A PROSPECTIVE STUDY OF CLINICAL EFFICACY AND TREATMENT OUTCOME EVALUATION OF PSYCHOSIS INDUCED BY ALCOHOL WITHDRAWAL IN A TERTIARY CARE HOSPITAL IN MARATHWADA REGION

Abstract

Alcohol-induced psychosis (also called alcoholic hallucinosis or alcohol-related psychosis, ARP) is a rare but serious complication of heavy and long-term alcohol use. It typically emerges during acute withdrawal—often within 12 to 24 hours after cessation—and presents with hallucinations, delusions, and disorganized thinking while consciousness usually remains intact. ARP is distinct from delirium tremens (DT), Wernicke’s encephalopathy, and other alcohol-related neurocognitive disorders, though clinical overlap can occur. The condition often features auditory hallucinations, occasionally accompanied by visual or tactile symptoms, and may resolve within days; however, persistent cases can progress to chronic, schizophrenia-like illness. Epidemiological data show that while alcohol use is widespread, ARP remains uncommon, with prevalence estimates ranging from 0.4% to 4% among individuals with alcohol dependence. Risk increases with chronic heavy drinking, co-occurring psychiatric disorders, nutritional deficiencies, and repeated withdrawal episodes. The neurobiology of ARP involves dysregulation of multiple neurotransmitter systems—including dopamine, serotonin, GABA, and glutamate—driven by acute or chronic effects of ethanol and associated metabolic disturbances.

Alcohol withdrawal syndrome (AWS) presents along a spectrum from mild symptoms (tremor, anxiety, insomnia) to severe manifestations such as withdrawal seizures and delirium tremens, the latter occurring in up to 5% of hospitalized cases and carrying significant mortality if untreated. Assessment tools such as the CIWA-Ar scale help determine withdrawal severity and guide management.

Timely diagnosis requires distinguishing ARP from primary psychotic disorders and from delirium, with DSM-5 and ICD-10 criteria emphasizing the temporal relationship to alcohol use, preservation of orientation, and exclusion of other causes. Management includes supportive care, correction of nutritional deficiencies—especially thiamine to prevent Wernicke’s encephalopathy—and pharmacologic interventions. Benzodiazepines are the first-line treatment for AWS and seizure prevention, while antipsychotics such as haloperidol may be used adjunctively for hallucinations or agitation. Long-term care focuses on relapse prevention with medications such as naltrexone or disulfiram and psychosocial interventions including CBT, motivational enhancement, and structured abstinence support. alcohol-induced psychosis represents a distinct clinical entity arising from complex interactions between chronic alcohol exposure, neurochemical imbalance, and withdrawal. Early recognition, appropriate treatment, and continued AUD management are essential to reduce complications, recurrence, and progression to chronic psychotic disorders.