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Alcoholic hallucinosis and paranoid schizophrenia-a comparative (clinical


and follow up) study

Article  in  Indian Journal of Psychiatry · October 1980


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Mun J. Pnckiiu. {1980), 82(4), S36—W2

ALCOHOLIC HALLUCINOSIS AND PARANOID SCHIZOPHRENIA—A COM-*


PARATIVE (CLINICAL AND FOLLOW UP) STUDY
G. SAMPATH* M D
Y. V I K R A M KUMAR" D M *
S. M . CHANNABASAVANNA* M D
M.S. KESHAVAN* MD

SUMMARY „
I n a Study Of 90 patients of Alcoholic Hallucinosis and 30 patients of Paranoid Schizophrenia, it was
found that delusions, delusion* of infidelity, third person and running commentary auditory hallucinations
and insight were not different in the two groups.
Delusions of grandeur, passivity, thought echo and thought broadcast were significantly more fre-
quent in paranoid schizophrenic patients. Anxiety, visual iiafracinatians and hallucinations in more than
one modality at the same time were commoner in alcoholic hallucionsis. Recovery from acute symptoms
was much earlier in a l c o h o l ^ hallucinosis.
Number of first degree relatives with schizophrenia was much higher i n the paranoid schizophrenic

In a mean follow up period of 18 months, it was found that patients with alcoholic hallucinosis did
much better than patients with paranoid schizophrenia.

Psychotic states in alcoholics have been T h e duration of alcoholic hallucinosis


known for long. The ICD-9 recognizes as per ICD-9 (WHO 1977) is less than
their classification into delirium tremens, 6 months ; Slater and Roth (1977) imply a
alcoholic hallucinosis and alcoholic pa- protracted course ; Forrest (1973) mentions
ranoia. Delirium tremens being charac- that it lasts for months and Parry (1973)
terised by an alteration in the level of states that alcoholic hallucinosis subsides
consciousness and autonomic instability is spontaneously in a few weeks and rarely
sufficiently delineated ; the clinical profiles contimies for over 12 months. It is thus
of alcoholic hallucinosis and alcoholic pa- evident that the duration of alcoholic hallu-
ranoia, however, remain unclarified. Cli- cinosis is uncertain.
nically alcoholic hallucinosis and schizo- The aim of this study was to determine
phrenia were considered indistinguishable if there was indeed a close resemblance
by many (May and Ebaugh, 1953). between alcoholic hallucinosis and paranoid
Chafetz (1975) claimed that many schizophrenia with respect to symptomato-
patients later became schizophrenic. How- logy, treatment outcome and family history
ever, Slater and Roth (1377.) state that in of schizophrenia.
the light of available evidence, aloholic
hallucinosis is a symptomatic psychosis re- M A T E R I A L AND M E T H O D
sembling schizophrenia. The work was carried out at
Schulkit and Winokur (1971) found NIMHANS, Bangalore from January 1977
that the incidence of schizophrenia in the to September 1978.
relatives of patients with alcoholic hallu- 30 patients diagnosed as alcoholic hallu-
cinosis was no higher than in the general cinosis as per ICD-8 criteria (ICD-9 criteria
population. Of the types of schizophrenia, are identical) formed one group. This
alcoholic hallucinosis resembles paranoid included patients with delusions consistent
schizophrenia most in view of the hallucina- with hallucinations as th* ICD does not
tions of persecutory content and delusions. state if presence of delusions precludes a

'Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore-560 029.
ALCOHOLIC HALLUCINOSIS AND PARANOID SCHIZOPHRENIA 339

diagnosis of alcoholic hallucinosis. sufficient as we limited our investigations


30 patients diagnosed as paranoid schi- to first degree relatives.
zophrenia without aloholism and with age The patients in the acute phase were
and sex matched, formed the other group. treated with either Chlorpromazine or Tri-
To obviate confusion, all patients chosen fluoperazine, the dosage ranging from 400
had a duration of illness of less than 6 to 1200 mg of Chlorpromazine equivalent
months. As the IGD glossary does not (calculated from Davis, 1976). The dose
give inclusion or exclusion criteria for range was adjusted on the guide lines given
paranoid schizophrenia ; we used the fol- by Lehman (1975).
lowing criteria : Patients who had stable
The patients were seen at least twice
delusional systems with either hallucina-
weekly while in the hospital. During follow
tions or formal thought disorder or both,
up (mean period 18.3 months i 1.850 months
without features that could entail their
for patients of alcoholic hallucinations ;
classification as affective or organic psy-
mean period 18.57 months±l .764 months
chosis.
for patients with ftaranoid schizophrenia)
The aim being to take an uncon- the patients were examined at the end of
taminated sample of patients with alcoholic 2 and 4 weeks after discharge, later at
hallucinosis, those with confusion (except monthly intervals for 3 months, and once
of the mildest degree) were deleted as this evey 2 months thereafter. The patients who
could bring in the possibility of other organic were receiving free drugs were seen re-
psychoses like delirium tremens, Korsakoff's gularly at 2 week intervals.
psychosis, etc.
The patients were on medication
The patients were interviewed on the throughout follow up ; the dose range was
lines of the schedule for mental status 300 to 1000 mg of Chlorpromazine equi-
examination given by Slater and Roth valent. The dose was adjusted for control
(1977). Each patient was examined by at of symptoms. Maintenance medication be-
least 2 investigators and a symptom was ing an area of trial and error, (Lehman,
considered to be present only if there was 1975) we ensured that the dsoage was always
unanimity of opinion as to its presence. more than adequate.
Insight was rated from 0 to 3 according
to the method described by Wing et al. The two groups were statistically com-
(1974). It was considered to be present if pared with respect to symptomatology,
the score was 0 or 1 and absent if 2 or 3. course, outcome, and genetic history.
Family history of Schizophrenia for first
RESULTS
degree relatives of the patient was obtained
from at least 2 of the family members. Delusions, delusions of infidelity and of
History of schizophrenia was considered to persecution do not differentiate paranoid
be present if (a) the relative had a schizophrenia from alcoholic hallucinosis.
schizophrenic attack and had been treated Delusions of grandeur and passivity feelings
for the same (psychiatric diagnosis avail- are significantly more in paranoid schizo-
able), (b) one of the family members had phrenics.
history of continuous mental illness sug- Visual hallucinosis and hallucinations
gestive of schizophrenia as indicated by is more than one modality at a time are
evidence of decompensation in at least 3 commoner in alcoholic hallucinosis. Third
of these five areas : thought, perception, person hallucinations, running commentary
mood, conduct, and personality. (These hallucinations do not differentiate the two
criteria were adopted from ICD-8). We entities. Thought echo is commoner in
felt that these criteria would be reasonably schizophrenia as also thought broadcast.
340 G. SAMPATH el at.

The number of patients with insight Anxiety was commoner in patients with
was not different in the two groups, nor was alcoholic hallucinosis. Depression, elation,
the insight ratings significantly different, irritability and blunting of emotions were
although 'the mean insight rating' was not diflerent in the two groups. Suicidal
higher in patients with alcoholic hallu- ideation was present in 6 patients with
cinosis. alcoholic hallucinosis (1 attempted suicide)
and in 4 patients with paranoid schizo-
TABLE 1 phrenia (1 attempted suicide).

Symptoms Sympto- Present Absent Signi- TABLE 2


matology ficance
Affect AH PS
1. Delusions AH 29 1 N.S.
Anxious 13 9
PS 30 0
Depressed 11 9
2. Delusion of AH 17 13 N.S. Elation 0 2
Infidelity PS **9 11 Blunting 1 5
3. Delusions of AH 3 27 p<0.01 Irritability .. 5 5
Grandeur PS 14 16 X«=6.93, d.f. = 2 , p<.05.
4. Delusions of AH 22 8 N.S.
persecution PS 24 6
5. Passivity AH 3 27 p<0.02
•Recovery from acute symptoms was
feelings PS 12 18 defined as—(a) absence of symptoms such
6. No. of patients AH 30 0 N.S. as anxiety, agitation and hallucinations, (b)
with PS 27 3 where delusions are present they are not
hallucinosis acted upon by the patient, and do not inter-
7. Thought AH 3 27 p<0.01 fere with day to day activity, (c) normal
Broadcast PS 14 16 sleep with medication for at least five days
8. Thought Echo AH 5 25 p<0.05 before discharge.
PS 12 18
Both schizophrenic patients and patients
9. Auditory AH 22 8 N.S. with alcoholic hallucinosis recover from
Hallucinations PS 21 9
acute symptoms as per this definition. Re-
10. Third person AH 16 14 N-S.
covery from acute symptoms was signifi-
Hallucinations PS 22 8
cantly earlier in alcoholic hallucinosis.
11. Running AH 14 16 N.S.
Commentary PS 18 12
TABLE 3—Time taken for recovery from acute
Hallucinations
symptoms
12. Visual AH 15 15 p<0.05
Hallucination PS 6 24
Mean
© CM
CM CM

13. Insight AH 10 N.S. No. of S.D.


PS 8 days
13A. Insight AH Mean S.D.=0.63
•Scores* = 1.7 Alcoholic Hallucinosis 14.4 ± 8.36 t=4.76
PS Mean S.D.=0.55 Paranoid schizophrenia 38.22 ±26.70 p<0.001
=2.0
t-1.51 d.f.=58 N.S.
By 'outcome' we mean the status of the
14. No. of Moda- patient after discharge, during follow up.
lities of AH 16 14 p<0.05 A "good" outcome was defined as total
Hallucinations PS 24 6 absence of disturbing symptoms, resumption
of premorbid level of occupational and
ALCOHOLIC HALLUCINOSIS AND PARANOID SCHIZOPHRENIA 341

social functioning. Continued alcohol in- DISCUSSION


take in alcoholics did not preclude their Although Scott ct al. (1969) did mention
inclusion in this category. "Moderate out- that patients with alcoholic hallucinosis
come" was defined as the presence of some were free from "formal thought disorder
symptoms not very disturbing but fair social and other schizophrenic features," no at-
and work functioning. Poor outcome meant tempt has till now been made to spell out
the persistence of symptoms or frequent differentiating points between alcoholic
relapses even with continued medication hallucinosis and paranoid schizophrenia (the
preventing social and occupational func- type of schizophrenia alcoholic hallucinosis
tioning to the satisfaction of the patient's most closely resembles).
attendant. 'Outcome' in alcoholic hallu-
We have found that thought broadcast,
cinosis was significantly better than in
feelings of passivity, delusions of grandeur
paranoid schizophrenia.
and thovight echo differentiate paranoid
schizophrenia from alcoholic hallucinosis.
TABLE 4—'Outcome' in alcoholic hallucinosis
Third person and running commentary
and paranoid schizophrenia
auditory hallucination are not useful in their
Good Moderate Poor differentiation. Anxiety was commoner in
patients with alcoholic hallucinosis. Blunt-
Alcoholic hallu- ing of affect was not found to be commoner
cinosis 19 7 4 in patients with schizophrenia possibly be-
Paranoid schizo- cause the patients were acutely ill and in
phrenia . . 4 11 15p<0.001 paranoid schizophrenia the personality is
more intact than in other varieties.
Neither the number of patients with
All patients with the alcoholic hallu-
insight nor insight ratings were very differ-
cinosis had been taking alcohol in varying
ent in the two groups. In fact, Victor and
amounts throughout the period of follow
Hope (1958) also found insight only in a
up. Only four of them had another attack
minority of patients with alcoholic hallu-
of hallucinosis ; none had more than one
cinosis.
attack during this period.
Recovery from acute symptoms was
There were significantly greater number
much earlier in alcoholic hallucinosis than
of first degree relatives with schizophrenia
implied by Slater & Roth (1977) and Forrest
for the group of patients with paranoid
schizophrenia. (1973).
Among the outcome studies of alcoholic
TABLE 5—Morbidity rise for Schizophrenia in hallucinosis one of the mot complete was
First Degree Relatives of probands that of Benedetti (1952), who followed up
113 cases of acute alcoholic hallucinosis.
No. of B.Z. No. Ill M.R. Out of these, 90 recovered within 6 months,
first degree % 12 had schizophrenic deterioration and 10
Relatives had a progressive organic dementia. Victor
Alcohol-
and Hope (1958), in a study of 76 patients,
ic hallu- found that 4 patients developed features of
cinosis.. 251 102 2 1.96 schizophrenia on follow up. In our study
Paranoid even though 4 out of 30 had poor social
Schizo- function, none had evidence of either schizo-
phrenia 207 83 7 8.4 p<0.05 phrenia or organic deterioration at follow
up. Admittedly, our follow up was short.
342 G. SAMPATH it al.

There seems to be no genetic back- Bull., 1975, Vol. l , N o . 13, p . 2 7 .


ground for the belief that alcoholic hallu- MAY AND EBAUGH. (1953). Pathological intoxi-
cation, AlcohoUc Hallucinosis a n d other reac-
cinosis and schizophrenia are different forms tions to alcohol. Quart. J . Studies in Alcohol.
of the same illness. 14 : 200.
PARRY, R . A. (1973). Alcoholism a n d Drug Abuse
REFERENCES in Companion to Psychiatric Studies. Vol. II
BENEDETTI, G. (1952). T h e Alcoholic Hallucinosis. Ed. Forrest, A. D., Churchill-Livingstone,
Stuttgrat Thieme. Edinburgh a n d London, 125-.
BLEULER, R. (1950). Dementia Praecox or the Group SCHULKIT, M., AND WINOKUR, G. (1971). Alcoholic
Schizorphrenias of (1911) (Translation J . Zin- Hallucinosis and Schizophrenia : A Negative
kin) International University Press, New York. Study. Brit. J . Psychiat., 119, 549.
CHAFETZ, M . A. (1975). Alcoholism a n d Alco- SCOTT D . F., DAVIES, D. L., AND M A L H E R B B , M .
holic Psychoses in Comprehensive Text Book E. L. (1969). Alcoholic Hallucinosis. I n t .
of Psychiatry. Vol. I I , Ed. 2, Eds. Freeman, J . Addiction., 14 : 319-330.
A. M-, Kaplan, H . I., and Sadock, B. J . , SLATER, E., AND R O T H , M . (1977). Clinical Psy-
Williams Wilkins, .Baltimore, 1342. chiatry. Ed. 3 Bailliere Tindall, London.
CUTTING, J . (1978). A reappraisal of Alcoholic VICTOR, M . , AND H O P E , J . M . (1958). The Pheno-
Psychoses. Psychol. Med. 8, 285. menon of Auditory Hallucinations in Chronic
Davis, J . M . (1976). Recent Developments in the Alcoholism. J . Nerv. Ment. Dis., 128,
Treatment of Schizophrenia. Psychiat. Ann. 451.
6, p. 71. W I N G , J . K . , COOPER, J . E., AND SARTORIUS, N . (1974).
FORREST, A. D . (1973). Paranoid states and Para- The Measurement and classification of Psy-
noid Psychoses in Companion to Psychiatric chiatric Symptoms. Cambridge Univ. Press.
Studies. Vol. I I , Ed. Forrest, A. D., Churchill- 177.
Livingstone, Edinburgh & London, 310. WORLD HEALTH ORGANIZATION. (1977). Interna-
LEHMAN, H . E. (1975). Psychopharmacological tional Classification of Diseases. Ninth
treatment of Schizophrenia. Schizophrenia Revision.

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