A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behaviour and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. He is most likely to be suffering from?
The patient in the question is a chronic alcoholic who has not taken alcohol since 2 days. His symptoms and findings on physical examination are most suggestive of delerium tremens. Delirium tremens is the most severe alcohol withdrawal syndrome. It typically appears after 3-4 days of abstinence from alcohol (24 hours to 7 days). Features of delirium tremens includes: presence of visual hallucinations, loss of orientation as to time and place, tremors and agitation, excess motor activity and features of autonomic nervous system hyperactivity. Ref: Current Diagnosis and Treatment Emergency Medicine, 7th edition, Chapter 37; Current Diagnosis and Treatment: Psychiatry, 2nd edition, Chapter 14
Delirium tremens
Alcoholic hallucinosis
Korsakoff's psychosis
Wernicke encephalopathy