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Background: From the second half of the 19th century eminent psychiatrists began referring to alcohol-induced psychotic disorder (AIPD) as a specific alcoholic psychosis. Over the last decades interest in AIPD seems to have declined: the last review dates form 1989., Aim: To review the recent literature on AIPD, revive interest in the disorder, evaluate the current scientific evidence and assess its clinical value., Method: We performed a Medline search based on the following terms: 'Psychoses, Alcoholic' [Mesh] OR 'alcohol induced psychotic disorder' OR 'alcoholic hallucinosis' OR 'alcohol hallucinosis'. Our search was restricted to articles written in English or Dutch and published between 1-1-1988 and 31-1-2013., Results: We found 164 papers, from which we selected 21 for further discussion. The quality of the papers selected was variable, most of the papers being the result of clinical research. The most important findings referred to epidemiology: 0.4% lifetime prevalence in the general population, 4.0% in patients with alcohol dependence. We found only limited evidence of psychopathological differentiation between delirium and primary psychotic disorder. Correct diagnosis of AIPD is important because of the implications regarding the length and nature of the treatment: short or long course of antipsychotics, referral to a substance-abuse unit., Conclusion: AIPD has survived as a clinical entity. However, scientific evidence of this is limited. Further research is needed because it is vitally important that the patient receives the most appropriate treatment.

Background: Epidemiological data on alcohol-induced psychotic disorder and delirium (alcohol-induced psychotic syndrome, AIPS) are scarce., Aims: To investigate the epidemiology of AIPS, the risk factors for developing AIPS among people with alcohol dependence, and mortality associated with alcohol dependence with or without AIPS, in a sample drawn from the general population of Finland., Method: A general population sample of 8028 persons were interviewed with the Composite International Diagnostic Interview and screened for psychotic disorders using multiple sources. Best-estimate diagnoses of psychotic disorders were made using the Structured Clinical Interview for DSM-IV Axis I Disorders and case notes. Data on hospital reatments and deaths were collected from national registers., Results: The lifetime prevalence was 0.5% for AIPS and was highest (1.8%) among men of working age. Younger age at onset of alcohol dependence, low socioeconomic status, father's mental health or alcohol problems and multiple hospital treatments were associated with increased risk of AIPS. Participants with a history of AIPS had considerable medical comorbidity, and 37% of them died during the 8-year follow-up., Conclusions: Alcohol-induced psychotic disorder is a severe mental disorder with poor outcome.

Aims: (i) To compare actual developments of alcohol-related harm in Sweden with estimates derived prior to major policy changes in 1995 and (ii) to estimate the effects on consumption and alcohol-related harm of reducing alcohol prices in Sweden., Design: Alcohol effect parameters expressing the strength of the relationship between overall alcohol consumption and different alcohol-related harms were obtained from ARIMA (Auto Regressive Integrated Moving Average) time-series analyses., Measurements: Measures of Swedish alcohol-related mortality (liver cirrhosis, alcoholic psychosis, alcoholism and alcohol poisoning), accident mortality, suicide, homicide, assaults and sickness absence from 1950 to 1995., Findings: Previous estimates of alcohol-related harm based on changes in alcohol consumption for the period 1994-2002 for Sweden were, in some cases (e.g. violent assaults and accidents), relatively close to the actual harm levels, whereas in other cases (e.g. homicides, alcohol-related mortality and suicide) they diverged from observed harm levels. A tax cut by 40% on spirits and by 15% on wine is estimated to increase total per capita alcohol consumption by 0.35 litre. This increase is estimated to cause 289 additional deaths, 1627 additional assaults and 1.6 million additional sickness absence days., Conclusions: The estimates of future changes in harm based upon even relatively modest increases in alcohol consumption produce considerable negative effects, with large economic consequences for the Swedish economy. The additional alcohol-related deaths, for instance, amount to more than half the number of yearly traffic fatalities in Sweden.

The aim of the study was to reveal risk factors for development of alcoholic psychosis in patients with eating disorders. Ten inpatients with anorexia nervosa and bulimia nervosa abusing alcohol for 1-4 years have been examined. Delirium tremens was diagnosed in 5 patients in the first few days of staying in the hospital, other 5 patients were included in the control group. Factors precipitating delirium tremens were low body mass index, water-electrolytic imbalance, severe dehydration caused by vomiting and hypoglycemia. A careful choice of doses of psychotropic drugs taking into account concomitant somatic-endocrine disturbances, the degree of electrolytic imbalance and thorough alcoholic anamnesis is important at the earlier stage of treatment.

Background: Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced., Aims: To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each., Method: Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared interms of cost, burden averted and efficiency of current and optimal treatment. We then calculated the burden unavertable given current knowledge. The unit of health gain was a reduction in the years lived with disability (YLDs)., Results: Summing across all disorders, current treatment averted 13% of the burden, at an average cost of 30,000 Australian dollars per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of 18,000 Australian dollars per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at 16,000 Australian dollars per YLD gained. Sixty per cent of the burden of mental disorders was deemed to be unavertable., Conclusions: The efficiency of treatment varied more than tenfold across disorders. Although coverage of some of the more efficient treatments should be extended, other factors justify continued use of less-efficient treatments for some disorders.

Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other Axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.

The purpose of this investigation was to find out the number of hospitalizations of alcoholics in a department of psychiatry throughout one year. Further, some characteristics of the patients were noted. The information was gathered from case sheets of patients who had been hospitalized in the period 01.10.96-30.09.97, and who were given a F10.x diagnosis from the ICD-10 system. The investigation showed that about one fifth of the patients hospitalized in the department were alcoholics. Fore more than half of these patients, the reason for hospitalization was for treatment that according to guidelines should have been given in an outpatient setting. The study confirms that there is a need for facilities for inpatient treatment for alcoholics, and that offering outpatient detoxification is not sufficient.

Alcohol misuse and alcohol withdrawal are associated with a variety of neuropsychiatric syndromes, some of which are associated with significant morbidity and mortality. B vitamin deficiency is known to contribute to the aetiology of a number of these syndromes, and B vitamin supplementation thus plays a significant part in prophylaxis and treatment. In particular, the Wernicke Korsakoff syndrome (WKS). due to thiamine deficiency, is a common condition in association with alcohol misuse, and is associated with high morbidity and mortality. Nicotinamide deficiency may result in a rarer condition, alcoholic pellagra encephalopathy, which often has a similar clinical presentation to WKS. This review considers the role of B vitamins in the aetiology and treatment of neuropsychiatric syndromes associated with alcohol misuse, with particular emphasis on WKS.

Over a 1-year study period all patients admitted to the department of psychiatry in a general hospital were asked to complete the General Health Questionnaire at admission, discharge, and first polyclinic (outpatient) follow-up contact. Seventeen per cent of admissions were alcoholics. Alcoholics improved rapidly after admission to the psychiatric department. This improvement was comparable to that of all the (psychiatric) patients admitted and continued after discharge.

153 chronic alcoholics were given treatment against food poisoning. 55 of them developed withdrawal syndrome, 98 had alcoholic psychosis including 88 with delirium tremens. The acute intestinal infection in these alcoholics was managed with rehydration using polyionic crystalloid solutions under controlled diuresis. Previous relief of central excitation contributed much to a positive treatment outcome.

A clinical trial covered 69 schizophrenics subjects to frequent rehospitalizations because the patients' need in repeated inpatient treatment. The author points out, that frequent hospitalizations form psychological hospital dependence.

The effects of alcohol on the central nervous system can be subdivided into three main categories: the effects of acute intoxication (drunkenness, acute encephalopathy, stroke), the effects of tolerance and ethanol withdrawal (delirium tremens, seizures) and the delayed manifestations of chronic alcohol consumption (cerebellar degeneration, Wernicke's encephalopathy, dementia).

Patients with alcoholism and tuberculosis suffer most frequently of alcoholism stage II. Tuberculosis effects unfavourably the course of alcoholism. Most frequently acute alcohol psychoses appear in patients with pulmonary tuberculosis showing a severe and prolonged course. Alcoholism effects the process of treatment of tuberculosis: healing of cavernosis is noted in 9.8%, abacillation--in 11.5%. Compulsory treatment of patients with alcoholism and tuberculosis should be carried out in large antitubercular clinics with special wards for these purposes. Decisions should be made by courts. In narcological clinics special wards for the treatment of the above mentioned patients should be singled out.

The authors analyze the destiny of 289 patients with associated schizophrenia and alcoholism. For the first time they were admitted to the psychiatric hospital in 1948-1951 (period I); 1959-1961 (period II); 1969-1971 (period III), and in 1979-1981 (period IV). The five-year catamnesis has demonstrated that schizophrenic patients abusing alcohol are often admitted to the hospital with paranoid symptomatology, retaining, however, a high enough level of social and labour adaptation, emotions, communicability for a long time. In the course of transition from the first to the fourth period, this group patients demonstrated an increase of the crime rate.

On the basis of a prospective random sample investigation of 611 alcohol-related visits to the four psychiatric emergency units of the City of Copenhagen, demographic variables, referral sources and dispositions of treatment are described. On every 10th day throughout 1985 all visits were registered. The distribution of all variables except age and sex deviate significantly from those of non-alcohol-related visits. Thus fewer alcoholics cohabit and more are divorced. 25% of the alcohol-related visits resulted in an overnight stay in the unit, while 10% resulted in admission to the psychiatric ward. For non-alcohol-related visits the proportions were the reverse.

It has been demonstrated by a double blind placebo-controlled study that transcranial electric treatment (TET) by means of combination of direct current and pulse current and pulse current at a frequency of 70-80 Hz is an effective method of correcting affective disorders (anxiety, depressions) in patients suffering from alcoholism. The therapeutic effects of TET are coupled with changes in GABA and monoamine metabolism rather than in beta-endorphin as well as with a decrease of the latent period of the occurrence of alpha-rhythm after eyes closing.

Craniocerebral hypothermia was employed in multimodality treatment of 10 patients with hypertoxic schizophrenia and 60 patients with intoxication psychoses, the clinical picture of which was characterized by increasing hypoxia and edema-swelling of the brain. Hypothermia was made to a cerebral temperature of 28-30 degrees C for 4-6 hours in the presence of the neurovegetative blockade. The data obtained attest to a high therapeutic efficacy of craniocerebral hypothermia.

The report deals with a study of 16 patients with alcoholic paraphrenia and 30 patients where the paraphrenic syndrome was a stage in Gaiie-Wernicke's encephalopathy, alcoholic paranoid state and alcoholic pseudoparalysis. Alcoholic paraphrenia was more frequently expressed in the form of systematized and confabulatory forms with a monotonous and primitive delusion accompanied by a psychoorganic syndrome. In the complex treatment injections of bijochinal (up to 40-50 ml) were used; this brought about a sufficient resocialization of the patients.

The authors report on a large-scale outpatient alcohol detoxification program, presenting a clinical rationale for outpatient detoxification, describing the program method, and giving initial evaluation data on the first 564 patients. Only 47 percent of the patients required detoxification, and only 19 percent of these required inpatient care. The majority of the patients successfully completed outpatient detoxification; half of these continued in the related rehabilitation program. There were no fatalities. The authors believe the results support the utility of outpatient detoxification as a cost-effective alternative to inpatient detoxification for the majority of acute alcoholics.

During the past ten years, treatment of delirium alcoholicum was almost exclusively by means of chlormethiazol (distraneurin), an agent which has sedative, hypnotic, and antiepileptic effects. A total of 111 deliriants with single and multiple deliria were subjected to 151 treatments. In the majority of cases the state of delirium was overcome after three days of specific treatment. The case histories of three patients, where the course of disease was extremely severe and additionally complicated by secondary diseases and who died during treatment (the percentage being 0.7% relative to 151 cases of treatment), are discussed in detail. In the case of severe states of delirium accompanied by repsiratory diseases it is necessary that the patient receiving specific treatment be supplied with additional amounts of oxygen because distraneurin, like other sedatives, trends to reduce the utilization of oxygen under certain conditions. The majority of deliriants were in their third to fourth decades of life. Accordingly, our patients were younger than those included in the reports presented by other authors. Also discussed by the present authors are attacks accompanying the state of delirium as well as concomitant diseases complicating the clinical picture and adverse effects of alcohol on the nervous system.

A 46 years old male alcoholic was admitted with an assumed alcohol withdrawal syndrome accompanied by tonic-clonic seizures. Parenteral nutrition with fructose, sorbitol, xylitol, dextran, hydroxyethylstarch, electrolytes, vitamins and amino acids was undertaken. He died 20 d later due to renal insufficiency and bronchopneumonia. Calcium-oxalate-monohydrate (whewellite) was found in the central nervous system, the kidneys, the testes, the epididymis, the cardiac muscle cells and the lungs. The presence of urate crystals was suspected. The pathogenesis of secondary oxalosis is discussed.

An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. The final sample consisted of 68 respondents: 34 clinicians, 17 activity therapists, and 17 art therapists. The three respondent groups agreed on the same optimum treatment modality for five patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modalities for those patients.