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Alcoholic Hallucinosis — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAlcoholic HallucinosisMRCPsych Paper B

A 45-year-old woman with alcohol dependence stopped drinking 24 hours ago after a prolonged period of heavy alcohol use. She reports vivid voices commenting on her behaviour. She is alert, fully oriented and able to sustain attention. Her observations are normal, with no tremor or autonomic hyperactivity. There is no previous psychotic disorder, prominent memory impairment, ataxia or abnormality of eye movements. Which is the most likely diagnosis?

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Correct answer: C — Alcohol-induced psychotic disorder (alcoholic hallucinosis)

The diagnosis is alcohol-induced psychotic disorder, traditionally termed alcoholic hallucinosis. The key features are prominent auditory hallucinations arising in close temporal association with heavy alcohol use or its cessation, while orientation, attention and consciousness remain intact. Delirium tremens is unlikely because it causes delirium with disorientation, impaired attention and usually marked tremor or autonomic hyperactivity. Wernicke encephalopathy is associated with confusion, ataxia and eye-movement abnormalities rather than isolated auditory hallucinations. Korsakoff syndrome produces disproportionate anterograde amnesia, sometimes with confabulation. Commenting voices can occur in schizophrenia-spectrum disorders, but the close relationship to alcohol use, absence of prior psychosis and preserved thought form make an alcohol-induced disorder more likely.

Reference: Royal College of Psychiatrists. Alcohol, mental health and the brain: sections on delirium tremens and alcoholic hallucinosis. 2024. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/alcohol-mental-health-and-the-brain?searchTerms=Special+Week