Alcohol Withdrawal Syndrome and Delirium –  from its Pathophysiology to Treatment


Authors: T. Kašpárek;  M. Dreisig;  R. Barteček
Authors‘ workplace: Psychiatrická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2014; 77/110(2): 153-157
Category: Review Article

Overview

Alcohol dependence leads to adaptations of the nervous system that leads to withdrawal syndrome manifestation when regular alcohol consumption is abruptly discontinued. Withdrawal syndrome is characterized mainly by excessive excitatory and diminished inhibitory mechanisms, mediated by glutamatergic and gaba-ergic systems. This imbalance leads to anxiety, restlessness, tremor and decreased seizure threshold. Furthermore, changes to dopaminergic, serotoninergic, noradrenergic, opioid system, or corticotropin releasing hormone-related activation of stress reaction contribute to the clinical picture that includes vegetative hyperactivity, affective changes, dysphoria, hypohedonia, etc. Delirium – a complication of severe withdrawal – is a significant clinical syndrome that complicates health care management and may lead to fatal outcomes. Treatment of alcohol withdrawal and delirium is based on gradual establishment of a new balance of excitatory and inhibitory systems without the presence of external inhibitory substance – alcohol. In clinical practice the pathophysiology is reflected in the administration of gaba-ergic compounds (benzodiazepines, clomethiazole) with gradual dose tapering. Complex effect of alcohol with a number of related somatic complications requires additional systematic somatic care.

Key words:
alcohol – withdrawal syndrome – delirium – neurotoxicity

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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