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In Sri Lanka WHO estimates 3.1% of the population to have alcohol used disorder and predicts that nearly 50% of them can present with alcohol withdrawal syndrome.
We describe a 51 year old male with the back ground history of alcohol abuse for 20 years duration and series of adverse life events facilitating him to develop severe alcohol used disorder and depression. When he presented to us, he exhibited features of major depression with suicidal thoughts and evidence of alcohol withdrawal syndrome according to DSM V criteria. He also had minor cognitive impairment according to MMSE.
After two months of inward treatments, he continued to have disturbing Lilliputian hallucinations, tremors and sleep disturbances which made us to diagnose him having protracted alcohol withdrawal syndrome after considering the other possibilities like major depression with psychotic symptoms, lewy body dementia and psychotic disorder with mood symptoms. His cognitive impairment can be explained by reduced attention and concentration together with low literacy, therefore the diagnosis of pseudo dementia secondary to depression was made.
This case illustrated us the multi-faceted presentations of alcohol used disorder which ultimately posing significant burden to the patient, family, society and also to the free health care system in the country.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
Center for Substance Abuse Treatment. Protracted Withdrawal. Substance Abuse Treatment Advisory. 2010;9(1).
Bonnet U, Specka M, Abedi RH, Wiltfang J, Scherbaum N. Severe protracted alcohol withdrawal syndrome: Prevalence and pharmacological treatment at an inpatient detoxification unit – A naturalistic study. Pharmacopsychiatry. 2009;42(2):76-78.
Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: Review and summary of findings. Soc Psychiatry Psychiatr Epidemiol. 2015; 50(11):1609–1640.
Kuria MW, Ndetei DM, Obot IS, et al. The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence. ISRN Psychiatry. 2012;Article ID 482802:6.
Brown SA, Schuckit MA. Changes in depression among abstinent alcoholics. Journal of Studies on Alcohol. 1988;49(5): 412–417.
He S, Brooks AT, Kampman KM, hakravorty S. The relationship between alcohol craving and insomnia symptoms in alcohol-dependent individuals. Alcohol Alcohol. 2019;54(3):287–294.
Shah SM, Carey IM, Harris T, Dewilde S, Victor CR, et al. The effect of unexpected bereavement on mortality in older couples. Am J Public Health. 2013;103:1140–1145.
Tamers SL, Okechukwu C, Bohl AA, Guéguen A, Goldberg M, Zins M. The impact of stressful life events on excessive alcohol consumption in the french population: Findings from the GAZEL cohort study. PLoS ONE. 2015;9(1): e87653.
Weil ZM, Corrigan JD, Karelina K. Alcohol use disorder and traumatic brain injury. Alcohol Res. 2018;39(2):171–180.
Ffytche DH. Visual hallucinatory syndromes: Past, present, and future. Dialogues Clin Neurosci. 2007;9(2):173–189.
Grover S, Kattharaghatta Girigowda V, Kumar V. Lilliputian hallucinations in Schizophrenia: A case report. Afr J Psychiatry. 2012;15:311-313.
Jesse S, Bråthen G, Ferrara M, et al. Alcohol withdrawal syndrome: mechanisms, manifestations and management. Acta Neurologica Scandinavica. 2017;135(1):4-16.
Krystal JH, Petrakis IL, Mason G. et al. N-Methyl-D-aspartate glutamate receptors and alcoholism: reward, dependence, treatment, and vulnerability. Pharmacol Ther. 2003; 99:79-94.
Eyer F, Schreckenberg M, Hecht D, et al. Carbamazepine and valproate as adjuncts in the treatment of alcohol withdrawal syndrome: A Retrospective cohort study. Alcohol and Alcoholism. 2011;46(2):177–184.
Malcolm R, Myrick H, Roberts J, Wang W, Anton RF, Ballenger JC. The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial. J Gen Intern Med. 2002;17(5):349- 55.
Malcolm R, Myrick H, Brady KT, Ballenger JC. Update on anticonvulsants for the treatment of alcohol withdrawal. Am J Addict. 2001;10(s1):s16-s23.
Le Bon O, Murphy JR, Staner L, et al. Double-blind, placebo-controlled study of the efficacy of trazodone in alcohol post-withdrawal syndrome: Polysomnographic and clinical evaluations. J Clin Psychopharmacol. 2003;23(4):377–83.