It appears more often at the remote stage of chronic alcoholism (with a duration of 10 years or more), that is, in the II-III stage. It occurs mainly against the background of withdrawal symptoms. In the clinical picture, true verbal hallucinations predominate, initially appearing in the evening and at night, as well as the associated delusions of persecution, anxiety and fear, protective behavior with aggressive and suicidal actions. At the height of the disease, there is a slight confusion, separate visual and tactile hallucinations. Verbal hallucinations are separate or multiple “voices”, mostly of familiar people, speaking among themselves or addressing the patient directly, who scold him, condemn, accuse, threaten, discuss his past actions, especially related to drunkenness and immoral acts. With the intensification of hallucinations (evening and night), anxiety, fear, agitation with a lack of criticism are noted. During the day, with a decrease in the intensity of hallucinatory experiences, the attitude towards them is semi-critical or critical. The duration of the disease is from several days to a month, the way out of this condition is gradual.
N. G. Shumsky distinguishes the following variants of acute alcoholic hallucinosis: 1) acute hypnagogic verbal hallucinosis (auditory hallucinations appear only when falling asleep); 2) acute abortive hallucinosis (auditory elementary and individual verbal hallucinations, anxiety, fear, duration – up to 1 day); 3) acute hallucinosis with severe delirium (verbal hallucinations of threatening content, delusions of persecution, fear); 4) acute hallucinosis, combined with delirium (visual join to verbal hallucinations at the height of psychosis); 5) acute hallucinosis with oneroid stupefaction (a similar change in consciousness, double orientation or disorientation in the environment, verbal hallucinations, the experience of fragmentary fantastic scenes, figurative nonsense with an illusory perception of the environment); 6) acute hallucinosis with mental automatisms (a sense of openness, the violent occurrence of thoughts, exposure using apparatuses, auditory pseudo-hallucinations); 7) acute hallucinosis, accompanied by depression; 8) protracted hallucinosis lasting from 1 to 6 months (accompanied by depression, delusions of self-accusation, harassment). Acute alcoholic hallucinosis can be accompanied by delirious and oneiric episodes, symptoms of mental automatism, pseudo-hallucinations, delusional ideas of exposure, depressive or vyforic mood background. These psychopathological manifestations are usually fragmented and transient.
Verbal hallucinosis syndrome remains “through”. Acute alcoholic paranoid. It usually occurs against the background of withdrawal symptoms, but there are cases of its occurrence with continued use of alcoholic beverages. It is characteristic, especially at the beginning, of a change in consciousness with an illusory perception and delusional understanding of the environment. Acute alcoholic paranoid is often observed in people who are on a long journey, in an unfamiliar environment. Fear covers the patient, a sharp figurative delirium of attitude and persecution arises, as a result of which he commits aggressive acts, strives to flee. After exiting psychosis, residual delirium is often observed. In atypical variants of acute alcoholic paranoid delirious and oneiric episodes, visual and other true hallucinations and pseudo-hallucinations, symptoms of mental automatism, delusions of physical and mental effects, which usually have significant imagery, brightness, concreteness, are noted. They are usually fragmented, transient and not prone to systematization. Therefore, acute alcoholic psychoses are characterized by a varying degree of psychotic change in consciousness with the presence and prevalence of vivid true visual or verbal hallucinations, figurative delirium. The more acute the disease, the more pronounced impaired consciousness. In connection with the pathomorphism of the clinical picture of psychoses, they increasingly acquire the character of acute hallucinatory-paranoid psychosis.