Alcoholic Psychoses

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Related to Alcoholic Psychoses: schizophrenia, alcoholic paranoia

Alcoholic Psychoses


a group of mental diseases produced by chronic alcoholism and exhibiting both acute and chronic forms. The most frequent acute form of alcoholic psychosis is delirium tremens. It usually lasts from three to seven days, but medical intervention may reduce the duration. For two to three days before the onset of delirium tremens a person experiences general restlessness, unaccountable fears, and sleep impairment. Then come hallucinations, primarily visual in nature, which are characterized by vividness and often frightening content (horrible people, animals and insects, bloody scenes, shots, threats, and so on). Under the influence of the hallucinations the sick person may, for the purpose of “self-defense,” do things that at times constitute a real hazard to himself and those about him. In some cases delirium tremens may end in death from heart failure.

Alcoholic hallucinosis takes an acute or chronic course. First come auditory hallucinations—noise, shouting, and voices commonly condemning the conduct of the sick person or uttering threats against him. As this takes place, the sick person retains a clear consciousness but lacks all critical judgment in regard to the hallucinations. He is at the mercy of the “voices” and displays ill regard toward those about him, who, it seems to him, want to kill or humiliate him or subject him to undeserved punishment (delusion of persecution, delusion of relations); he becomes dangerous to himself and those about him. Similar delirious thoughts which coalesce into a system and remain unyielding may spring up apart from hallucinations. Such a form of alcoholic psychosis, alcoholic paranoia, is encountered relatively infrequently and is usually characterized by slow progression. The most characteristic of the chronic alcoholic psychoses is the alcoholic obsession of jealousy—a groundless, absurd, unyielding jealousy. The sufferer may do things that hold danger for the person he suspects.

A special form of alcoholic psychosis resulting from alcoholic affection of the brain—that is, from alcoholic encephalopathy (alcoholic polyneuritic psychosis)—was described in 1887 by S. S. Korsakov and was named Korsakov’s psychosis. Its most characteristic symptom is gross dysmnesia, primarily in regard to current and recent events. The sick person does not remember what happened today, cannot tell whether he has eaten dinner, forgets the content of what he has just read, and so on, and often fills in the gaps in his memory with false recollections. This condition is accompanied by apathy, lack of initiative, and pain along the nerve trunks (polyneuritis). Sometimes alcoholism gives rise to a peculiar form of illness, dipsomania. The sick drink only during fits of the disease, and in the intervals between the fits they experience no desire for alcoholic beverages or even manifest an aversion for them. In typical cases the fits are preceded by melancholy, irritability, unaccountable anxiety, and physical malaise. Sometimes the sick person resorts to wine for the purpose of relieving his oppressive feeling, but more often he does so under the influence of an irresistible pull that he vainly attempts to fight off. Once he has begun to drink wine, he drinks without restraint, abandons his job, and locks himself up at home or wanders about aimlessly. He forgets his duties and his former promises not to drink and is ready to do anything to get wine. Toward the end of his drinking bout the sick person experiences general weakness, difficulty in sleeping, trembling, and hallucinations. The intervals during which he has no craving for alcohol may sometimes last a year or more.

A distinction must be drawn between alcoholic psychoses and brief (up to several hours long) disturbances of mental activity—pathologic intoxication. This state may appear even in people who do not suffer from chronic alcoholism after they take alcohol (more often in small amounts). In case of severe clouding of consciousness some sufferers display a blind, senselessly aggressive, unruly agitation, while the behavior of others is determined by distorted perception of their surroundings or by delirium. Upon coming out of this state the sick person has no recollection of what has happened. Unlike plain drunkenness, which does not free a person of the responsibility for his acts, pathologic intoxication, while not belonging to the alcoholic psychoses, is placed on the same footing in decisions concerning legal responsibility.

Alcoholic psychoses are treated in hospital conditions. Psychotropic means are used in all cases that are characterized by hallucinations and delirium; cases involving Korsakov’s psychosis are given vitamin therapy (B complex).


Zhislin, S. G. Ob alkogol’nykh rasstroistvakh. Voronezh, 1935.
Strel’chuk, I. V. Khronicheskie alkogol’nye galliutsinozy. Moscow, 1947.
Strel’chuk, I. V. Klinika i lechenie narkomanii, [3rd ed.]. Moscow, 1956.