Jump to content

Alcohol withdrawal syndrome

From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by AristonAstuanax (talk | contribs) at 21:16, 30 October 2008. The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Alcohol withdrawal syndrome
SpecialtyPsychiatry, narcology, addiction medicine Edit this on Wikidata

Alcohol withdrawal syndrome is the set of symptoms seen when an individual reduces or stops alcohol consumption after prolonged period of excessive alcohol intake. Excessive misuse of alcohol leads to tolerance, physical dependence and an alcohol withdrawal syndrome.

Neurochemistry

Chronic use of [[ethanol|alcoholAristonAstuanax (talk) 21:16, 30 October 2008 (UTC)]] leads to changes in brain chemistry especially in the GABAergic system. Various adaptions occur such as changes in gene expression and down regulation of GABAa receptors. During acute alcohol withdrawal changes also occur such as upregulation of alpha4 containing GABAa receptors and down regulation of alpha1 and alpha3 containing GABAa receptors. Neurochemical changes occurring during alcohol can be minimised with drugs which are used for acute detoxification. With abstinence from alcohol and cross tolerant drugs these changes in neurochemistry gradually return towards normal.[1]

Presentation

The severity of the alcohol withdrawal syndrome can vary from mild symptoms such as mild sleep disturbances and mild anxiety to very severe and life threatening including delirium, particularly visual hallucinations in severe cases and convulsions (which may result in death).[2] The severity of alcohol withdrawal depends on various factors including age, genetics and most importantly degree of alcohol intake and length of time the individual has been misusing alcohol for and number of previous detoxifications.[3][4]

Withdrawal symptoms

Protracted withdrawal

A protracted alcohol withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to as the post acute withdrawal syndrome. Some withdrawal symptoms can linger for at least a year after discontinuation of alcohol. Symptoms can include a craving for alcohol, inability to feel pleasure from normally pleasurable things (also known as anhedonia), clouding of sensorium, disorientation, nausea and vomiting or headache.[11] Insomnia is also a common protracted withdrawal symptom which persists after the acute withdrawal phase of alcohol. Insomnia has also been found to influence relapse rate. Studies have found that magnesium or trazodone can help treat persisting withdrawal symptom of insomnia in recovering alcoholics. Insomnia can be difficult to treat in alcoholics because many of the traditional sleep aids eg benzodiazepine receptor agonists and barbiturate receptor agonists work via a GABAA receptor mechanism and are cross tolerant with alcohol. However, trazodone is not cross tolerant with alcohol.[12][13][14] The acute phase of the alcohol withdrawal syndrome can also occasionally be protracted. Protracted delirium tremens has been reported in the medical literature as a possible but unusual feature of alcohol withdrawal.[15]

Kindling

Kindling is the phenomenon where repeated alcohol detoxifications leads to an increased severity of the withdrawal syndrome. For example binge drinkers may initially experience no withdrawal symptoms but with each period of resumption of drinking followed by abstinence their withdrawal symptoms intensify in severity and may eventually result in full blown delirium tremens with convulsive seizures. Alcoholics who experience seizures during hospital detoxification have been found to be much more likely to have had experienced more previous detoxifications from alcohol than alcoholics who did not have seizures and are more likely to have a more medically complicated alcohol withdrawal syndrome. Kindling can cause complications and may increase the risk of relapse, alcohol related brain damage and cognitive deficits. The mechanism behind kindling is sensitisation of some neuronal systems and desensitisation of other neuronal system which increasingly leads to increasingly gross neurochemical imbalances. This in turn leads to more profound withdrawal symptoms including anxiety, convulsions and neurotoxicity.[4]

Treatment

Treatment of alcohol withdrawal syndrome can be managed with various pharmaceutical medications including barbiturates, benzodiazepines and clonidine. Certain vitamins are also an important part of the management of alcohol withdrawal syndrome.

Baclofen

Baclofen has been shown to be as effective as diazepam in uncomplicated alcohol withdrawal syndrome.[16]

Barbiturates

Barbiturates are superior to diazepam in the treatment of severe alcohol withdrawal syndromes such as delirium tremens but equally effective in milder cases of alcohol withdrawal.[17]

Benzodiazepines

Benzodiazepines are the most commonly used drug for the treatment of alcohol withdrawal and are safe and effective in suppressing alcohol withdrawal signs.[18]

Carbamazepine

Some evidence indicates that carbamazepine may be effective in the treatment of alcohol withdrawal but more research is needed.[19] It has the advantage of not causing rebound withdrawal symptoms and appears to have a higher success rate compared with lorazepam.[20]

Clonidine

Clonidine has demonstrated superior clinical effects in the suppression of alcohol withdrawal symptoms in a head to head comparison study with the benzodiazepine drug chlordiazepoxide.[21][22][23]

Ethanol

Alcohol (ethanol) itself at low doses has been found to be superior to chlordiazepoxide in the detoxification of alcohol dependent patients. Low dose ethanol as a means of weaning alcoholics off of alcohol was found to produce less profound sleep disturbances during withdrawal.[24] Low dose ethanol has been found to reduce treatment time, improve the failure rate from 20% down to 7% and increase retention in treatment centres with an increased rate of alcoholics attending substance misuse clinics after detoxification.[25]

Trazodone

Trazodone has demonstrated efficacy in the treatment of the alcohol withdrawal syndrome. It may have particular use in withdrawal symptoms, especially insomnia, persisting beyond the acute withdrawal phase.[26][13][14]

Vitamins

Alcoholics are often deficient in various nutrients which can cause severe complications during alcohol withdrawal such as the development of wernicke syndrome. The vitamins of most importance in alcohol withdrawal are thiamine and folic acid. To help to prevent wernicke syndrome alcoholics should be administered a multivitamin preparation with sufficient quantities of thiamine and folic acid. Vitamins should always be administered before any glucose is administered otherwise wernicke syndrome can be precipitated.[27]

See also

References

  1. ^ Sanna, E; Mostallino, Mc; Busonero, F; Talani, G; Tranquilli, S; Mameli, M; Spiga, S; Follesa, P; Biggio, G (2003). "Changes in GABA(A) receptor gene expression associated with selective alterations in receptor function and pharmacology after ethanol withdrawal". The Journal of neuroscience : the official journal of the Society for Neuroscience. 23 (37): 11711–24. ISSN 0270-6474. PMID 14684873. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  2. ^ a b c d e f g h i j Harada K (1993). "[Emotional condition in alcohol withdrawal acute psychosis]". Seishin Shinkeigaku Zasshi. 95 (7): 523–9. PMID 8234534.
  3. ^ Liskow BI (1989). "Alcohol withdrawal in the elderly". J Stud Alcohol. 50 (5): 414–21. PMID 2779242. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  4. ^ a b Howard C. Becker (1998). "Kindling in Alcohol Withdrawal" (PDF). Alcohol Health & Research World. 22 (1). NIAAA. Cite error: The named reference "kiaw" was defined multiple times with different content (see the help page).
  5. ^ a b c d e f g h i j k l m n o p q MAX BAYARD (15). "Alcohol Withdrawal Syndrome". American Family Physician. aafp. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help) Cite error: The named reference "aws" was defined multiple times with different content (see the help page).
  6. ^ Cowley DS (24). "Alcohol abuse, substance abuse, and panic disorder". Am J Med. 92 (1A): 41S–48S. doi:10.1016/0002-9343(92)90136-Y. PMID 1346485. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
  7. ^ Muralidharan K (2007). "Catatonia as a presenting feature of alcohol withdrawal: a case report". Prim Care Companion J Clin Psychiatry. 9 (6). pubmed: 465. PMID 18185829. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ Burov YV (1986). "Types of alcohol withdrawal syndrome and dexamethasone suppression test". Drug Alcohol Depend. 17 (1): 81–8. doi:10.1016/0376-8716(86)90039-6. PMID 3720534. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  9. ^ Abitan J (8-15). "[Treatment of alcohol withdrawal symptoms: a clinical study (author's transl)]". Sem Hop. 55 (21–22): 1105–7. PMID 225818. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  10. ^ Gann H (1). "Sleep and the cholinergic rapid eye movement sleep induction test in patients with primary alcohol dependence". Biol Psychiatry. 50 (5): 383–90. doi:10.1016/S0006-3223(01)01172-6. PMID 11543743. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  11. ^ Martinotti G (2008). "Alcohol protracted withdrawal syndrome: the role of anhedonia". Subst Use Misuse. 43 (3–4): 271–84. doi:10.1080/10826080701202429. PMID 18365930. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  12. ^ Hornyak M (2004). "Magnesium treatment of primary alcohol-dependent patients during subacute withdrawal: an open pilot study with polysomnography". Alcohol Clin Exp Res. 28 (11): 1702–9. doi:10.1097/01.ALC.0000145695.52747.BE. PMID 15547457. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  13. ^ a b Le Bon O (2003). "Double-blind, placebo-controlled study of the efficacy of trazodone in alcohol post-withdrawal syndrome: polysomnographic and clinical evaluations". J Clin Psychopharmacol. 23 (4): 377–83. doi:10.1097/01.jcp.0000085411.08426.d3. PMID 12920414. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  14. ^ a b Borras L (2006). "Successful treatment of alcohol withdrawal with trazodone". Pharmacopsychiatry. 39 (6): 232. doi:10.1055/s-2006-951385. PMID 17124647. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  15. ^ Miller FT (1994). "Protracted alcohol withdrawal delirium". J Subst Abuse Treat. 11 (2): 127–30. doi:10.1016/0740-5472(94)90029-9. PMID 8040915. {{cite journal}}: Unknown parameter |month= ignored (help)
  16. ^ Addolorato G (2006). "Baclofen in the treatment of alcohol withdrawal syndrome: a comparative study vs diazepam". Am J Med. 119 (3): 276.e13–8. doi:10.1016/j.amjmed.2005.08.042. PMID 16490478. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  17. ^ Kramp P (1978). "Delirium tremens: a double-blind comparison of diazepam and barbital treatment". Acta Psychiatr Scand. 58 (2): 174–90. doi:10.1111/j.1600-0447.1978.tb06930.x. PMID 358756. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  18. ^ Ebell MH (1). "Benzodiazepines for alcohol withdrawal". 73 (7): 1191. PMID 16623205. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Cite journal requires |journal= (help); Unknown parameter |month= ignored (help)
  19. ^ Prince V (1). "Treatment of alcohol withdrawal syndrome with carbamazepine, gabapentin, and nitrous oxide". Am J Health Syst Pharm. 65 (11): 1039–47. doi:10.2146/ajhp070284. PMID 18499876. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  20. ^ Malcolm R (2002). "The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial". J Gen Intern Med. 17 (5): 349–55. doi:10.1046/j.1525-1497.2002.10201.x. PMID 12047731. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  21. ^ Baumgartner GR (1988). "Clonidine versus chlordiazepoxide in acute alcohol withdrawal: a preliminary report". South Med J. 81 (1): 56–60. doi:10.1097/00007611-198801000-00012. PMID 3276009. {{cite journal}}: Unknown parameter |month= ignored (help)
  22. ^ Baumgartner GR (1987). "Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal syndrome". Arch Intern Med. 147 (7): 1223–6. doi:10.1001/archinte.147.7.1223. PMID 3300587. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  23. ^ Björkqvist SE (1975). "Clonidine in alcohol withdrawal". Acta Psychiatr Scand. 52 (4): 256–63. doi:10.1111/j.1600-0447.1975.tb00041.x. PMID 1103576. {{cite journal}}: Unknown parameter |month= ignored (help)
  24. ^ Funderburk FR (1978). "Residual effects of ethanol and chlordiazepoxide treatments for alcohol withdrawal". J Nerv Ment Dis. 166 (3): 195–203. PMID 205633. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  25. ^ Dissanaike S (2006). "An ethanol protocol to prevent alcohol withdrawal syndrome". J Am Coll Surg. 203 (2): 186–91. doi:10.1016/j.jamcollsurg.2006.04.025. PMID 16864031. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  26. ^ Roccatagliata G (1980). "Alcohol withdrawal syndrome: treatment with trazodone". Int Pharmacopsychiatry. 15 (2): 105–10. PMID 6108298. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  27. ^ Hugh Myrick (1998). "Treatment of Alcohol Withdrawal" (PDF). Alcohol Health & Research World. 22 (1). niaaa. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Alcohol_withdrawal_syndrome&oldid=248690816"