alcoholic hallucinosis

   Also known as alcohol hallucinosis and alcohol-induced psychotic disorder. All three terms refer to a nosological concept characterized by acute onset, a predominance of * auditory hallucinations (although delusions and hallucinations in other sensory modalities may be present as well), a history of significant alcohol consumption, and the absence of disturbances of consciousness. The course of alcoholic hallucinosis is seen as more protracted than that of alcohol withdrawal or * delirium tremens, i.e. on the order of several weeks to months. The introduction of the term alcoholic hallucinosis has been attributed to the Swiss psychiatrist Paul Eugen Bleuler (1857— 1939). However, in his 1916 textbook of psychiatry, where he explains the general notion of * hallucinosis and illustrates its use with reference to the term alcoholic hallucinosis (Alkoholhal-luzinose), Bleuler shows himself indebted to the German neurologist Carl Wernicke (1848—1904). Moreover, in his discussion of the subject itself, Bleuler repeatedly refers to alcoholic hallucinosis as alcoholic madness (Alkoholwahnsinn). Wer-nicke, in turn, employs the expression chronic hallucinosis in alcoholics (chronische Halluzinose bei Alcoholisten) in his 1900 textbook. Before Wer-nicke, many others addressed more or less similar syndromes, using a variety of terms. As noted by the British addiction specialist Ilana Belle Glass, as early as 1847 the French author C.N.S. Marcel used the term folie d'ivrogne (drinking madness) to denote a symptom complex similar to alcoholic hallucinosis. Marcel has also been credited with being the first to distinguish this symptom complex from * delirium tremens. Whether or not this distinction is justifiable from a clinical and nosological point of view is a somewhat complex issue. As regards the clinical level of conceptualization, the distinction between delirium tremens and alcoholic hallucinosis has traditionally been defended by recourse to the alleged differences in clinical presentation, as well as to the differences in recommended therapeutic approach. As regards the scientific level of conceptualization, however, it has been argued that conditions such as alcohol intoxication, alcohol withdrawal, delirium tremens, and alcoholic hallucinosis may well be different manifestations of a single morbid process. Protagonists of this continuum hypothesis tend to downplay the purported clarity of consciousness in individuals with alcoholic hallucinosis and to stress the host of auxiliary symptoms that may accompany the condition, including physical symptoms characteristic of * delirium and hallucinations in other than the auditory modality. A second school of thought, represented pre-eminently by Bleuler, conceptualizes alcoholic hallucinosis as a manifestation of an underlying — but until then latent — vulnerability to * schizophrenia. As Bleuler wrote in 1916, "In cases with an ordinary, subacute course, I could always demonstrate with certainty or great probability, that besides the alcoholism a long-standing schizophrenia existed. In my experience, the (rare) acute cases were also somewhat abnormal in the direction of schizophrenia, although here the connection was less plainly pronounced." In a footnote, Bleuler added, "Alcoholic madness could therefore be a mere syndrome concomitant to schizophrenia, induced by alcohol." In addition to the continuum hypothesis and the hypothesis of alcohol as a precipitating factor for schizophrenia-like psychosis, various other hypotheses have been formulated. For example, a conceptual and pathophysiological kinship has been suggested between alcoholic hallucinosis and paraphrenia and between alcoholic hallucinosis and involutional depression. But the nosological status of alcoholic hallucinosis has remained ambiguous. Neuroimaging and other promising techniques may well prove of value in unravelling the neurophysiological correlates of the syndrome, but the preliminary results of SPECT and PET studies in this area of research would seem to be hampered by a lack of specificity due to the absence of conceptual clarity in this matter.

   As a nosological category, alcoholic hallucinosis is classified as a specific type of * hallucinosic syndrome.

   References

   Marcel, C.N.S. (1847). De la folie causée par l'abus des boissons alcooliques. Paris: Imprimeur de la Faculté de Médecin.

   Wernicke, C. (1900). Grundriss der Psychiatrie. Leipzig: Verlag von Georg Thieme.

   Bleuler, E.(1916). Lehrbuch der Psychiatrie. Berlin: Verlag von Julius Springer.

   Glass, I.B. (1989). Alcoholic hallucinosis: A psychiatric enigma — 1. The development of an idea. British Journal of Addiction, 84, 29—41.