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

Abstract

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.