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Lilliputian hallucinations concern hallucinated human, animal or fantasy entities of minute size. Having been famously described by the French psychiatrist Raoul Leroy in 1909, who wrote from personal experience, to date they are mentioned almost routinely in textbooks of psychiatry, albeit with little in-depth knowledge. I therefore systematically reviewed 145 case reports and case series comprising 226 case descriptions, concluding that lilliputian hallucinations are visual (61 %) or multimodal (39 %) in nature. In 97 % of the cases, they are perceived as grounded in the actual environment, thus indicating involvement of higher-level regions of the perceptual network subserving the fusion of sensory and hallucinatory content. Perceptual release and deafferentiation are the most likely underlying mechanisms. Etiology is extremely diverse, with schizophrenia spectrum disorder, alcohol use disorder and loss of vision accounting for 50 % of the cases and neurological disease for 36 %. Recovery was obtained in 62 % of the cases, whereas 18 % of the cases ended in chronicity and 8 % in death. Recommendations are made for clinical practice and future research.

Lilliputian hallucinations concern hallucinated human, animal or fantasy entities of minute size. Having been famously described by the French psychiatrist Raoul Leroy in 1909, who wrote from personal experience, to date they are mentioned almost routinely in textbooks of psychiatry, albeit with little in-depth knowledge. I therefore systematically reviewed 145 case reports and case series comprising 226 case descriptions, concluding that lilliputian hallucinations are visual (61 %) or multimodal (39 %) in nature. In 97 % of the cases, they are perceived as grounded in the actual environment, thus indicating involvement of higher-level regions of the perceptual network subserving the fusion of sensory and hallucinatory content. Perceptual release and deafferentiation are the most likely underlying mechanisms. Etiology is extremely diverse, with schizophrenia spectrum disorder, alcohol use disorder and loss of vision accounting for 50 % of the cases and neurological disease for 36 %. Recovery was obtained in 62 % of the cases, whereas 18 % of the cases ended in chronicity and 8 % in death. Recommendations are made for clinical practice and future research.

Delirium tremens is one of the most common complications of alcohol withdrawal. It is potentially lethal and therefore should be detected as early as possible and be monitored and treated intensively. The assessment of risk factors with the Luebeck Alcohol-Withdrawal Risk Scale short form (LARS-11) can help to predict the risk of severe withdrawal adequately. As delirium cannot be differentiated from Wernicke-Encephalopathy with sufficient certainty high parenteral doses of Vitamin B1 and Magnesium orally should be given in case of any severe withdrawal symptoms. According to guidelines delirium tremens should be treated with benzodiazepines besides adequate electrolyte and fluid substitution. Haloperidol is often additionally given to better control hallucinations. Delirium tremens usually subsides within 10 days of treatment. The article gives an overview of alcohol withdrawal with its different facets, its differential diagnoses, and the treatment options.

Little is known about the prevalence and in particular the outcome of alcohol-induced psychotic disorder (AIPD). Data from hospital statistics of the BARMER GEK, one of the major health insurance companies in Germany, show a low overall prevalence of AIPD. An analysis of readmission rates for patients hospitalized for AIPD in 2005 (N = 462) and 2006 (N = 404) for the period up to 2010 revealed very high readmission rates. Only a minority of patients were without relapse [144 (31.2 %) of the 2005 sample; 152 (37.6 %) of the 2006 sample]. Thus, AIPD appears to be a rare complication of the alcohol use disorder but to have an extremely high rehospitalization rate, probably indicating a more chronic course and worse prognosis than previously thought. More follow-up studies are needed to elucidate this syndrome.

ZusammenfassungBei der Alkoholhalluzinose (psychotische Störung durch Alkohol) handelt es sich um ein relativ seltenes Krankheitsbild, das durch die Leitsymptome (akustische) Halluzinationen, Angst und gegebenenfalls Verfolgungswahn bei fehlenden Bewusstseins- und Orientierungsstörungen gekennzeichnet ist. Die wichtigste Differenzialdiagnose ist die Schizophrenie, aber auch das Alkoholdelir sowie drogeninduzierte Psychosen. Die Prognose ist in den meisten Fällen gut, zur Akuttherapie werden Neuroleptika eingesetzt.Selten sind paranoide Störungen, speziell der alkoholische Eifersuchtswahn, der manchmal als Residuum einer chronischen Alkoholhalluzinose persistiert und monosymptomatisch bleibt. Gefürchtet sind die resultierenden Gewaltdelikte. Die Therapie ist meist schwierig, Neuroleptika nur begrenzt wirksam.

We report findings obtained with positron emission tomography with fluorodeoxyglucose-F18 (FDG PET) as tracer in two patients with acute alcohol hallucinosis. In line with previous findings, both patients had a significant hypometabolism in the left relative to the right thalamus. When the second patient was retested after clinical recovery, FDG PET findings were normalized, suggesting the probable thalamic dysfunction to be a functional rather than a structural abnormality.

OBJECTIVE Palinacousis seems to be a rare phenomenon in mental disorders. METHODS In this paper, we report on a subject with alcohol hallucinosis who displayed one episode with palinacousis after remission from the typical acoustic hallucinations according to the disorder. DISCUSSION The theoretical background and the relevance of this observation are discussed.

Summary: Alcohol hallucinosis is a rare complication of chronic alcoholism with schizophreniform symptomatology. The pathophysiology is basically unclear. We report the case of a 48-year-old, never-medicated, long-term alcoholic suffering from alcohol hallucinosis with pure acoustic hallucinations for at least six months. Current FDG PET data suggest a hypofrontality and possibly a thalamic hypofunction in alcohol hallucinosis, findings similar to those reported in unme-dicated schizophrenics. Current IBZM SPECT data do not support a dopamine receptor dysfunction in alcohol hallucinosis but TRODAT SPECT showed reduced dopamine transporter binding. Possible implications of these findings are discussed.

The psychotic manifestations of alcohol physical and psychiatric disorders have been documented for many centuries; however, the distinction of the various disorders remains less well defined. Individuals often have comorbid elements of several disorders, and the psychotic phenomenon are often diverse. The psychotic manifestations of alcohol withdrawal, delirium tremens, alcohol hallucinosis, Wernicke’s-Korsakoff’s psychosis, alcohol pellagra and hepatic encephalopathy, Marchiafava-Bignami, central pontine myelinosis, and alcohol dementia are discussed in this article.

We read with interest and sympathy the recent paper of Aliyev and Aliyev (2008) reporting results of a double-blind placebo-controlled study in 40 patients with acute alcohol hallucinosis indicating valproate to be effective in reducing verbal hallucinations. This is the first placebo-controlled study in this rare disorder, a widely neglected subject of research. The pathophysiology of alcohol hallucinosis is not clear (Soyka, 1995; Soyka et al ., 2000a). There is no evidence for a common genetic basis for alcohol psychosis and schizophrenia (Glass, 1989a). An impaired dopaminergic neurotransmission and hyperdopaminergic state has not been shown in alcohol hallucinosis (Soyka et al. 2000b). Recent PET findings indicate a hypofunction of the thalamus …

Alcohol hallucinosis is a rare complication of chronic alcoholism. The key symptoms are vivid, acoustic hallucinations following the reduction or cessation of drinking within 48 hours, mostly combi...

SIR: Alcohol hallucinosis is a psychiatric condition characterized by auditory hallucinations, without consciousness disturbance, following drinking or cessation of alcohol. Although it is an important clinical issue in the management of alcohol dependence, the neuropsychiatric background of alcohol hallucinosis remains unknown. We report a case of alcohol hallucinosis in which we examined the neuropsychiatric background of the condition using Nisopropyl-p- 123 I iodoamphetamine ( 123 I-IMP) single photon emission

The following neuropsychiatric disorders have been briefly described: alcohol withdrawal syndrome, delirium tremens, alcohol hallucinosis, Wernicke-Korsakow syndrome, seizures, tremor, Marchiafava-Bignami disease, central pontine myelinol·ysis, alcoholic ambl·yopia, alcoholic cerebellar degeneration, cerebral atrophy, alterations of personality in chronic alcoholics, alcoholic polyneuropathy. The pathogenetical aspects as well as the pathological findings have been reviewed with special emphasis on nutritional factors.