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Alcoholic Hallucinosis

Alcoholic hallucinosis (AH), also known as Alcohol Induced Psychotic Disorder, is described as persistent hallucinations without other strong evidence of alcohol withdrawal or alcohol delirium. Hallucinations are predominantly auditory though can be visual and can be accompanied by delusions and suicidality. AH is a heterogeneous disorder with variable presentation and clinical course. Hallucinosis typically lasts 2-7 days, though persistent hallucinosis lasting weeks to months is possible.

As AH is a relatively rare phenomenon there is not consensus in the literature regarding treatment. Two approaches are generally utilized. The first approach considers alcoholic hallucinosis as a symptom of alcohol withdrawal, with treatment utilizing gaba agonists. The second approach considers alcoholic hallucinosis as a primary psychotic disorder treated with either first or second generation antipsychotics. Both approaches appear equally efficacious, though data is limited by a lack of single studies comparing treatments via a randomized approach.

A reasonable approach is to treat for alcohol withdrawal as long as symptoms of withdrawal persist, then adjunct treatment with a second generation antipsychotic if hallucinosis persists after other withdrawal symptoms have improved. Providers are cautioned against the use of anti-psychotics during DTs as these are associated with increased mortality, likely via QT prolongation and lowering of seizure threshold.

Alcoholic hallucinosis. Bhat PS et al. Ind Psychiatry J. 2012 Jul;21(2):155-7.

Phenomenology and Course of Alcoholic Hallucinosis. Narasimha VL, et al. J Dual Diagn. 2019 Jul-Sep;15(3):172-176.

Alcohol-induced psychotic disorder: a review. Jordaan GP, Emsley R. Metab Brain Dis. 2014 Jun;29(2):231-43.