An alcoholic is brought to the Emergency OPD with the complaint or irrelevant talking. He had stopped using alcohol three days back. On examination, he is found to be disoriented to time, place and person. He also has visual illusions and hallucinations. There is no history of head injury. Most likely diagnosis is:
B i.e. Delirium tremens- Delirium tremens (most severe alcohol withdrawl syndrome) develops within 1 week (usually 3-4 days) of complete or significant abstinence from heavy & prolonged drinking. It is characterized by features of delirium (i.e. clouding of consciousness, confusion, disorientation, memory deficit & language disturbance) and of alcohol withdrawl (i.e.autonomic hyperactivity such as MP/PR/sweating, tremors, psychomotor agitation, ataxia,insomnia, anxiety, tactile or visual hallucinations and seizures)In delirium tremens, there is anxiety (not depression), insomnia (not drowsiness or hypersomnia). This is true for almost all withdrawl syndromes. Delusion when present are secondary interpretations of hallucination.- Agitated, confusion associated with tactile or visual hallucinations indicate the diagnosis of alcohol withdrawl delirium tremens. Presence of autonomic hyperactivity such as tachycardia, fever, diaphoresis, anxiety, insomnia; fluctuating levels of psychomotor activity ranging from hyperexcitability to lethargy; and perceptual distoions most frequently visual or tactile hallucinations within a week of alcohol withdrawl confirm the diagnosis of DTs.
Demetia praecox
Delirium tremens
Schizophrenia
Korsakoff's psychosis