Alcohol-induced Psychotic Disorder Research Articles

Objective predictors for delirium tremens based on physiological and metabolic parameters

The aim of study: clinical validation of a model for early detection of patients at high risk of developing complicated forms of alcohol withdrawal syndrome (hereinafter - AWS), based on laboratory diagnostics.
 Subjects and methods: The study was a prospective, cohort, observational. The total number of included patients was 200, 9 of them were excluded, and the included patients were distributed as follows: uncomplicated AWS developed in 98 patients (51.3%), alcohol delirium in 67 patients (35.1%), and alcohol-induced psychotic disorder in 26 patients (13.6%). Potassium, sodium, calcium and platelet count levels were compared between the groups, and the relationships between gender, age and potassium levels in patients with alcohol delirium were studied.
 Results: levels of potassium, sodium and platelet count were significantly different in groups of patients with alcohol delirium, uncomplicated AWS and alcohol-induced psychotic disorder. Blood calcium levels were significantly different between patients with alcohol delirium and uncomplicated AWS. Women were found to be less sensitive to metabolic disorders that developed as a result of alcohol consumption, as evidenced by their lower incidence of delirium. The high prevalence of alcohol delirium among elderly patients is a consequence of decompensation of metabolic regulation mechanisms in them. Predictive model of alcohol delirium, based on the results of blood potassium level study, proved effectiveness in clinical application.

Clinical Variables and Peripheral Biomarkers Associated with Substance-Induced Psychotic Disorder: Differences Related to Alcohol, Cannabis, and Psychostimulant Abuse.

Background: The present retrospective observational study aims to identify differences in clinical features and peripheral biomarkers among patients affected by substance-induced psychotic disorder (SIPD) according to the primary substance of abuse. Methods: A sample of 218 patients was divided into three groups according to the type of consumed substance: alcohol, cannabis, and psychostimulants. The three groups were compared using one-way analyses of variance (ANOVAs) for continuous variables and χ2 tests for qualitative variables. After excluding the alcohol-induced psychotic disorder group, the same analyses were repeated. The statistically significant variables from these subsequent analyses were included in a binary logistic regression model to confirm their reliability as predictors of cannabis- or psychostimulant-induced psychotic disorder. Results: Psychotic cannabis abusers were younger (p < 0.01), with illness onset at an earlier age (p < 0.01). Alcohol consumers presented a longer duration of illness (p < 0.01), more frequent previous hospitalizations (p = 0.04) and medical comorbidities (p < 0.01), and higher mean Modified Sad Persons Scale scores (p < 0.01). Finally, psychostimulant abusers had a higher frequency of lifetime history of poly-substance use disorders (p < 0.01). A binary logistic regression analysis revealed that higher mean Brief Psychiatric Rating Scale scores (p < 0.01) and higher sodium (p = 0.012) and hemoglobin (p = 0.040) plasma levels were predictors of cannabis misuse in SIPD patients. Conclusions: Different clinical factors and biochemical parameters con be associated with SIPD according to the main substance of abuse, thus requiring specific management by clinicians.

Alcohol Withdrawal Presenting with Cut Throat Injury during COVID-19 Lockdown: Case Reports from Nepal

Background. The relationship between alcohol dependence and suicidal tendency is well recognized. Self-harm by cut throat is an uncommon but is potentially life-threatening when attempted. We present a description and discussion of a series of three cases of alcohol dependence syndrome who presented with self-inflicted cut throat wounds during the lockdown period from 24th March to 7th July 2020 due to the COVID-19 pandemic at the largest tertiary care hospital in Nepal. Case description. During the three and a half months of COVID-19 lockdown, we had three cases of alcohol dependence syndrome presenting to emergency services with a self-inflicted cut throat injury. Two cases were diagnosed as having alcohol withdrawal delirium and one case as alcohol-induced psychotic disorder (alcoholic hallucinosis) as per the international classification of mental and behavioral disorders diagnostic criteria for research. All three cases were alcohol dependent for more than a decade, but with no prior self-harm attempts. Necessary surgical interventions were done by the Department of Otorhinolaryngology, and in liaison with the Department of Psychiatry, appropriate psychiatric management was done. All three cases had uneventful outcomes in regard to wound care and mental disorder. Conclusion. Suicidal precautions should be taken in alcohol dependence during phases of consumption and abstinence. Screening for alcohol dependence and withdrawal should be a standard process in all self-harm cases that present to the emergency department during a crisis.

Investigating the Use of Pharmacogenetic and Pharmacometabolomic Markers to Predict Haloperidol Efficacy and Safety Rates.

Background: Haloperidol is commonly prescribed to patients with alcohol-induced psychotic disorder (AIPD). Notably however, individuals differ extensively with regards to therapeutic response and adverse drug reactions (ADRs). Previous studies have shown that haloperidol biotransformation is mainly metabolized by CYP2D6. Objective: The objective of our study was to investigate the use of pharmacogenetic (CYP2D6*4 genetic polymorphism) and pharmacometabolomic biomarkers to predict haloperidol efficacy and safety rates. Material and Methods: The study enrolled 150 patients with AIPD. Therapy included haloperidol in a daily dose of 5 to 10 mg/day by injections for 5 days. Efficacy and safety of treatment were evaluated using the validated psychometric scales PANSS, UKU, and SAS. Results: No association of the urinary 6-НО-ТНВС/pinoline ratio values which could be evidence of the CYP2D6 activity level with both the efficacy and safety rates of haloperidol was demonstrated. However, a statistically significant association between haloperidol safety profile and CYP2D6*4 genetic polymorphism was demonstrated (P < .001). Conclusion: To predict haloperidol efficacy and safety rates, utilization of pharmacogenetic testing that defines CYP2D6*4 genetic polymorphism is found preferable over the use of the pharmacometabolomic marker in a clinical setting.

Genetic testing is superior over endogenous pharmacometabolomic markers to predict safety of haloperidol in patients with alcohol-induced psychotic disorder.

Previous studies have shown that haloperidol biotransformation is mainly metabolized by CYP2D6. The CYP2D6 gene is highly polymorphic, contributing to inter-individual differences in enzymatic activity, and may impact haloperidol biotransformation rates, resulting in variable drug efficacy and safety profiles. The study aimed to investigate the correlation of the CYPD6 activity with haloperidol's efficacy and safety rates in patients with alcohol-induced psychotic disorders. One hundred male patients received 5-10 mg/day haloperidol by injections for 5 days. The efficacy and safety assessments were performed using PANSS, UKU, and SAS-validated psychometric scales. No relationship between haloperidol efficacy or safety and the experimental endogenous pharmacometabolomic marker for CYP2D6 activity, urinary 6-НО-ТНВС/pinoline ratio was identified. In contrast, we found a statistically significant association between haloperidol adverse events and the most common CYP2D6 loss-of-function allele CYP2D6*4 (p<0.001). Evaluation of the single polymorphism rs3892097 that defines CYP2D6*4 can predict the safety profile of haloperidol in patients with AIPD, whereas metabolic evaluation using an endogenous marker was not a suitable predictor. Furthermore, our results suggest haloperidol dose reductions could be considered in AIPD patients with at least one inactive CYP2D6 allele.

Alcohol-induced psychotic disorder: a study of hospitalized patients in Lisbon

IntroductionWhile alcohol-induced psychotic disorder (AIPD) is a well-recognised clinical disorder, relativery little is known about aspects such as epidemiology, course and treatment of the condition. Current evidence suggests AIPD can be clinically distinguised from alcohol-withdrawal delirium and schizophrenia. AIPD is associated with high comorbidity with other psychiatric disorders, high re-hospitalization and mortality rate, namely suicidal behaviour.ObjectivesThe objetive of the study was to examine the correlates, clinical features, psycopathology, and short-term response in an inpatient sample with alcohol-induced psychotic disorder, predominant hallucinations (ICD-10 F10.52) admitted to Centro Hospitalar Psiquiátrico de Lisboa.MethodsWe collected retrospectively data from all admitted patients to our Alcohol Unit between January 2010 and January 2020 with the diagnosis of AIPD. The exclusion criteria were: presence of preexisting psychotic disorder, delirium, or other substance use disorders. We characterized our sample in Demographic categories, Clinical categories, Treatment and Short-term course.Results A total of 113 subjects were included in the study. The prevalance of alcoholic hallucinosis was found to be 1.3% of all patients who received inpatient treatment. Most individuals reported auditory hallucinations, that iniciated when they decrease their alcohol intake, and 1 in 4 had past episodes of AIPD.ConclusionsThere are specific challenges in studiyng AIPD, such as the relatively rarity of the disorder, its often transient nature and high levels of comorbidity. A high degree of recurrence and morbidity indicates a need to prevent, and intervene early with an abstinent-oriented management goal.DisclosureNo significant relationships.

Research on the OPRM1 A118G polymorphism in patients with alcohol-induced psychotic disorder

Research on the OPRM1 A118G polymorphism in patients with alcohol-induced psychotic disorder

Alcohol-Induced Psychotic Disorder and Depressive Disorder: a Dual Diagnosis Case Series

Alcohol-induced psychotic disorder (AIPD) is a diagnosis in the ICD 10. Previous studies of AIPD do not appear to have reported the co-morbid presence of depressive disorder in either prevalence studies or treatment studies. Five cases are presented with a dual diagnosis of AIPD and depressive disorder. These cases were assessed using the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression Severity score (CGI-S), Clinical Global Impression Improvement score (CGI-I), Drug Attitude Inventory 10 (DAI 10), Short Assessment Personality-Abbreviated Scale (SAPAS) and Modified Sainsbury Tool. Antidepressants and antipsychotics were chosen based on drug attitude scores from DAI 10. Cases demonstrate inpatient and outpatient treatment with good treatment outcomes after six months. Three cases demonstrate suicide risk. The majority did not have a personality disorder. These cases highlight the importance of treating a depressive disorder in AIPD and of tailored medication treatments for poor medication compliance.

Alcohol and Psychosis: A Narrative Review of the Prevalence, Clinical Manifestations, and Management of Alcohol-related Psychotic Symptoms

Background: Alcohol use disorders, defined as the maintenance of alcohol use for at least a 12-month period despite negative psychological, biological, behavioral, and social consequences, are frequently associated with psychotic symptoms. Objective: Our aim in this paper is to review alcohol-related clinical conditions that are accompanied by psychotic symptoms, alcohol-induced psychotic disorder, alcohol withdrawal delirium, Wernicke’s encephalopathy, Korsakoff’s dementia, comorbid schizophrenia, or delusional disorder. Methods: This is a non-systematic, narrative review based on the relevant literature indexed in PubMed and Google Scholar databases [2000-2020]. Results: Alcohol-induced psychotic disorder is characterized by the presence of auditory hallucinations or delusions. In the state of alcohol withdrawal, tactile, visual hallucinations and delusions are common. Wernicke-Korsakoff syndrome, caused by malnutrition secondary to chronic alcohol misuse, is characterized by the presence of ataxia, ophthalmoplegia, and a range of mental disturbances. The dual diagnosis of schizophrenia and alcohol use disorder rests on shared biological impairments, as shown by neuroendocrinological and brain imaging studies. The subtype of the delusional disorder called Othello’s syndrome, or delusional jealousy based on false beliefs of infidelity, is often seen in the context of alcohol alone or alcohol and neurological disorder. Treatment for alcoholic disorders with psychotic symptoms are dietary, psychological, and pharmacological. Conclusions: There are a number of alcohol-related psychotic syndromes, each requiring its own specific treatment approach.

Alcohol-Induced Psychotic Disorder with Suspected Pulmonary Embolism: A Case Report

The patient, a 51-year-old male, was admitted to the Department of Psychology of our hospital in 2020-10-05 because of “poor physique, mental abnormality and aggravation for 4 days”. Patients began to drink alcohol 20 years ago, drinking liquor 0.25Kg per day, there is morning drinking, physical condition has been OK. Before one month, poor appetite and food intake, weight loss, weight loss of more than 20 Kg, walking easy to fall, weak legs, has not been treated. Half a month ago, the patient stopped drinking, intermittent symptoms such as lethargy, hand scratching and nonsense, unstable walking, aggravated symptoms on October 1, and incontinence in the evening. On October 2, the family took the patient to the second Hospital of Mudanjiang for medical treatment. The wardrobe CT, DWI, biochemistry, blood routine and other related tests suggested multiple cavity infarction, due to the patient’s restlessness, head DWI was affected, not hospitalized and other special treatment.

Analytical Value of Cell-Free DNA Based on Alu in Psychiatric Disorders.

Psychiatric disorders impose a huge burden on individuals, families, and society. The Alu repeat sequence is a member of the short interspersed nuclear element (SINE) family of mammalian genomes, however, its expression pattern and role in psychiatric disorders is unclear. The current paper aimed at determining the concentrations of Alu in patients with schizophrenia (SZ), major depressive disorder (MDD), and alcohol-induced psychotic disorder (AIPD), and to further define the role and value of Alu as a potential biomarker in psychiatric disorders. In this work, we found that the concentration of Alu was considerably incremented in patients with SZ, and a significant difference existed between patients diagnosed with SZ and MDD or AIPD. ROC analysis also indicated that Alu was effective in the complementary diagnosis of SZ, and differentially diagnosed between SZ patients and patients with MDD or AIPD. In addition, we found a positive relationship between the Alu concentrations and interleukin-1β (IL-1β) in patients with SZ, MDD, and AIPD, and between the concentrations of Alu and interleukin-18 (IL-18) in patients with SZ. Overall, the present work indicates that Alu might be an innovative biomarker for diagnosing psychiatric disorders, and provides the basis for hypotheses about the pathophysiology of psychiatric disorders.

Prevalence and pattern of alcohol-induced psychosis and personality profile of male alcohol use disorder patients: A hospital-based study

Background: There is a paucity of data on the prevalence and pattern of alcohol-induced psychotic disorder (AIPD) and the role of personality traits in alcohol use disorders (AUDs) and AIPD. Aim: This study aims to study the prevalence and pattern of AIPD and personality profile in AUD and AIPD patients. Materials and Methods: Consecutive sample of 100 patients with AUD fulfilling Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) criteria and between 18 and 60 years old were included in the study with their informed consent. Psychotic symptoms were assessed in keeping with DSM 5 criteria for substance (alcohol)-induced psychosis. The Eysenck Personality Questionnaire (EPQ) was used to explore personality traits. Results: In the present study, middle class and lower middle class people were found to develop AUD. Early age of initiation of alcohol intake placed the individual at risk of developing severe AUD and psychotic symptoms. Psychotic symptoms were seen in 9% of the individuals. Persons with severe alcohol dependence and longer duration of alcohol use were at increased risk for developing psychotic features. The most common psychotic symptom was auditory hallucination. The EPQ showed that 65.93% of the individuals had psychoticism trait; 67.03% were extroverts. Persons with psychoticism trait were found to start taking alcohol at an early age and develop severe AUD. In the neurotic dimension, 54.95% were highly neurotic; 45.05% had average emotional stability. Conclusions: Psychotic symptoms were seen in 9% of patients with AUD. Psychosis in AUD was associated with severity of alcohol dependence, early initiation, longer duration of alcohol intake, and psychoticism personality trait. Psychoticism and extraversion personality traits were predominant in AUD compared to neuroticism trait.

Treatment of Alcohol-Induced Psychotic Disorder (Alcoholic Hallucinosis)—A Systematic Review

To evaluate the effectiveness of evidence based treatments for alcohol-induced psychotic disorder (AIPD) as described by ICD-10 and DSM-5, a condition that is distinct from schizophrenia and has a close relationship with alcohol withdrawal states. Systematic review using PRISMA guidelines. Of 6205 abstracts found, fifteen studies and ten case reports met criteria and were examined. Larger studies examined the use of first-generation antipsychotic drugs, reporting full or partial remission in most patients. Newer case reports report similar results using second generation antipsychotic drugs. Novel treatments, such as those acting on GABA receptors reported low numbers of patients in remission. Some large studies report the successful use of standard alcohol withdrawal treatments. The findings of our systematic review are inconclusive. There was significant heterogeneity between and within studies. Significant publication bias is likely. Randomized control trials of more carefully delineated samples would produce evidence of greater clinical utility, for example, on differential effectiveness of antipsychotics and optimal length of standard alcohol withdrawal treatments. AIPD patients who show poor treatment responses should be studied in greater depth. This systematic review of alcohol-induced psychotic disorder treatment found 15 studies and 10 case reports of relevance. Older studies of first-generation antipsychotics reported full or partial remission in most patients, as did newer studies with second-generation antipsychotics. Novel drugs reported low remission rates. Standard alcohol withdrawal treatments were successful.

Cognitive changes in alcohol-induced psychotic disorder

AimsThis study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence.MethodsParticipants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital.ResultsThe groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking.ConclusionThis study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.

Quantification of cell-free DNA in blood plasma and DNA damage degree in lymphocytes to evaluate dysregulation of apoptosis in schizophrenia patients

Oxidative DNA damage has been proposed as one of the causes of schizophrenia (SZ), and post mortem data indicate a dysregulation of apoptosis in SZ patients. To evaluate apoptosis in vivo we quantified the concentration of plasma cell-free DNA (cfDNA index, determined using fluorescence), the levels of 8-oxodG in cfDNA (immunoassay) and lymphocytes (FL1-8-oxodG index, flow cytometry) of male patients with acute psychotic disorders: paranoid SZ (total N = 58), schizophreniform (N = 11) and alcohol-induced (N = 14) psychotic disorder, and 30 healthy males. CfDNA in SZ (N = 58) does not change compared with controls. In SZ patients. Elevated levels of 8-oxodG were found in cfDNA (N = 58) and lymphocytes (n = 45). The main sources of cfDNA are dying cells with oxidized DNA. Thus, the cfDNA/FL1-8-oxodG ratio shows the level of apoptosis in damaged cells. Two subgroups were identified among the SZ patients (n = 45). For SZ-1 (31%) and SZ-2 (69%) median values of cfDNA/FL1-8-oxodG index are related as 1:6 (p < 0.0000001). For the patients with other psychotic disorders and healthy controls, cfDNA/FL1-8-oxodG values were within the range of the values in SZ-2. Thus, apoptosis is impaired in approximately one-third of SZ patients. This leads to an increase in the number of cells with damaged DNA in the patient's body tissues and may be a contributing cause of acute psychotic disorder.

The epidemiology and progression time from transient to permanent psychiatric disorders of substance-induced psychosis in Taiwan

IntroductionSubstance-induced psychosis (SIP), including alcohol-induced psychotic disorder (AIPD) and substance-induced psychotic disorder (SIPD), is gradually increasing in importance in clinical practice. However, few studies have investigated the epidemiology and progression time from transient to permanent psychiatric disorders for AIPD and SIPD patients. MethodsWe utilized the National Health Insurance Research Database (NHIRD) to investigate the incidence and prevalence of AIPD and SIPD in Taiwan and determined the timing of AIPD or SIPD followed by the development of persistent psychotic conditions. ResultsThe average incidence and prevalence were 1.97 and 2.94 per 100,000person-years for AIPD, 3.09 and 5.67 per 100,000person-years for SIPD in Taiwan. Moreover, 10.9% to 24.3% of subjects with either AIPD or SIPD had a change in diagnosis to either schizophrenia or affective disorder, and ~50% of patients had a psychotic or affective transformation in their first year after AIPD and SIPD diagnoses. The mean progression time of psychotic or affective transformation was 1.9 to 2.7years. ConclusionsSIP is a predictive factor for persistent psychotic and affective transformation, and a three-year follow-up may be an optimal clinical practice to prevent psychotic or affective transformation in 60% of patients.

STUDY THE CLINICAL FEATURES AND RELATED FACTORS AND THERAPEUTIC RESULTS ALCOHOL- INDUCED PSYCHOTIC DISORDERS WITH DELUSION, HALLUCINATION.

Background: Alcohol-related mental disorders have become more popular in recent years. Alcohol-induced psychotic disorders (APD) with delusions, hallucinations are accounted for the highest percentage. Studying the clinical features and related factors and therapeutic results to enhance the therapeutic quality. Methodology: Retrospective, longitudinal study combined with description and analysis on 45 patients at Danang psychiatric hospital from 03/2013 to 07/2014. Results All patients are male, age from 30-49 are common, low educational level, alcoholic family history, many of them are peasants and poor. Average alcohol-consumption time is from 11-15 years, with average amount of 500-1000 ml/day, mainly rice wine. The rate of APD with delusions and hallucinations is highest (44.4%), high rate of delusion of persecution (66.7%), and followed by delusion of jealousy and delusion of being followed. Most common hallucinations are auditory (92.9%), mainly with menace content (61.5%). Visual and tactile hallucinations are also pretty high. Patient's behaviour is influenced by delusions and hallucinations. AUDIT results show all patients are alcohol addicts. Blood tests have no significant changes. Hepatic enzymes rise dramatically. Good response to haloperidol with average dose around 6-9mg/day, symptoms disapear after 4-6 days. The longer alcohol consumption time needs the longer delay for recovery. Clear corelation between the AUDIT reasults and recovery delay. Conclusion: APD has polymorphic symptomatology. Good response to antipsychotic medications. Key words: AUDIT (Alcohol Use Disorders Identification Test)

P.3.d.041 Alcohol-induced psychotic disorder: brain perfusion and psychopathology – before and after anti-psychotic treatment

P.3.d.041 Alcohol-induced psychotic disorder: brain perfusion and psychopathology – before and after anti-psychotic treatment

Highlights of neuroscience research in Africa

This special issue highlights recent achievements in neuroscience research in Africa. It reveals some of the diversity of clinical and basic neuroscience research currently being conducted in Africa and opens opportunities for future collaborative research. The issue begins with an overview of some of the challenges and highlights steps that are being taken to promote neuroscience education and research in Africa. This is followed by reviews of major health concerns in Africa: vertically transmitted HIV, alcohol-induced psychotic disorder, and the increasing problem of prenatal methamphetamine exposure and its devastating effects on cognitive function of the affected children. This is followed by an overview of achievements in basic research in Africa determining the effects of early life stress and exercise on brain function in a rodent model. Clinical neuroscience research has focused on the major health problems in Africa, as well as risk factors and genetic markers of susceptibility to certain brain disorders. Topics include assessment of cognitive function in patients with HIV, or those who have suffered adversity during the early stages of development, exposure to toxins or drugs of abuse, as well as patients with Addison’s disease. Other researchers have investigated the utility of cognitive therapy in bipolar disorder as well as specific tests, including imaging, neuropsychological tests and genotyping, to aid diagnosis of nervous system disorders. Papers on basic neuroscience focus on elucidating the underlyingmechanisms of drugs of addiction, includingmethamphetamine and khat, as well as neurotoxins such as cyanide, methylmercury and paint thinner. The consequences of glia activation and NMDA receptor inhibition are explored and several papers describe the beneficial effects of honey as well as various drugs and plant extracts in the treatment of different rodent models of human disorders.

Psychotische Störungen durch Alkohol – eine eigene diagnostische Entität?

Alcohol-induced psychotic disorders are relatively rare schizophrenia-like disorders characterized by key symptoms, such as auditory hallucinations, anxiety and delusions while disorders of consciousness and orientation are lacking. The diagnostic entity of this disorder has been questioned. Recent findings indicate a high risk for rehospitalization and relapse but compared to other drug-induced disorders a low risk of schizophrenia-like course of the illness (5 % compared to 40-50 % with other drugs). Pathophysiological, diagnostic and therapeutic aspects of alcohol-induced psychotic disorders are discussed.