severe aggression or psychotic reactions for several hours. Often, they won't remember anything (amnesia) following the psychotic episode. 

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

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.

The periods of psychoses last longer with alcoholics. They may last hours, days, or weeks. This makes alcoholic hallucinosis seem like paranoid schizophrenia. However, there has been no genetic connection shown between the two conditions.

Early Warning Signs of Alcohol-Induced Psychosis

Alcohol-induced psychosis consists of three different types, as mentioned earlier. Warning signs of the condition 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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Alcohol-Induced Psychosis vs Schizophrenia

Alcohol-induced psychosis can mimic schizophrenia. Especially chronic alcoholic hallucinosis. However, there are some differences in how the two conditions present.

Individuals with alcohol-induced psychosis often have lower education levels. They also have fewer negative symptoms.

Alcohol-induced psychosis often happens at an older age. They may experience stronger anxiety and depression. Insight and judgment may also be better in individuals with alcohol-induced psychosis. 

Can Alcohol Cause Schizophrenia?

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

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

Individuals who have received an alcohol-induced psychosis diagnosis face a 68% probability of readmission. 37% receive a dual diagnosis (co-occurring mental illness). 

Alcohol-Induced Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome (WKS) refers to 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. It can also damage your liver, gastrointestinal tract, and pancreas.

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.

Wicke-Korsakoff syndrome is caused directly by thiamine deficiency. Memory loss is often an indicator of WKS.

How Serious is Alcohol-Induced Psychosis?

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

Individuals with the condition can become violent and require physical restraints. Higher rates of suicidal behaviors have been associated with alcohol-induced psychosis.

The mortality risk for those with untreated delirium tremens psychosis is signifcant. Seizures, cardiac arrhythmia, and many more clinical symptoms can arise. 

Fortunately, if individuals 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. 

Clinicians will consider different approaches depending on an individual’s airway, breathing, and vital signs. If sedation is necessary, clinicians may administer neuroleptics (antipsychotics) such as haloperidol or ziprasidone.  

Benzodiazepines, like lorazepam, may be another treatment strategy for alcohol withdrawal symptoms and seizures. 

Quitting alcohol is necessary. This lowers the risk of recurence or developing a chronic syndrome. Inpatient and outpatient treatment can help you quit.

These programs include supervised detox processes, provide medical support, and even organize support groups to help individuals reach recovery.

Resources

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Masood, Barkat, et al. “Treatment of Alcohol-Induced Psychotic Disorder (Alcoholic Hallucinosis)-A Systematic Review.” OUP Academic, Oxford University Press, 14 Nov. 2017, www.academic.oup.com/alcalc/article/53/3/259/4627701.

Soyka, M. “Alcohol-Related Disorders.” International Encyclopedia of the Social & Behavioral Sciences, Pergamon, 2 Nov. 2002, www.sciencedirect.com/science/article/pii/B008043076703744X?via%3Dihub.

Stankewicz, Holly A, et al. “Alcohol Related Psychosis.” StatPearls [Internet]., U.S. National Library of Medicine, 18 Nov. 2020, www.ncbi.nlm.nih.gov/books/NBK459134/.

“What Causes Schizophrenia?” Department of Health | What Causes Schizophrenia?, www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-w-whatschiz-toc~mental-pubs-w-whatschiz-cau.

Isenberg-Grzeda, Elie, et al. “Wernicke-Korsakoff-Syndrome: Under-Recognized and Under-Treated.” Psychosomatics, Elsevier, 16 Nov. 2012, www.sciencedirect.com/science/article/pii/S0033318212000771.

Allan D. Thomson, Mechanisms of Vitamin Deficiency in Chronic Alcohol Misusers and the Development of the Wernicke-Korsakoff Syndrome, Alcohol and Alcoholism, Volume 35, Issue Supplement_1, May/June 2000, Pages 2–1, https://doi.org/10.1093/alcalc/35.Supplement_1.2

Day, Ed, et al. “Thiamine for Wernicke-Korsakoff Syndrome in People at Risk from Alcohol Abuse.” The Cochrane Database of Systematic Reviews, U.S. National Library of Medicine, Jan. 2004, pubmed.ncbi.nlm.nih.gov/14974055/.

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