233 Alcohol Withdrawal(291.81)
DSM-IV-TR criteria
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (or more) of the following, developing within several hours to a few days after Criterion A:
- Automatic hyperactivity (e.g., sweating or pulse rate greater than 100)
- Increased hand tremor
- Insomnia
- Nausea or vomiting
- Transient visual, tactile, or auditory hallucinations or illusions
- Psychomotor agitation
- Anxiety
- Grand mal seizures
C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Specify if:
With Perceptual Disturbances
Emperically supported treatment
- Many treatment with alcohol withdrawal syndroms can be managed with various pharmaceutical medications including barbituates, benzodiazepines, and clonidine, certain vitamins are also an important part of the management of alcohol withdrawal syndrome.
- Barbituates are superiors to diazepam in the treatment of severe alcohol withdrawal syndromes such as delirium tremens but equally effective in mildr cases of alcohol withdrawal.
- Clonidine has demonstrated superior clinical effects in the suppression of alcohol withdrawal symtpoms in a head to head comparison study with the benzodiazepine drug.
- Benzodiazepines are the most commonly used drug for the treatment of alcohol withdrawal and are generally safe and effective in suppressing alcohol withdrawal signs. Chlordiazepoxide and diazepam are the benzodiazepines most commonly used in alcohol detoxification. Benzodiazepines can be life saving, particularly if delerium tremens appears during alcohol withdrawal. Benzodiazepines should only be used short term in alcoholics who aren’t already dependent on benzodiazepines as benzodiazepines share cross tolerance with ethanol and there is a risk of replacing the addiction with a benzodiazepine dependence or worse still adding an additional addiction. Furthermore disrupted GABA benzodiazepine receptor function is part of alcohol dependence and chronic benzodiazepines may prevent full recovery from alcohol induced mental effects. Benzodiazepines have the problem of increasing cravings for alcohol in problem alcohol consumers and they also increase the volume of alcohol consumed by problem drinkers. The combination of benzodiazepines and alcohol can amplify the adverse psychological effects of each other causing enhanced depressive effects on mood and increase suicidal actions and are generally contraindicated except for alcohol withdrawal.
- 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 sh