Alcohol-Related Psychosis Follow-up

Updated: Dec 03, 2015
  • Author: Zhongshu Yang, MD, PhD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK)  more...
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Follow-up

Further Outpatient Care

A day treatment program or partial hospitalization can be used for those who do not require a highly structured inpatient environment. Daily individual, group, and weekly family therapy provide intensive treatment that is similar to inpatient settings. Programs specifically designed for substance abuse also provide daily substance abuse meetings and education. Medication evaluations and monitoring assure stabilization in the least restrictive environment.

Institute a psychiatric follow-up visit within 2 weeks of the initial evaluation to assure compliance.

Consider a follow-up examination with a neurologist or internal medicine specialist, depending on the complications of alcohol abuse.

Carefully monitor patients for recurring psychosis, depression, and relapse of alcohol use.

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Further Inpatient Care

Admit for observation if further withdrawal, cognitive impairment, psychosis, and medical complications occur.

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Inpatient & Outpatient Medications

If the psychosis has resolved and the patient is medically stable, no further medication is needed.

If psychosis persists beyond elimination of the offending substance, an atypical antipsychotic drug (eg, risperidone, olanzapine, quetiapine) may be considered. No single atypical antipsychotic drug has been proven most beneficial for treatment of persistent alcohol-related psychosis.

Once thiamine levels have been restored, daily multivitamins are recommended to maintain appropriate levels of essential vitamins that often are depleted in patients with alcoholism.

Disulfiram (Antabuse) is an agent indicated to facilitate abstinence from alcohol. This can be started 12 hours after a patient consumes alcohol (125-500 mg/d).

Continue thiamine (100 mg PO tid).

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Transfer

If psychosis persists past initial treatment, the patient may be suffering from an undiagnosed psychotic disorder, such as schizophrenia or bipolar affective disorder. Inpatient psychiatric hospitalization may be required for diagnosis and psychopharmacological treatment.

If a risk of delirium tremens or suicide is present, transferring the patient to a psychiatric inpatient unit might be required.

A day treatment program or partial hospitalization can be used for those who do not require a highly structured inpatient environment. Daily individual, group, and weekly family therapy is provided. Programs specifically designed for substance abuse also provide daily substance abuse meetings and education. Medication evaluations and monitoring assure stabilization in the least restrictive environment.

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Deterrence/Prevention

Prevention is a result of abstinence and is the primary treatment of choice. Some patients may achieve success by attending 90 AA meetings in 90 days.

A sponsor (a recovering alcoholic committed to sobriety) helps provide a support network for attending meetings and seeking community resources.

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Complications

Theoretically, alcohol may potentiate or initiate a psychotic disorder, such as schizophrenia, through kindling, a process where repetitive neurological insult results in greater expression of disease.

In some instances, psychosis may persist and may be considered by DSM-V criteria as a substance-induced psychotic disorder.

Other complications may include increased risks for suicide, depression, and/or psychosocial impairment.

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Prognosis

Alcohol-related psychosis is indicative of severe alcohol abuse and suggests a poor prognosis. The prognosis is similar to that of severe alcoholism.

Of all psychosis cases, 10-20% tend to become permanent.

Symptoms of any accompanying Korsakoff syndrome (amnestic disorder) are highly resistant to treatment because of the irreversible neurological damage.

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Patient Education

Refer the patient to AA, Smart Recovery, Rational Recovery, or other appropriate self-help group.

Refer the patient for psychosocial counseling.

Instruct the patient to abstain from the use of alcohol and illicit drugs.

Refer the patient's family to Al-Anon/Alateen and family therapy.

For excellent patient education resources, visit eMedicineHealth's Mental Health Center. Also, see eMedicineHealth's patient education articles Alcoholism, Alcohol Intoxication, and Substance Abuse.

The following Web sites are also useful:

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