Kallu, a 24-year-old occasional alcoholic had got a change in behaviour. He has become suspicious that people are trying to conspire against him, though his father states that there is no reason for his fears. He is getting hallucinations of voices commenting on his actions. What is the most probable diagnosis: March 2013 (f, g)

**Core Concept**
Delirium tremens (DTs) is a severe form of alcohol withdrawal characterized by altered mental status, hallucinations, and autonomic instability. It typically occurs 48-72 hours after the last drink in individuals with a history of chronic alcohol use.

**Why the Correct Answer is Right**
The onset of DTs is often preceded by a lucid interval, where the patient appears to be recovering from alcohol withdrawal. However, this period of relative calmness is followed by a rapid deterioration in mental status, with patients becoming increasingly agitated, paranoid, and hallucinatory. The presence of auditory hallucinations, such as voices commenting on actions, is a classic symptom of DTs. The autonomic instability associated with DTs can manifest as hypertension, tachycardia, and sweating.

**Why Each Wrong Option is Incorrect**
**Option A:** Wernicke's encephalopathy is a different condition characterized by the triad of confusion, ataxia, and ophthalmoplegia. While it is also associated with chronic alcohol use, it does not typically involve hallucinations.

**Option B:** Schizophrenia is a chronic psychiatric disorder characterized by hallucinations, delusions, and disorganized thinking. However, it is not typically associated with a clear history of alcohol use or the acute onset of symptoms seen in DTs.

**Option C:** Bipolar disorder is a mood disorder characterized by episodes of mania or depression. While it can involve psychotic symptoms such as hallucinations, it is not typically associated with the acute onset of symptoms seen in DTs.

**Clinical Pearl / High-Yield Fact**
The "100% sign" is a clinical sign associated with DTs, where patients will often point to their own chest or abdomen when asked to point to their own eye. This is a result of the severe autonomic instability and confusion associated with the condition.

**Correct Answer:** D.

✓ Correct Answer: C. Schizophrenia