a 43-year - old dsc soldier with few months of service was referred for psychiatric evaluation in january 2010 by unit authorities in view of his behavioral abnormalities noted since joining the unit . he was found to be gloomy , reclusive , not sleeping and talking to oneself . evaluation revealed that he was apparently asymptomatic when he retired after 18 year of service in army ( para unit ) in 2004 . he had been consuming alcohol since 1984 and gradually the frequency and quantity increased to 360 ml of rum daily by 1996 . he used to have sleep disturbances irritability and tremors on temporarily stopping alcohol consumption . after leaving the service in 2004 , he started consuming about 600 ml of country liquor daily . by 2005 , family members noted him to be talking to himself , not taking adequate self care and becoming irritable easily . he complained of hearing voices of family members , even when he was alone , abusing him and threatening him . sometimes he used to see the faces of pervious acquaintances , which used to change in shape and size . all these things used to disturb him , he was not doing any job and to over come these problems used to drink country liquor regularly . though his family members got him treated from local doctor , there was no significant improvement . after the initial training of short duration , while on leave he was consuming country liquor daily , before joining the new unit . there also he started consuming about 120 ml of rum daily . his behavior was abnormal and hence he was hospitalized . there was no other significant family or past history . mental status examination showed multimodal hallucinations in visual , auditory and tactile spheres , no delusions but biodrives were deranged . investigations showed human immunodeficiency virus ( hiv ) positive status ( elisa and western blot ) , raised aspartate amino transferase ( ast ) and alanine amino transferase ( alt ) , computed tomography ( ct ) and magnetic resonance imaging ( mri ) brain revealed bilateral lateral ventricle enlargement with narrowing of lower end of aqueduct of sylvius . the dose was gradually increased to 4 mg per day and he responding quickly . on improvement subsequently he was noted to be abstinent from alcohol , compliant with treatment and free from all kinds of hallucinations . alcohol is the most frequently abused psychoactive substance and may lead to various clinical conditions like intoxication , withdrawal , delirium tremens , wermicke - korskoff syndrome , alcohol - induced psychotic disorder and alcoholic dementia . although a syndrome similar to what we now call alcoholic hallucinosis was described as a separate entity as early as 1847 by marcel , who called it folie divrogne ( drunken madness ) , there continued to be great uncertainty as to which group this condition belonged diagnostically . patients were even given a diagnosis of paranoid schizophrenia and treated with neuroleptics , indefinitely . alcoholic hallucinosis has also been considered to be a heterogeneous condition with a varied outcome , or even a distinct entity in its own right with a particular etiology , course and outcome . did a follow - up study of 52 patients diagnosed with alcoholic hallucinosis and after three years noted that 13.5% patients continued to hallucinate even though remained abstinent , and 21% patients did not have relapse even though continued to consume alcohol . no relationship of development of hallucination to severity of alcohol dependence at baseline was noted . based on positron emission tomography ( pet ) findings , soyka , et al . suggested a hypo function of thalamus in alcoholic psychosis . jm anderson in east glasgow , where alcohol dependence syndrome ( ads ) is known to be particularly severe in the population . initially 16 of 124 ( 13% ) patients with a diagnosis of ads had alcoholic hallucinosis of which five had continuous hallucinations . hallucinations were auditory , distinct and usually in second person . at follow - up after eight years three had deceased , five were abstinent and without psychosis and two were abstinent but had features of schizophrenia . computed tomography ( spect ) noted decreased regional blood flow in frontal lobes , left basal ganglia and left thalamus in alcoholic hallucinosis . on treatment with neuroleptics and benzodiazepines , hallucinations disappeared and spect showed normalization of blood flow in basal ganglia and thalamus but not in frontal lobes . recently valproate has also been found to be effective in the treatment of alcoholic hallucinosis and was well tolerated . alcoholic hallucinosis is a rare complication of chronic alcohol abuse and a prevalence of 0.6 - 0.7% in alcoholics has been reported . no study has conclusively demonstrated that it is an acute illness with pronounced similarities to delirium tremens or as a chronic illness resembling paranoid schizophrenia . in short , there is no consensus as to the nature of the illness . in our case , the individual with chronic alcohol abuse had presented with multimodal hallucinations that persisted even when he remained abstinent .
alcoholic hallucinosis is a rare complication of chronic alcohol abuse characterized by predominantly auditory hallucinations that occur either during or after a period of heavy alcohol consumption . 
 bleuler ( 1916 ) termed the condition as alcohol hallucinosis and differentiated it from delirium tremens . 
 usually it presents with acoustic verbal hallucinations , delusions and mood disturbances arising in clear consciousness and sometimes may progress to a chronic form mimicking schizophrenia . 
 one such case with multimodal hallucinations in a defence service corps soldier is presented here .