ABSTRACT | PDF
CASE CONFERENCE
Alcohol induced psychotic disorder, predominantly delusional
Arnab Bhattacharya
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital
Patient D. B., 48 years old Hindu married male working as a constable in police consulted in the Psychiatry Department with complaints of alcohol consumption for a period of 22 years (increased for three months), irritability towards people and household articles, threatening to harm himself and family, and suspecting that wife was being unfaithful to him and having some illicit relation with other men for the past months. There was history of tolerance, withdrawal features, neglect of alternate pleasure associated with his alcohol intake. Also his interpersonal relation were hampered, his hobbies were affected, his work output at office suffered, his role functioning at home deteriorated, his social and religious activities stopped, and his self care and hygiene showed decline. His biological functions also were affected especially his sleep and appetite were reduced. Past history revealed two bouts of malaria 15 years ago and patellar fracture two years ago. Family history revealed hypertension in his father. Physical examination showed healed operative scar over his right knee and two fingers enlarged, nontender hepatomegaly. Investigation showed grade one fatty liver and reduced serum albumin. Mental status examination revealed depressed mood, restricted range of affect, ideas of infidelity, intact memory, orientation, impaired judgement, precontemplation motivation and level one insight. He was admitted to psychiatry ward and begun on Inj Multivitamin, Tab Metadoxine 500 mg twice daily, Cap Ursodeoxycholic acid 450 mg daily, Tab Chlordiazepoxide 10 mg four tabs a day in tapering doses. On the above regimen he showed response in his irritability, suspiciousness, and anger to his wife and children, and his biological functions also improved. Diagnosis was mental and behavioural disorder due to use of alcohol, induced psychotic disorder, predominantly delusional (F 10.51).
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