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Editorial.
“How is the differential diagnosis made between (a) acute alcohol poisoining, (b) acute lysergide poisoning and (c) acute schizophrenia when there is no history of any previous illness and a patient presents with symptoms of hallucinosis and amnesia?”.
Brit. med. J.. 1980 May;280:1224.
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Abstract
How is the differential diagnosis made between (a) acute alcoholic poisoning, (b) acute lysergide poisoning, and (c) acute schizophrenia when there is no history of any previous illness and a patient presents with symptoms of hallucinosis and amnesia? The physician must obtain a complete history of the events leading up to the acute illness from the patient after recovery from the acute stages and from those who were with the patient at the onset of the illness. The diagnosis will depend very much on this history. Such conditions as delirium tremens or barbiturate-withdrawal psychosis are more likely to be the cause if the patient drank extremely heavily or took large amounts of barbiturates in the period before admission. If there is no such history they may be instantly excluded. Psychoses due to such drugs as LSD, amphetamines, or phencyclidine may again be relatively excluded if there is a reliable history that the patient never takes illicitly obtained drugs and has definitely not taken LSD or any other such substance. (There have been rare cases of hallucinations due to the accidental ingestion of psilocybin mushrooms, but the history after the event will make this clear.) If there is no history of taking drugs or alcohol, nor of their sudden withdrawal, schizophrenia or a schizophrenic reaction must be considered a more likely diagnosis. Drugs and alcohol may be taken by those with other illnesses, and a patient who smells of alcohol may also have ingested amphetamines or hare a schizophrenic illness. If there is no history of previous schizophrenia it is unlikely that the symptoms of an acute illness of this type would have been due to the fortuitous onset of a sudden, severe schizophrenic illness in a case where drugs had been taken. Acute alcohol poisoning includes a progression from severe intoxication to coma and death. The history of ingestion of alcohol, the smell of alcohol on the breath, and blood alcohol concentrations will confirm if this is the cause. Urine analysis on admission to hospital may confirm suspicion of a drug-induced psychosis. However carefully the phenomenology, the continuing symptoms of the illness, and the mental state are examined it is unlikely that they will do much to clarify the differential diagnosis, which depends on an accurate history of the events leading up to, and the onset of, the illness. The history is all: if it cannot be obtained from the patient it must be obtained from others.
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