46 year old chronic alcoholic, one day after abstinence from alcohol comes to casualty presenting with restlessness, seizures, coarse tremors. He is not able to recognize the doctor, he think himself in a jail. He also complains uncontrolable fear of being murdered, insomnia and insects crawling over body, probable diagnosis is –

**Core Concept**
Alcohol withdrawal syndrome is a complex clinical condition that occurs in individuals who have been chronically consuming alcohol and then suddenly stop or significantly reduce their intake. This condition is characterized by a range of symptoms, from mild to severe, including tremors, seizures, and delirium tremens.

**Why the Correct Answer is Right**
Delirium tremens (DTs) is a severe form of alcohol withdrawal that typically occurs 48-72 hours after the last drink. In this condition, the individual experiences a severe state of confusion, agitation, and hallucinations, often with a disconnection from reality. The symptoms described in the scenario, including restlessness, seizures, coarse tremors, confusion, and hallucinations, are consistent with DTs. The pathophysiology involves an imbalance of neurotransmitters, particularly GABA and glutamate, which leads to an overactivation of the brain's excitatory pathways.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option might be incorrect as it could potentially be a case of delirium caused by other factors such as infection, medication, or other medical conditions. However, the specific context of recent abstinence from alcohol points towards alcohol withdrawal syndrome.
* **Option B:** This option might be incorrect as it could be a case of anxiety disorder, but the severity and complexity of symptoms described in the scenario are more consistent with alcohol withdrawal syndrome.
* **Option C:** This option might be incorrect as it could be a case of substance-induced psychotic disorder, but the presence of seizures and coarse tremors points more towards delirium tremens.

**Clinical Pearl / High-Yield Fact**
Delirium tremens is a medical emergency that requires immediate treatment with benzodiazepines, such as lorazepam or diazepam, to manage symptoms and prevent further complications.

**Correct Answer:** D.

✓ Correct Answer: C. Delirium tremens