A 40-year-old man abstinent from alcohol for 36 hours reports hearing threatening voices commenting on his behaviour. He is fully oriented, attentive, and has no tremor, disorientation, or autonomic instability. Which statement about his condition is correct?

• A This condition always evolves into Korsakoff psychosis without treatment
• B This is early delirium tremens and will progress to clouded sensorium within hours
• C Auditory hallucinations with clear sensorium indicate primary schizophrenia unmasked by abstinence
• D This is alcoholic hallucinosis, which carries a better prognosis than delirium tremens ✓

Explanation

Alcoholic hallucinosis consists of vivid auditory hallucinations, often threatening or derogatory, arising within 12 to 48 hours of abstinence with a clear sensorium, in contrast to delirium tremens where hallucinations occur within global confusion and autonomic hyperactivity. Sensorium is the discriminating feature here. It usually resolves spontaneously though a minority become chronic, and it is not linked to thiamine deficiency or inevitable Korsakoff progression. Schizophrenia is diagnosed only when hallucinations persist well beyond the withdrawal period.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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