The diagnosis of alcoholic psychosis should be restricted to those mental disorders arising with few exceptions in connection with chronic drinking and presenting fairly well-defined symptom-pictures. We must guard against making the alcoholic group too inclusive. Over-indulgence in alcohol is often found to be merely a symptom of another psychosis, or at any rate may be incidental to another psychosis, such as general paralysis, manic-depressive insanity, dementia pracox, epilepsy, etc. The cases to be regarded as alcoholic psychoses and which do not result from chronic drinking are the episodic attacks in some psychopathic personalities, the dipsomanias (the true periodic drinkers) and pathological intoxication, any one of which may develop as the result of a single imbibition or a relatively short spree.

The following alcoholic reactions usually present symptoms distinctive enough to allow of clinical differentiation:

(a) Pathological intoxication: An unusual or abnormal immediate reaction to taking a large or small amount of alcohol. Essentially an acute mental disturbance of short duration characterized usually by an excitement or furor with confusion and hallucinations, followed by amnesia.

(b) Delirium tremens: A hallucinatory delirium with marked general tremor and toxic symptoms.

(c) Korsakow's disease: This occurs with or without polyneuritis. The delirious types are not readily differentiated in the early stages from severe delirium tremens but are more protracted. The non-delirious type presents a characteristic retention defect with disorientation, fabrication, suggestibility and tendency to misidentify persons. Hallucinations are infrequent after the acute phase.

(d) Acute hallucinosis: This is chiefly an auditory hallucinosis of rapid development with clearness of the sensorium, marked fears, and a more or less systematized persecutory trend.

(e) Chronic hallucinosis: This is an infrequent type which may be regarded as the persistence of the symptoms of the acute hallucinosis without change in the character of the symptoms except perhaps a gradual lessening of the emotional reaction accompanying the hallucinations.

(/) Acute paranoid type: Suspicions, misinterpretations, and persecutory ideas, often a jealous trend; hallucinations usually subordinate; clearing up on withdrawal of alcohol.

(g) Chronic paranoid type: Persistence of symptoms of the acute paranoid type with fixed delusions of persecution or jealousy usually not influenced by withdrawal of alcohol; difficult to differentiate from non-alcoholic paranoid states or dementia praecox.

(h) Alcoholic deterioration: A slowly developing moral, volitional and emotional change in the chronic drinker; apparently relatively few cases are committed as the mental symptoms are not usually looked upon as sufficient to justify the diagnosis of a definite psychosis. The chief symptoms are ill humor and irascibility or a jovial, careless, facetious mood; abusiveness to family, unreliability and tendency to prevarication; in some cases definite suspicions and jealousy; there is a general lessening of efficiency and capacity for physical and mental work; memory not seriously impaired. To be excluded are cases with residual defects due to Korsakow's disease, or with mental reduction due to arteriosclerosis or to traumatic lesions.

(i) Other types to be specified.