A 44-year-old man admitted for alcohol detoxification, 24 hours after his last drink, reports hearing two male voices calling him a coward and telling him to harm himself. He is fully oriented, attentive, and converses coherently. Pulse is 92/min, blood pressure 130/84 mmHg, and there is no tremor or diaphoresis. The most likely diagnosis is:

• A Delirium tremens
• B Alcohol hallucinosis ✓
• C Wernicke encephalopathy
• D Schizophreniform disorder

Explanation

Alcohol hallucinosis occurs 12 to 48 hours after cessation in chronic drinkers and consists of persistent auditory hallucinations, often threatening or accusatory, in a patient with a clear sensorium and stable vitals. Delirium tremens requires clouded consciousness with autonomic instability, typically peaking at 72 hours. Wernicke encephalopathy presents with confusion, ataxia, and ophthalmoplegia. New-onset paranoid auditory hallucinations with clear consciousness shortly after stopping alcohol favour hallucinosis over a primary psychotic disorder.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.