A 38-year-old man with a history of alcohol dependence (alcohol consumption started at the age of 6 years) was admitted to our unit for generalized tremor; sweating; agitation; auditory, visual, and kinesthetic hallucinations; thought-broadcasting; and persecutory delusion. He was medicated with diazepam, 20 mg, and thiamine, 200 mg. Agitation and the vegetative symptoms gradually subsided within 48 hours. Lab work showed no significant changes, and EEG and ECG were normal. A brain MRI showed generalized cortical atrophy. Seven days after the admission, we prescribed olanzapine 10 mg because the psychotic symptoms had persisted. There was a gradual improvement, and, 26 days after admission, the patient was discharged home asymptomatic. Two months later he was admitted to a medical unit for a grand mal seizure after a 48-hour period of abstinence. After medical stabilization, psychiatric evaluation elicited the same previous psychotic symptoms. Olanzapine, 10 mg, was again prescribed, with symptomatic improvement. A neuropsychological study, requested during follow-up because of his cognitive impairment, revealed a severe frontotemporal cognitive defect.
During the year before the admission, the patient presented with auditory and kinesthetic hallucinations, thought-broadcasting, and persecutory delusions. Also, he had continued drinking large amounts of alcohol daily during this period.