From the Guidelines
Alcoholic hallucinosis is a rare complication of chronic alcohol abuse that requires immediate treatment with benzodiazepines, such as lorazepam or diazepam, to manage symptoms and prevent further complications. The condition is characterized by auditory hallucinations that occur while the person is alert and oriented, typically beginning within 48 hours after reducing or stopping heavy alcohol consumption and can persist for days or weeks 1. Unlike delirium tremens, patients with alcoholic hallucinosis maintain clear consciousness and don't experience significant confusion or vital sign abnormalities.
Symptoms and Diagnosis
The symptoms of alcoholic hallucinosis include:
- Auditory hallucinations
- Clear consciousness
- No significant confusion or vital sign abnormalities
- Onset typically within 48 hours after reducing or stopping heavy alcohol consumption
Treatment Options
Treatment involves:
- Benzodiazepines, such as lorazepam (1-2mg every 4-6 hours as needed) or diazepam (5-10mg every 4-6 hours as needed), to manage symptoms during acute presentation 1
- Antipsychotics, like haloperidol, may be added if hallucinations persist, but should be used carefully as adjunctive therapy only in cases of agitation or psychotic symptoms that are not controlled by benzodiazepine 1
- Complete alcohol abstinence is essential for long-term management, typically requiring enrollment in a structured alcohol rehabilitation program and possibly maintenance medications like naltrexone or acamprosate
- Thiamine should be given to prevent Wernicke's encephalopathy, especially in malnourished patients or those with suspected Wernicke's encephalopathy 1
Management and Prevention
Patients at risk of severe withdrawal, or who have concurrent serious physical or psychiatric disorders, or who lack adequate support, should preferably be managed in an inpatient setting 1. As part of withdrawal management, all patients should be given oral thiamine, and those at high risk should be given parental thiamine 1. Benzodiazepines should be used to treat alcohol withdrawal syndrome, and psychiatric consultation is recommended for the evaluation, treatment, and long-term planning of alcohol abstinence 1.
From the FDA Drug Label
In acute alcohol withdrawal, diazepam may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinosis The symptoms of Alcoholic Hallucinosis include agitation, tremor, delirium tremens, and hallucinosis. The treatment option for Alcoholic Hallucinosis is diazepam, which may be useful in the symptomatic relief of these symptoms 2.
From the Research
Symptoms of Alcoholic Hallucinosis
- Auditory hallucinations are the most common type, found in 75.4% of patients 3
- Visual hallucinations are less common, found in 5% of patients, while 19.7% experience both auditory and visual hallucinations 3
- Delusions are present in 55.7% of patients, usually secondary to hallucinations 3
- Suicidality, including suicidal ideas and attempts, is noted in 19.7% of patients 3
- Hallucinations typically occur during alcohol withdrawal, but can also occur while consuming alcohol in 13.1% of patients 3
Treatment Options for Alcoholic Hallucinosis
- Benzodiazepines are the primary mode of management, used in 60.7% of patients, either alone or in combination with antipsychotics 3
- Antipsychotics may be required in selected cases, particularly for patients with florid psychotic symptoms or incomplete symptom resolution with benzodiazepines 3
- Diazepam is a suitable agent for treating severe alcohol withdrawal and hallucinosis, with a rapid onset of action and a self-tapering effect 4, 5
- High-dose diazepam (260-480 mg/day) may be required in some patients to relieve symptoms of delirium tremens 4
- Haloperidol may be used to treat hallucinations in patients with alcohol hallucinosis, with partial recovery reported in some cases 6