eMedicine Specialties > Psychiatry > Addiction

Alcohol-Related Psychosis: Differential Diagnoses & Workup

Author: Michael Larson, DO, Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard University
Contributor Information and Disclosures

Updated: Oct 9, 2008

Differential Diagnoses

Cannabis Compound Abuse
Hallucinogens
Cocaine-Related Psychiatric Disorders
Schizophrenia
Delirium
Stimulants
Delirium Tremens
Wernicke-Korsakoff Syndrome

Workup

Laboratory Studies

  • The purpose of the workup is to eliminate other possible causes of psychosis, altered mental status, and medical complications. Laboratory evaluation should include the following:
    • Finger-stick blood glucose test for rapid determination of hypoglycemia or hyperglycemia in a patient with diabetes
    • Complete blood cell count to rule out blood dyscrasias, infection, and anemia
    • Electrolytes with magnesium, amylase, albumin, total protein, uric acid, BUN, alkaline phosphatase, and bilirubin
    • Urinalysis to determine the presence of a urinary tract infection and determine renal function
    • Stat urine or serum drug screen to determine if illicit drugs are contributing to psychosis and change in mental status
    • Stat urine or serum toxicology screen for levels of acetaminophen, tricyclic antidepressants, aspirin, and other potential toxins from either an accidental or deliberate overdose
    • Prothrombin time
    • Stool for occult blood
    • BAL measurement (although a patient may appear intoxicated, clinical intoxication can be determined only by BAL)

Imaging Studies

  • If a head injury is suspected, a CT scan is recommended to rule out a subdural hematoma.
  • In those with comorbid schizophrenia and alcoholism, MRIs have shown that the gray matter volume deficits in the prefrontal and anterior superior temporal regions is greater than in those with schizophrenia and alcoholism alone.

Other Tests

  • Some other tests that might be administered include a Brief Psychotic Rating Scale (BPRS), Beck Depression Scale, Violence and Suicide Assessment (VASA), and Mini-Mental State Examination. Other measures also might be useful.
  • If persistent psychosis is noted, neuropsychological testing to assess the level of psychosocial and neurological function can be beneficial for treatment and placement.
  • Projective testing, such as the Rorschach and the Thematic Apperception Test, can clarify a thought disorder.

More on Alcohol-Related Psychosis

Overview: Alcohol-Related Psychosis
Differential Diagnoses & Workup: Alcohol-Related Psychosis
Treatment & Medication: Alcohol-Related Psychosis
Follow-up: Alcohol-Related Psychosis
References
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References

  1. Reed T, Page WF, Viken RJ, Christian JC. Genetic predisposition to organ-specific endpoints of alcoholism. Alcohol Clin Exp Res. Dec 1996;20(9):1528-33. [Medline].

  2. Razvodovsky YE. Suicide and alcohol psychoses in Belarus 1970-2005. Crisis. 2007;28(2):61-6. [Medline].

  3. Soyka M. [Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy]. Nervenarzt. Nov 1996;67(11):891-5. [Medline].

  4. Kaplan HI, Sadock BJ, eds. Pocket Handbook of Emergency Psychiatric Medicine. Baltimore, Md: Lippincott Williams & Wilkins; 1993:93-4.

  5. Preuss UW, Soyka M. [Wernicke-Korsakow syndrome: clinical aspects, pathophysiology and therapeutic approaches]. Fortschr Neurol Psychiatr. Sep 1997;65(9):413-20. [Medline].

  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

  7. Fogel B, Schiffer R, Rao S. Neuropsychiatry. Baltimore, Md: Lippincott Williams & Wilkins; 1996:309-310, 336, 378, 685-7, 704.

  8. Galanter M, Kleber HD, eds. The American Psychiatric Press Textbook of Substance Abuse Treatment. 2nd ed. Washington, DC: American Psychiatric Press; 1999:7-8,155, 283-5.

  9. Guze BH, Ferng H, Szuba MP, Richeimer SH. The Psychiatric Drug Handbook. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1995:14-15, 178-9, 222 -5.

  10. Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, et al. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA. Oct 10 2007;298(14):1641-51. [Medline].

  11. Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995:784-5, 792-5, 1046, 1053.

  12. Krausz M, Mass R, Haasen C, Gross J. Psychopathology in patients with schizophrenia and substance abuse: a comparative clinical study. Psychopathology. 1996;29(2):95-103. [Medline].

  13. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. Jul 9 1997;278(2):144-51. [Medline].

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Further Reading

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Keywords

alcoholic psychosis, alcohol psychosis, alcohol withdrawal, Wernicke-Korsakoff syndrome, Korsakoff psychosis, thiamine deficiency, hallucinations, alcohol idiosyncratic intoxication, Alcoholics Anonymous, AA

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Contributor Information and Disclosures

Author

Michael Larson, DO, Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard University
Michael Larson, DO is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Jennifer S Morse, MD, Assistant Clinical Professor, Department of Psychiatry, University of California at San Diego
Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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