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Wednesday, March 16, 2005

AIPG 2005 Psychiatry Delirium Tremens

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 behavior and tremulousness for having missed the alcohol drink since 2 days, Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgment and insight.
He is most likely to be suffering from:
1. Alcoholic hallucinosis.
2. Delirium tremens.
3. Wernicke encephalopathy.
4. Korsakoff's psychosis.
2. Delirium tremens.
A Short Textbook of Psychiatry by Ahuja 4 ed Page No 36
Delirium Tremens (DT) is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking in 5 % of the patients, as compared to acute tremulousness which occurs in 34 % of the patients. The course is short with recovery occurring within 3 - 7 days. This is an acute organic brain syndrome with the characteristic features of
a) Clouding of consciousness with disorientation in time and place
b) Poor attention span and distractibility
c) Visual and Auditory hallucinations and illusion which are often vivid and frightening. Tactile hallucinations of insects crawling over body may occur
d) Marked autonomic disturbance with tachycardia, fever, sweating, hypertension and pupillary dilation.
e) Psychomotor agitation and ataxia
f) Insomnia, with a reversal of sleep - wake pattern.
g) Dehydration with electrolyte imbalance
1. Alcoholic hallucinosis when the patient has consumed alcohol.
2. Delirium tremens is classically seen when a patient who has history of consuming alcohol habitually has missed his drink for 2 to 4 days.
3. Wernicke encephalopathy is an effect of Drinking alcohol.
4. Korsakoff's psychosis is an effect of Drinking alcohol
This question is easier to answer as choices 1,3,4 are concerned with Alcoholic Intoxication
This question and the next one given here forms an example of the “theme couple” that you so often see in All India and AIIMS question

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