Alcohol induced Psychosis?

[Smithy92]

Good evening, unfortunately another unpleasant one. Looking for info if anyone else has encountered anything similar. In update, dad's still getting iller and iller. Having more occasions where he now doesn't eat for days on end, more falls through being more drunk and weaker due to not eating.
He is now back to laying in bed all day every day and not having the energy / want to do anything other than lay and drink. He is however waking up on multiple mornings / late evenings and can be heard shouting "No, No!". My question is, has anyone had any interactions with someone with alcohol induced Psychosis (i.e. hallucinations) or could he simply be shouting at himself to try to stop himself from going to drink (or is that a stupid assumption?).
Thanks all

Is he having any sort of care from palliative team? You don't need to be days away from death to access it.
He is probably suffering from hepatic encephalopathy which can manifest lots of different ways but generally in aggressive/irritable outbursts which the person has no memory of.

Nothing as of yet for that. He's not yet confirmed with Hepatitis or Cirrhosis (somehow) so we're all confused how he isn't and how long it will be before it gets there (we don't think long now).
I've asked my mum to check with his GP for exactly that (HE) next time he goes as he is definitely aggressive / irritable and his emotions swing so so fast.
I'm just not sure now if he's getting Psychosis too. When he stops drinking for a week or so previously, he goes back to almost normal brain wise which is why I'm struggling to understand whether it's all just drink.

I have no experience of psychosis, I'm sorry. Is he under any sort of specialist? Has he been assessed in hospital? Sounds alot for you to have to deal with.

@Nothingsfine He's regularly visiting a psychologist and was previously assessed in hospital for mental health issues but both so far are giving no results (he knows how to play on his normal side despite being drunk. Unfortunately hes Left with the option of rehab for a second time or that's it. All other help he has previously had and has failed unfortunately.

But only recently has he had these shouting episodes where he's either fighting himself or hallucinations.

Hi OP, I have experience of hallucinations (DTs) from my past as an active alcoholic, but they were always in relation to withdrawal. They were without doubt the most frightening experiences of my life and I am sure that I shouted at the (it was usually) ghosts who I believed were trying to kill me. This doesn't happen to all alcoholics when they stop drinking - even in AA many were able to stop drinking with just shakes and sweats etc, and far higher quantities than I was on. The danger time for me was 24 to 36 hours after the last drink, and had to be managed with diazepam to offset seizures. I'm not sure if this is in any way similar to what your father is experiencing. I always advise people in AA to decrease quantities of alcohol steadily and slowly.

Have a read around wernickes Korsakoff’s syndrome . He may need medical attention sooner than a routine GP appointment

A family member of mine has suffered with alcohol induced psychosis but they were highly agitated, aggressive , paranoid and were seeing and hearing things. So my experience is totally different to what your father is experiencing.

@HuntingoftheSnark thanks for the help, he's trying to reduce his amounts so may be linked (he's dropped from 70cl vodka daily to 20cl vodka daily as he's trying to avoid rehab again). May be linked to some sort of withdrawal.

@Adm1010 thanks I'll have a read this evening, I've read roughly around HE which I think is part of Wet Brain from memory but haven't read up about it in detail enough really.

@romdowa thanks, aside from seeing / hearing things (that we know of) other symptoms are identical to what you've said. He's clearly talking to someone, I just wish we could find out if it was himself or something else.

@Smithy92 is the reducing being done under medical advice? It really is so dangerous to decrease too quickly and even doctors often don't understand this. The first time I decided to stop drinking, years and years ago, I did exactly that and stopped. The first night was ok but the next, I was awake all night and ghosts were flying in my window and conspiring against me. In the morning, everything electrical was talking to me, I believed that a monitoring device had been implanted in my ear and tried to dig it out with tweezers. I removed all light bulbs as they were giving me electric shocks. I was obviously completely sober - went to work and the voices kept up a constant stream of conversation in my head, and in addition there were groups of women singing outside the window (there was nobody there). Boxes seemed to be moving under my desk. I subsequently had a seizure, and in hospital the connection with drink wasn't established and it certainly hadn't occurred to me because I wouldn't even have identified as an alcoholic at that stage.

@HuntingoftheSnark unfortunately not. He was previously on withdrawal and craving meds but GP told to take them back off him once his drinking accelerated again. He's now trying to do it himself ignoring all medical advice and there's little me / my mum can do. Could dropping the amount he's drinking (but still drinking a fair amount) have a similar effect to what you've described? (On a side note that sounds terrifying)

HE ( hepatic encephalopathy ) and wernickes encephalopathy are different . Wernickes is related to thiamine deficiency . Left untreated it can lead to korsakoffs . Have a read around the symptoms as he may need a medical review

@Smithy92 it depends how quickly he's dropped from 70cl to 20cl. He really shouldn't make that kind of drastic reduction in a day or two.

I'm not a doctor and would not advise any alcohol dependent person on how quickly or slowly to reduce, just that it is so very dangerous to do without proper supervision. I have known people who have been told that they must keep drinking regularly until a rehab place is available for them so that their detox is monitored.

I really feel for you.

He’s reducing to quickly as well . 70 to 20 is a huge drop . No more than than 10 percent drop is recommended . DTs ( delirium tremens) are a medical emergency . I honestly think your dad needs medical attention with the symptoms you have described .

@Adm1010 thanks will read in more detail as I think I got lost down a wormhole clearly. Will have a read on DT too.

@HuntingoftheSnark I've previously read of attempts at reducing increasing the risks of seizures at each unsuccessful attempt and this is unfortunately becoming a common occurance a few weeks prior to each liver / blood test.

Both, I completely agree he needs medical help. He's wobbling and falling over, his temperament is non existent and has not eaten for 5 days currently. Previously it was 2 weeks not eating. Unfortunately hes in such a deep and dark hole he refuses any sort of medical help, and having attempted rehab unsuccessfully at the start of this year, he is now terrified of that and the help potentially coming his way.

I would question at present whether he lacks capacity to refuse medical treatment ??? Capacity in alcohol dependence is a sticky wicket as it fluctuates massively but with his symptoms I’d wonder about seeking medical attention in best interests ?

Could you speak to 111 / out of hours for advice ?

We did try to go down that route last time he fell (he lost a tooth, fractured an eye socket, and needed stitches in his lip) but despite having a complete lack in judgement / capacity for everything else in life, he's able to turn it on just enough to convince them he's fine.

Our last hope was that he would be unresponsive when the ambulance arrived but unfortunately we ended up having to drive him before the ambulance could turn up.

Sounds like what my brother was like when he withdrew too quickly. Ranting and raving about beings and creatures in his house, paranoid that we had stolen all his belongings. I think was delirium tremens. Sounds like your dad has decreased far to quickly. Db was told to reduce by a bottle cap per day. However when someone is drinking 80/90 units per day they can’t even see a bottle cap let alone measure it! Does he live with someone? The best thing would be if they could reduce his amounts per day by a bottle cap.

I’m so sorry . This must be so difficult for you
.

OP look up the GMAWS (alcohol withdrawal scale). If he's in proper DT's it is a medical emergency - huge risk of seizure as you know.

Is he known to any community addictions services or are there any healthcare professionals that he trusts?

It sounds extremely difficult - and I do have some empathy with him too, because when you really want to stop drinking, it feels so counterproductive to be told that stopping too suddenly could kill you. My experience above was caused by DTs, doesn't affect all alcoholics and in one of George Best's autobiographies, he says that he never experienced full on DTs so it's not just quantity based.

Would he allow you to monitor his alcohol dosage and would you be prepared to do that? Little and often, watered down, but daily not reducing by more than 10% as @Adm1010 suggested?

And this must be horrible for you and your mum (and your dad)

Like I said capacity is a nightmare in this scenario as it fluctuates massively and is very difficult to assess . It’s also decision specific at that point in time . Nightmare for you all .

The problem with capacity is that with alcoholics even if they manage to get them into hospital with no capacity the most they do is stabilise them until they regain capacity, then turf them out to repeat. It’s a circle of hell. Without a prior MH diagnosis you will not be able to have them detained for any period of time and even with one it’s virtually impossible. So sorry op it’s awful.

You could demand a full mental health assessment with an adult social worker present? I think they would have to come out to asses him at home? This is what we did and my relative was actually sectioned because he was suffering seizures, severe DTs but was refusing hospital treatment. Prior mental illness diagnosed though.

On a positive note, I had several experiences of DTs and seizures and have been sober for 14 years in AA. A dear friend found AA in his late sixties and has eight years of sobriety (after two litres of gin a day). We actually say that "no matter how far down the scale we have gone ..." there is still hope and time for recovery. I so hope that your father finds peace from this - and you too.