Alcoholic Delirium and Other Withdrawal Syndromes

  • Volker Schuchardt
  • Dennis L. Bourke
  • Michael N. Diringer

Abstract

Alcoholism is a major public health problem causing various neurological diseases (Table 1), the most frequent and most important of them being delirium tremens (DT). In our experience, more than 20% of 1720 patients admitted to the neurological intensive care unit (ICU) during a 7-year period were alcohol dependent. Of these, 78 admissions (4.5%) were because of delirium tremens. Three distinct scenarios associated with alcoholism are frequently encountered in the neurological ICU:
  1. 1.

    A known alcoholic is admitted because of an illness not directly caused by alcohol; prophylactic treatment to avoid DT is required.

     
  2. 2.

    An alcoholic is admitted with clear signs of alcohol withdrawal (impending delirium tremens); development of full-blown delirium tremens must be prevented.

     
  3. 3.

    A patient is admitted specifically because of active delirium tremens or has developed DT while being treated for another disease.

     

Keywords

Magnesium Depression Dopamine Schizophrenia Meningitis 

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Suggested Reading

  1. Athen D (1986) Comparative investigation of clomethiazole and neuroleptic agents in the treatment of alcoholic delirium. Acta Psychiatr Scand 329 [Suppl]: 167–170CrossRefGoogle Scholar
  2. Ballenger JC, Post RM (1978) Kindling as a model of alcohol withdrawal syndromes. Br J Psychiatry 133: 1–14PubMedCrossRefGoogle Scholar
  3. Baumgärtner GR (1988) Clonidine vs. chlordiazepoxide in the management of acute alcohol withdrawal: a preliminary report. Southern Med J 81: 56–60PubMedCrossRefGoogle Scholar
  4. Braun U (1991) Therapie des perioperativen Alkoholdelirs. Dtsch Med Wochenschr 116: 501–503PubMedCrossRefGoogle Scholar
  5. Busch H, Frings A (1988) Pharmacotherapy of alcohol-withdrawal syndrome in hospitalized patients. Pharmacopsychiatry 21: 232–237PubMedCrossRefGoogle Scholar
  6. Castaneda R, Cushman P (1989) Alcohol withdrawal: a review of clinical management. J Clin Psychiatry 50: 278–284PubMedGoogle Scholar
  7. Chick J (1989) Delirium tremens. Br Med J 298: 3–4CrossRefGoogle Scholar
  8. Feuerlein W, Reiser E (1986) Parameters affecting the course and results of delirium tremens treatment. Acta Psychiatr Scand 329 [Suppl]: 120–123CrossRefGoogle Scholar
  9. Hansbrough JF (1989) Massive doses of midazolam infusion in delirium tremens. Crit Care Med 17: 597PubMedCrossRefGoogle Scholar
  10. Hemmingsen R, Kramp P (1988) Delirium tremens and related clinical states: psychopathology, cerebral pathophysiology, and psychochemistry: a two-component hypothesis concerning etiology and pathogenesis. Acta Psychiatr Scand 345: 94–107Google Scholar
  11. Jaffe JH, Martin WR (1985) Drug addiction and drug abuse. In: Godman C, Gilman A (eds) The pharmacological basis of therapeutics. McMillan, New York, pp 548–550Google Scholar
  12. Pfitzer F, Schuchardt V, Heitmann R (1988) The treatment of severe alcoholic delirium. Nervenarzt 59: 229–236PubMedGoogle Scholar
  13. Ritola E, Malinen L (1981) A double-blind comparision of carbamazepine and clomethiazole in the treatment of alcohol withdrawal syndrome. Acta Psychiatr Scand 64: 254–259PubMedCrossRefGoogle Scholar
  14. Robinson BJ, Robinson GM, Maling TJ, Johnson RH (1989) Is clonidine useful in the treatment of alcohol withdrawal? Alcoholism 13: 95–98PubMedGoogle Scholar
  15. Rommelspacher H, Schmidt LG, Heimchen H (1991) Pathobiochemistry and pharmacotherapy of alcohol withdrawal. Nervenarzt 62: 649–657PubMedGoogle Scholar
  16. Schied HW, Kimmerle K, Braunschweiger M (1986) A retrospective comparision of delirium tremens cases before and after the availability of clomethiazole. Acta Psychiatr Sand 73 [Suppl]: 157–161CrossRefGoogle Scholar
  17. Schuchardt V (1988) Der Alkoholiker als Intensivpatient — Erfahrungen einer neurologischen Intensivstation. Intensivmedizin 25: 55–62Google Scholar
  18. Schuckit MA (1991) Alcohol and alcoholism. In: Braunwald E (ed) Harrison’s principles of internal medicine. McGraw-Hill, New York, pp 2146–2151Google Scholar
  19. Schuckit MA, Segal DS (1991) Opioid drug use. In: Braunwald E (ed) Harrison’s principles of internal medicine. McGraw-Hill, New York, pp 2151–2154Google Scholar
  20. Sellers EM, Naranjo CA (1986) New strategies for the treatment of alcohol withdrawal. Psychopharmacol Bull 22: 88–92PubMedGoogle Scholar
  21. Sullivan JT, Sykora CHB, Schneiderman J, Naranjo CA, Sellers EM (1989) Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale ( CIWA-Ar ). Br J Addict 84: 1353–1357Google Scholar
  22. Sutton T (1813) Tracts on delirium tremens, on peritonitis, and some other internal inflammatory affections and on the gout. Underwood, LondonGoogle Scholar
  23. Victor M, Adams RD (1959) The effect of alcohol on the nervous system. Res Publ Assoc New Ment Dis 32: 526–573Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • Volker Schuchardt
  • Dennis L. Bourke
  • Michael N. Diringer

There are no affiliations available

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