31st January 2024

Psychiatric disorders secondary to alcohol misuse

Background

Chronic alcohol use can both result in and coexist with several psychiatric disorders (termed ‘dual’ disorders), such as psychosis and mood disorders. Several factors can influence this, including extent of drinking behaviour, existing predisposition to developing psychiatric symptoms, when alcohol was last consumed and the effects of alcohol itself, e.g., disinhibition., and the socioeconomic consequences of chronic, heavy drinking, e.g., relationship issues.

Presentation

These disorders can present very similarly to their independent psychiatric counterparts, making accurate diagnosis and access to necessary treatment difficult. The DSM-IV states that psychiatric symptoms experienced by someone dependent on alcohol must be ongoing and prominent, directly attributable to the effects of alcohol itself and occur within 1 month of withdrawal/last intake of alcohol. However, it should not be solely attributable to signs of withdrawal or intoxication. Therefore, any comorbid presentation attributable to alcohol use would usually resolve or improve without intervention if abstinence was maintained, compared to independent psychiatric disorder presentations.

Diagnosis 

If these disorders arise as a direct result of alcohol misuse, once alcohol use is ceased, symptoms should begin to ease, alongside other measures such as relapse prevention. However, if these disorders have arisen independent from alcohol use, they will need to be assessed and managed as per NICE current guidelines, depending on the condition, alongside sobriety. It can be difficult to differentiate how independently these disorders can arise in a person with alcohol dependence, but where possible, it is important to try and determine this to ensure optimal management of the presentation.

Differential diagnosis

The table below summarises some of the psychiatric disorders that can develop due to/alongside heavy alcohol use:

Source: Adapted from: Shivani R, Goldsmith RJ, Anthenelli RM. Alcoholism and psychiatric disorders: Diagnostic challenges [Internet]. Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism; 2002 [cited 2022Dec3]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683829/

Management

As explained before, if these disorders have developed solely because of alcohol use, once the causative factor is removed, symptoms should improve and resolve. Encouragement and support with abstinence and preventing relapse will likely be required, and if symptoms do not improve, investigation into whether a primary psychiatric disorder exists would need to be explored and managed appropriately.

References

• Public Health England (2017) Better care for people with co-occurring mental health and alcohol/drug use conditions. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/625809/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf (Accessed: December 27, 2022).
• Shivani R, Goldsmith RJ, Anthenelli RM. Alcoholism and psychiatric disorders: Diagnostic challenges [Internet]. Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism; 2002 [cited 2022Dec3]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683829/
• Stringer S, Church L, Keynejad R, Hurn J. Psychiatry P.R.N.: Principles, reality, next steps. Oxford: Oxford University Press; 2020.