alcohol withdrawal delirium


Summary: An acute organic mental disorder induced by cessation or reduction in chronic alcohol consumption. Clinical characteristics include CONFUSION; DELUSIONS; vivid HALLUCINATIONS; TREMOR; agitation; insomnia; and signs of autonomic hyperactivity (e.g., elevated blood pressure and heart rate, dilated pupils, and diaphoresis). This condition may occasionally be fatal. It was formerly called delirium tremens. (From Adams et al., Principles of Neurology, 6th ed, p1175)

Top Publications

  1. Mayo Smith M, Beecher L, Fischer T, Gorelick D, Guillaume J, Hill A, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004;164:1405-12 pubmed
    b>Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.
  2. Khan A, Levy P, DeHorn S, Miller W, Compton S. Predictors of mortality in patients with delirium tremens. Acad Emerg Med. 2008;15:788-90 pubmed publisher
    ..The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT)...
  3. Blondell R, Dodds H, Blondell M, Looney S, Smoger S, Sexton L, et al. Ethanol in formularies of US teaching hospitals. JAMA. 2003;289:552 pubmed
  4. Rovasalo A, Tohmo H, Aantaa R, Kettunen E, Palojoki R. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report. Gen Hosp Psychiatry. 2006;28:362-3 pubmed
    ..dose of dexmedetomidine, a very selective alpha(2)-adrenergic agent, resulted in a rapid response to alcohol withdrawal delirium after the standard treatment...
  5. DeCarolis D, Rice K, Ho L, Willenbring M, Cassaro S. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy. 2007;27:510-8 pubmed
    To compare outcomes of treating alcohol withdrawal delirium (AWD) with a symptom-driven benzodiazepine protocol versus nonprotocol benzodiazepine infusions in the intensive care unit (ICU).
  6. Kahn D, Barnhorst A, Bourgeois J. A case of alcohol withdrawal requiring 1,600 mg of lorazepam in 24 hours. CNS Spectr. 2009;14:385-9 pubmed
    ..The authors present a case of a patient with delirium tremens requiring up to 1,600 mg/day of lorazepam and discuss alternative treatments for alcohol withdrawal...
  7. Smoger S, Looney S, Blondell R, Wieland L, Sexton L, Rhodes S, et al. Hospital Use of Ethanol Survey (HUES): preliminary results. J Addict Dis. 2002;21:65-73 pubmed
    ..Alcohol is widely dispensed with few guidelines in this sample of acute-care hospitals. Additional research on therapeutic efficacy, consequences, and institutional oversight of alcohol in hospitals is needed...
  8. Takeshita J. Use of propofol for alcohol withdrawal delirium: a case report. J Clin Psychiatry. 2004;65:134-5 pubmed
  9. Trendelenburg G, Strohle A. [Gamma-hydroxybutyrate--a neurotransmitter, medicine, and drug]. Nervenarzt. 2005;76:832, 834-8 pubmed
    ..For this reason and because GHB is not easy to detect, it is important to be aware of the symptoms of GHB intoxication. Moreover, some recent case reports document the danger of GHB dependence. ..

More Information

Publications111 found, 100 shown here

  1. Mirafzali S. Alcohol withdrawal delirium. Arch Intern Med. 2005;165:586; author reply 587 pubmed
  2. Bouchard N, Meltzer A, Hoffman R. Treatment of delirium tremens. Arch Intern Med. 2005;165:587; author reply 587 pubmed
  3. DeBellis R, Smith B, Choi S, Malloy M. Management of delirium tremens. J Intensive Care Med. 2005;20:164-73 pubmed
    ..Delirium tremens is recognized as a potentially fatal and debilitating complication of ethanol withdrawal. Research thus far has primarily focused on the prevention of delirium tremens. ..
  4. Szubert S, Bobinska K, Florkowski A, Zboralski K, Kuśmierek M, Wierzbiński P. [Diagnostic and stating problems in delirium tremens cases]. Pol Merkur Lekarski. 2008;25 Suppl 1:16-9 pubmed
    ..In all of the cases chronic alcoholism with delirium tremens accompanying as the one however indirect cause of death was revealed. The direct cause of death in all the cases was acute circulatory or circulatory and respiratory failure. ..
  5. Chrostek Maj J, Kamenczak A, Bock R, Polewka A, Krawczyk E. [Assessment of socio-demographic factors in alcohol-addicted patients recurrently treated in a detoxification unit]. Przegl Lek. 2005;62:361-4 pubmed
    ..and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients. ..
  6. Kim J, Park C, Hwang J, Shin M, Hong K, Cho S, et al. Clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder. Alcohol Alcohol. 2006;41:407-11 pubmed
  7. Lewis F. Iatrogenic hypotension in an elderly man with diagnosed angina. Br J Nurs. 2006;15:727 pubmed
  8. Csemy L, Nespor K, Brozova J. [Incidence of delirium tremens in the Czech Republic: a rapid increase]. Cas Lek Cesk. 2007;146:82-3 pubmed
    ..g. higher taxation of alcohol), early intervention and appropriate treatment of alcohol dependence are important. The self-help manual for problem drinkers can be downloaded free of charge from. ..
  9. Jaeger T, Lohr R, Pankratz V. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc. 2001;76:695-701 pubmed
    ..This result was most apparent in patients with no history of delirium tremens. ..
  10. Gold J, Rimal B, Nolan A, Nelson L. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35:724-30 pubmed
    ..Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections. ..
  11. Nseir S. Acute alcohol withdrawal as a risk factor for intensive care unit-acquired infection. Crit Care Med. 2008;36:3131-2 pubmed publisher
  12. Liappas J, Paparrigopoulos T, Tzavellas E, Rabavilas A. Amisulpride may help alcoholics in the early postdetoxification phase. J Clin Psychopharmacol. 2005;25:396-8 pubmed
  13. Heberlein A, Muschler M, Lenz B, Frieling H, Büchl C, Gröschl M, et al. Serum levels of vascular endothelial growth factor A increase during alcohol withdrawal. Addict Biol. 2010;15:362-4 pubmed publisher
    ..252, P = 0.008). Increase of VEGF-A serum levels is closely associated to alcohol intoxication and severity of alcohol dependence. ..
  14. Gómez Méndez R, Monte Secades R, Ventura Valcárcel P, Rabuñal Rey R, Guerrero Sande H, Chamorro Fernández A, et al. Incidence rates of admissions associated with alcohol withdrawal syndrome in Spain: Analysis of minimum basic data set 1999-2010. Med Clin (Barc). 2018;151:103-108 pubmed publisher
    ..81), alcohol withdrawal delirium (CIE9-MC 291.0) and alcohol withdrawal hallucinosis (CIE9-MC 291.3), since 1999 to 2010...
  15. Anders S, Stein S, Reinhardt A, Tsokos M. [Suspicious circumstances on discovery of the cadaver]. Arch Kriminol. 2002;209:102-9 pubmed
    ..External force was ruled out in all three fatalities by cooperative work of police investigators and forensic medicine. ..
  16. Galankin L, Livanov G. [The disorders of blood circulation and consciousness in non-psychotic and delirious alcohol withdrawal syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova. 2004;104:15-9 pubmed
    ..The authors suggest that the complex of disorders observed is similar to shock process, and hemodynamic disturbances may be involved in the development of consciousness disorders. ..
  17. Cuculi F, Kobza R, Ehmann T, Erne P. ECG changes amongst patients with alcohol withdrawal seizures and delirium tremens. Swiss Med Wkly. 2006;136:223-7 pubmed
    ..Alcohol withdrawal seizures and delirium tremens (DT) are serious complications of alcohol dependence. The prevalence of arrhythmias and other electrocardiographic (ECG) changes occurring in these clinical situations is not well studied...
  18. Hemmingsen R, Vorstrup S, Clemmesen L, Holm S, Tfelt Hansen P, Sørensen A, et al. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography. Am J Psychiatry. 1988;145:1384-90 pubmed
    ..The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability. ..
  19. Ahveninen J, Jääskeläinen I, Pekkonen E, Hallberg A, Hietanen M, Naatanen R, et al. Increased distractibility by task-irrelevant sound changes in abstinent alcoholics. Alcohol Clin Exp Res. 2000;24:1850-4 pubmed
    ..The MMN enhancement suggested that this reflects impaired neural inhibition of involuntary attention shifting, being most pronounced in early-onset alcoholics. ..
  20. Kalmar S. [Adjuvant therapy with parenteral piracetam in alcohol withdrawal delirium]. Orv Hetil. 2003;144:927-30 pubmed
    ..piracetam treatment in 193 patients admitted to the Psychiatric Department of Semmelweis Hospital with alcohol withdrawal delirium. Alcohol withdrawal delirium is a complex metabolic disorder, the disturbance of the highest cerebral ..
  21. Preuss U, Zill P, Koller G, Bondy B, Hesselbrock V, Soyka M. Ionotropic glutamate receptor gene GRIK3 SER310ALA functional polymorphism is related to delirium tremens in alcoholics. Pharmacogenomics J. 2006;6:34-41 pubmed
    ..Although this result is suggestive for a significant role of this polymorphism in the pathogenesis of delirium tremens in alcohol-dependent individuals, further investigation and confirmation are warranted...
  22. Burapakajornpong N, Maneeton B, Srisurapanont M. Pattern and risk factors of alcohol withdrawal delirium. J Med Assoc Thai. 2011;94:991-7 pubmed
    To determine the incidence, prescribing risk factors of alcohol withdrawal delirium (AWD), and factors complicating AWD, in alcohol dependent patients hospitalized for alcohol detoxification...
  23. Homanics G, Le N, Kist F, Mihalek R, Hart A, Quinlan J. Ethanol tolerance and withdrawal responses in GABA(A) receptor alpha 6 subunit null allele mice and in inbred C57BL/6J and strain 129/SvJ mice. Alcohol Clin Exp Res. 1998;22:259-65 pubmed
  24. Spies C. [Anesthesiologic aspects of chronic alcohol abuse]. Ther Umsch. 2000;57:261-3 pubmed
  25. Rasmussen D, Boldt B, Bryant C, Mitton D, Larsen S, Wilkinson C. Chronic daily ethanol and withdrawal: 1. Long-term changes in the hypothalamo-pituitary-adrenal axis. Alcohol Clin Exp Res. 2000;24:1836-49 pubmed
    ..Thus, these chronic daily ethanol-induced persistent changes in the HPA axis may have significant roles in alcohol abstinence syndrome and may increase vulnerability to relapse. ..
  26. Holt J, Watson W, Little H. Studies on a model of long term alcohol drinking. Behav Brain Res. 2001;123:193-200 pubmed
    ..However the unexpectedly low alcohol intake may have prevented any effects of nimodipine being seen. ..
  27. Chang P, Steinberg M. Alcohol withdrawal. Med Clin North Am. 2001;85:1191-212 pubmed
  28. Foster J. The recognition and treatment of acute alcohol withdrawal. Nurs Times. 2004;100:40-3 pubmed
    ..This article describes the symptoms of alcohol withdrawal that are likely to be encountered in a general hospital setting, and offers evidence-based guidance on monitoring the process and providing nursing care. ..
  29. Wright T, Myrick H, Henderson S, Peters H, Malcolm R. Risk factors for delirium tremens: a retrospective chart review. Am J Addict. 2006;15:213-9 pubmed
    ..While not reaching statistical significance, there were differences in reason for admission and relapse rate upon follow-up between the groups. ..
  30. Sarai M, Tejani A, Chan A, Kuo I, Li J. Magnesium for alcohol withdrawal. Cochrane Database Syst Rev. 2013;:CD008358 pubmed publisher
    ..22 to 0.30). No clinically important changes in adverse events were reported. There is insufficient evidence to determine whether magnesium is beneficial or harmful for the treatment or prevention of alcohol withdrawal syndrome. ..
  31. Graef J, Huitt T, Nordskog B, Hammarback J, Godwin D. Disrupted thalamic T-type Ca2+ channel expression and function during ethanol exposure and withdrawal. J Neurophysiol. 2011;105:528-40 pubmed publisher
  32. Adinoff B. Double-blind study of alprazolam, diazepam, clonidine, and placebo in the alcohol withdrawal syndrome: preliminary findings. Alcohol Clin Exp Res. 1994;18:873-8 pubmed
  33. Shear P, Jernigan T, Butters N. Volumetric magnetic resonance imaging quantification of longitudinal brain changes in abstinent alcoholics. Alcohol Clin Exp Res. 1994;18:172-6 pubmed
    ..These results provide the first evidence suggestive of significant volumetric white matter increase with abstinence. ..
  34. Samochowiec J, Kucharska Mazur J, Kaminski R, Smolka M, Rommelschpacher H, Wernicke C, et al. Norepinephrine transporter gene polymorphism is not associated with susceptibility to alcohol dependence. Psychiatry Res. 2002;111:229-33 pubmed
    ..These results suggest that the NET gene polymorphism in exon 9 accession number: mRNA: NM_001043, genomic contig.: NT_019610, is unlikely to be involved in the susceptibility to alcoholism and severe alcohol withdrawal. ..
  35. Castledine G. Nurses should know how to tackle alcohol withdrawal. Br J Nurs. 2003;12:644 pubmed
  36. Bär K, Boettger M, Koschke M, Boettger S, Grotelüschen M, Voss A, et al. Increased QT interval variability index in acute alcohol withdrawal. Drug Alcohol Depend. 2007;89:259-66 pubmed
    ..In part, these changes might be related to increased cardiac sympathetic activity or low potassium, thus suggesting the latter as possible targets for adjuvant pharmacological therapy during withdrawal. ..
  37. Alldredge B, Lowenstein D, Simon R. Placebo-controlled trial of intravenous diphenylhydantoin for short-term treatment of alcohol withdrawal seizures. Am J Med. 1989;87:645-8 pubmed
    ..Our goal was to evaluate the effectiveness of intravenous diphenylhydantoin for prevention of alcohol withdrawal seizures in high-risk patients using a prospective, randomized, double-blind, placebo-controlled study design...
  38. Rice T. Folic acid in alcohol-withdrawal delirium. Am J Health Syst Pharm. 2005;62:355-6; author reply 356 pubmed
  39. Benson G, McPherson A, Reid S. An alcohol withdrawal tool for use in hospitals. Nurs Times. 2012;108:15-7 pubmed
    ..It is part of a more comprehensive assessment and management protocol and incorporates a protocol to help nurses decide whether to administer fixed-dose or symptom-triggered benzodiazepine to these patients. ..
  40. Grover S, Kate N, Sharma A, Mattoo S, Basu D, Chakrabarti S, et al. Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version. Am J Drug Alcohol Abuse. 2016;42:196-202 pubmed publisher
    The symptom profile of alcohol withdrawal delirium (AWD), relative to deliriums of other etiology, remains uncertain...
  41. Bokström K, Balldin J. A rating scale for assessment of alcohol withdrawal psychopathology (AWIP). Alcohol Clin Exp Res. 1992;16:241-9 pubmed
    ..This new scale, capable of identifying psychopathology and changes over time, may be used alone or together with physiological scales to identify subgroups of patients undergoing withdrawal. ..
  42. de Zeeuw J, Baberg H. [DRG and coding: alcoholism and withdrawal]. Med Klin (Munich). 2006;101:846-7 pubmed
  43. Cole R, Ash J. Benzodiazepine administration and need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35:1810-1; author reply 1811-2 pubmed
  44. Feuerlein W. Neuropsychiatric disorders of alcoholism. Nutr Metab. 1977;21:163-74 pubmed
    ..The pathogenetical aspects as well as the pathological findings have been reviewed with special emphasis on nutritional factors. ..
  45. Kampman K, Volpicelli J, McGinnis D, Alterman A, Weinrieb R, D ANGELO L, et al. Reliability and validity of the Cocaine Selective Severity Assessment. Addict Behav. 1998;23:449-61 pubmed
    ..The CSSA appears to be a reliable and valid measure of cocaine abstinence symptoms and a useful predictor of negative outcomes in cocaine dependence treatment. ..
  46. Nikitopoulos J, Croissant B. [New holistic treatment strategies in alcoholism: the goal is abstinence]. Pflege Z. 2002;55:545-50 pubmed
  47. Pienaar W. Alcohol: use, abuse and dependence. SADJ. 2004;59:284, 286 pubmed
    ..The multidisciplinary team should be involved, and doctors should not hesitate to seek help and advice. Alcoholism is potentially quite treatable. ..
  48. Jaekel C, Paar C, Schiltz J, Peterson R. Care of the trauma patient beyond the emergency department: a patient care standard to guide bedside nurses. J Trauma Nurs. 2009;16:27-32 pubmed publisher
    ..An example of a multiple trauma diagnosis-related patient care standard is presented. ..
  49. Okubo T, Harada S, Higuchi S, Matsushita S. Investigation of quantitative trait loci in the CCKAR gene with susceptibility to alcoholism. Alcohol Clin Exp Res. 2002;26:2S-5S pubmed
    ..In this study, association analyses were re-examined between the polymorphisms of the promoter region of the CCKAR gene and patients with alcohol withdrawal symptoms, in addition to patients with alcoholic liver injury...
  50. Kitabayashi Y, Narumoto J, Shibata K, Ueda H, Fukui K. Neuropsychiatric background of alcohol hallucinosis: a SPECT study. J Neuropsychiatry Clin Neurosci. 2007;19:85 pubmed
  51. Helland A, Skjøtskift S. [Drug treatment of alcohol withdrawal]. Tidsskr Nor Laegeforen. 2008;128:1182-4 pubmed
  52. Dunn N, Cook C. Psychiatric aspects of alcohol misuse. Hosp Med. 1999;60:169-72 pubmed
    ..Liver disease and hypoglycaemia are also associated with their own psychiatric syndromes. Many psychiatric patients also turn to alcohol as an easily available 'medication'...
  53. Spies C, Otter H, Hüske B, Sinha P, Neumann T, Rettig J, et al. Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med. 2003;29:2230-2238 pubmed publisher
    ..continuous infusion adjustment on severity and duration of alcohol withdrawal syndrome (AWS), the medication requirements for AWS treatment, and the effect on ICU stay in surgical intensive care unit (ICU) patients...
  54. Meyer T, Stohler R. [Outpatient alcohol withdrawal]. Praxis (Bern 1994). 2005;94:1555-60 pubmed
    ..The general conditions and the practical process of outpatient detoxification are outlined. At the same time the question of medication of the withdrawal syndrome is addressed...
  55. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010;:CD005063 pubmed publisher
    ..Benzodiazepines have been widely used for the treatment of alcohol withdrawal symptoms. Moreover it is unknown whether different benzodiazepines and different regimens of administration may have the same merits...
  56. Gay N, Lamy O, Pouget R. [Unusual alcoholic weaning, complicated: do you check the blood phosphate?]. Praxis (Bern 1994). 2013;102:49-54 pubmed publisher
    ..A severe hypophosphatemia is diagnosed, associated with hypovitaminosis D, mild hypomagnesemia, mild hypokaliemia and a refeeding syndrome. 24 hours after the normalisation of his phosphatemia, the neurologic symptoms are adjusted...
  57. Banger M, Philipp M, Herth T, Hebenstreit M, Aldenhoff J. Development of a rating scale for quantitative measurement of the alcohol withdrawal syndrome. Eur Arch Psychiatry Clin Neurosci. 1992;241:241-6 pubmed
    ..From these a psychosensory and an autonomic factor have been extracted. This instrument can be used repeatedly for clinical assessment as well as for evaluation of the alcohol withdrawal syndrome in clinical drug studies...
  58. Hori K, Tominaga I, Inada T, Oda T, Hirai S, Hori I, et al. Donepezil-responsive alcohol-related prolonged delirium. Psychiatry Clin Neurosci. 2003;57:603-4 pubmed
  59. Hayanga A, Weiss E. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35:1809-10; author reply 1811-2 pubmed
  60. Welch K. Neurological complications of alcohol and misuse of drugs. Pract Neurol. 2011;11:206-19 pubmed publisher
    ..I hope this review will increase vigilance to the possibility of substance use disorder, and persuade neurologists that they have a role in the detection and treatment of these conditions...
  61. Dickov A, Vuckovic N, Martinovic Mitrovic S, Savkovic I, Dragin D, Dickov V, et al. Disorder verbal memory in alcoholics after delirium tremens. Eur Rev Med Pharmacol Sci. 2012;16:1052-60 pubmed
    ..However, it is not that well known whether the consequences of the damage following delirium are only quantitative or qualitative...
  62. Palmstierna T. A model for predicting alcohol withdrawal delirium. Psychiatr Serv. 2001;52:820-3 pubmed
    The aim of this study was to develop a model for identifying patients with a high risk of developing alcohol withdrawal delirium after assessment in the emergency department.
  63. Kela N, Kela P. [Learning in nursing: too much of a good thing]. Pflege Z. 2002;55:569-70 pubmed
  64. Cook R, Chung T, Kelly T, Clark D. Alcohol screening in young persons attending a sexually transmitted disease clinic. Comparison of AUDIT, CRAFFT, and CAGE instruments. J Gen Intern Med. 2005;20:1-6 pubmed
  65. Pourhassan S. [Postoperative delirium]. Chirurg. 2006;77:858-60; author reply 860 pubmed
  66. Bergese S, Khabiri B, Roberts W, Howie M, McSweeney T, Gerhardt M. Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases. J Clin Anesth. 2007;19:141-4 pubmed
    ..Dexmedetomidine was used to provide a moderate level of conscious sedation without causing respiratory distress or hemodynamic instability during fiberoptic intubation...
  67. Jockers Scherübl M, Bauer A, Kuhn S, Reischies F, Danker Hopfe H, Schmidt L, et al. Nerve growth factor in serum is a marker of the stage of alcohol disease. Neurosci Lett. 2007;419:78-82 pubmed
    ..In accordance with this hypothesis, NGF values are "normal" in patients with persistent alcohol-related cognitive decline...
  68. McKeon A, Frye M, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry. 2008;79:854-62 pubmed
    ..Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients...
  69. Al Sinawi H, Al Adawi S, Al Guenedi A. Ramadan fasting triggering koro-like symptoms during acute alcohol withdrawal: a case report from Oman. Transcult Psychiatry. 2008;45:695-704 pubmed publisher
    ..The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro...
  70. Pienaar W, Roberts M, Emsley R, Aalbers C, Taljaard F. The thyrotropin releasing hormone stimulation test in alcoholism. Alcohol Alcohol. 1995;30:661-7 pubmed
    ..A possible role of genetic factors and serum magnesium needs to be further explored...
  71. Wasilewski D, Matsumoto H, Kur E, Dziklińska A, Woźny E, Stencka K, et al. Assessment of diazepam loading dose therapy of delirium tremens. Alcohol Alcohol. 1996;31:273-8 pubmed
    ..The results show a large efficacy of the loading dose method corresponding to substantial reduction of the psychosis duration (fivefold in comparison to the control group). The method proved to be safe, with no significant complications...
  72. Muhl E. [Delirium and intensive care unit syndrome]. Chirurg. 2006;77:463-71; quiz 472 pubmed
    ..Knowledge of differential diagnosis and causality is essential for curative therapy. Drug therapy is recommended for the treatment of psychotic symptoms and vegetative disorders...
  73. Scott D, Williams C, Cain G, Kwagyan J, Kalu N, Ehlers C, et al. Clinical course of alcohol dependence in African Americans. J Addict Dis. 2008;27:43-50 pubmed publisher
    ..The sequence and progression of alcohol related life events were investigated in a sample of African Americans and compared with findings from a predominantly Caucasian sample...
  74. Monte Secades R, Rabuñal Rey R, Paz Fuentes F, Pazos Ferro A, Pertega Diaz S, Bal Alvaredo M, et al. [Course of alcohol withdrawal syndrome in a general hospital]. Adicciones. 2010;22:141-6 pubmed
    ..The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications...
  75. Soyka M, Helten B, Cleves M, Schmidt P. High rehospitalization rate in alcohol-induced psychotic disorder. Eur Arch Psychiatry Clin Neurosci. 2013;263:309-13 pubmed publisher
    ..More follow-up studies are needed to elucidate this syndrome...
  76. Jost A, Hermle L, Spitzer M, Oepen G. [Clinical and laboratory differentiation of alcohol withdrawal syndrome ("predelirium") and alcoholic delirium]. Psychiatr Prax. 1992;19:16-22 pubmed
    In a retrospective study, data from 99 male and female inpatients with alcohol withdrawal syndrome or alcohol withdrawal delirium, treated between 1977 and 1987, were analyzed...
  77. Brambilla F, Zarattini F, Gianelli A, Bianchi M, Panerai A. Plasma opioids in alcoholics after acute alcohol consumption and withdrawal. Acta Psychiatr Scand. 1988;77:63-6 pubmed
    ..Beta-EP and beta-LPH concentrations were normal on all four occasions. A reduced sensitivity of opioid receptors to acute alcohol administration due to chronic alcohol consumption is suggested...
  78. Rosenwasser A. Alcohol, antidepressants, and circadian rhythms. Human and animal models. Alcohol Res Health. 2001;25:126-35 pubmed
    ..However, other neurochemical systems also are likely to be involved...
  79. Breuer J, Neumann T, Heinz A, Kox W, Spies C. [The alcoholic patient in the daily routine]. Wien Klin Wochenschr. 2003;115:618-33 pubmed
  80. McMullin N, Queen J. A construction worker with recent confusion, disorientation, and somnolence. Cleve Clin J Med. 2004;71:809-14 pubmed
  81. Nagel M, Ferbert A. [Diseases due to alcoholism]. Fortschr Neurol Psychiatr. 2005;73:470-82; quiz 483-4 pubmed
  82. Treutlein J, Cichon S, Ridinger M, Wodarz N, Soyka M, Zill P, et al. Genome-wide association study of alcohol dependence. Arch Gen Psychiatry. 2009;66:773-84 pubmed publisher
    ..Identification of genes that contribute to alcohol dependence will improve our understanding of the mechanisms that underlie this disorder...
  83. Caspari D, Wappler M, Bellaire W. [Treatment of delirium tremens--a comparison between clomethiazole and clorazepate with reference to effectiveness and rate of side effects]. Psychiatr Prax. 1992;19:23-7 pubmed
    ..So treatment with clorazepate proved to be an alternative to standard therapy with clomethiazol even for severe cases of delirium tremens regarding its wide therapeutical range and the low rate of cardio-pulmonary complications...
  84. Hawley R, Schulman E, Major L, Poplack J, Catravas G. Elevated cerebrospinal fluid histidine in alcohol withdrawal. Alcohol. 1988;5:321-3 pubmed
    ..Possible reasons for these high concentrations and the extreme variability (especially early in alcohol withdrawal) are discussed...
  85. Nardoni A, Copetti R, Baldissera S, Busettini G, Cella R, Nador G. [Hypopotassemia during delirium tremens. Pathogenesis and clinical significance]. Minerva Med. 1982;73:3059-62 pubmed
    ..The authors think that an adrenergic mechanism is responsible for this quick and transient hypokalemia. The significance of this adrenergic mechanism in the alcohol withdrawal syndrome is at present widely proved...
  86. Batel P, Lariviere P. [Late-onset alcohol withdrawal syndrome]. Ann Med Interne (Paris). 2000;151 Suppl B:B27-9 pubmed
    ..The first symptoms of AWS appeared only the 4-th day after hospitalization and the patient quickly developed a clinical state of delirium tremens. Delay in the onset of this AWS is discussed...
  87. Litton K. Delirium in the critical care patient: what the professional staff needs to know. Crit Care Nurs Q. 2003;26:208-13 pubmed
    ..A comprehensive and aggressive clinical management plan that incorporates appropriate pharmacological agents will result in less morbidity and improved long-term outcomes...
  88. Irwin P, Murray S, Bilinski A, Chern B, Stafford B. Alcohol withdrawal as an underrated cause of agitated delirium and terminal restlessness in patients with advanced malignancy. J Pain Symptom Manage. 2005;29:104-8 pubmed
    ..Many of the medications utilized for the treatment of agitated delirium and terminal restlessness in the palliative care setting are effective therapies for alcohol withdrawal...
  89. Zaleski M, Morato G, Silva V, Lemos T. [Neuropharmacological aspects of chronic alcohol use and withdrawal syndrome]. Rev Bras Psiquiatr. 2004;26 Suppl 1:S40-2 pubmed
    ..This understanding is necessary to new pharmacological options to alcohol harm reduction as well as to alcohol withdrawal treatment...
  90. Narumoto J, Oka S, Shimizu H, Sumi M, Kitabayashi Y, Ueda H, et al. Case of prolonged alcohol withdrawal syndrome accompanied with hyperthyroidsim. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2005;40:57-9 pubmed
    ..In addition, cognitive function was recovered to the normal level as he scored 28/30 on the Mini Mental State Examination. We propose that hyperthyroidism contributed to the occurrence of psychotic symptoms and cognitive dysfunction...
  91. Phung O, Quercia R, Keating K, Baker W, Bell J, White C, et al. Improved glucose control associated with i.v. chromium administration in two patients receiving enteral nutrition. Am J Health Syst Pharm. 2010;67:535-41 pubmed publisher
    ..The effect of i.v. chromium administration on glucose control in two patients receiving enteral nutrition is described...
  92. Niemela S. [Treatment of alcohol withdrawal symptoms]. Duodecim. 2011;127:1373-7 pubmed
    ..Initiation of rehabilitation is determined by the severity of the patient's withdrawal symptoms. Benzodiazepines are the first-line drugs...