Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

2021 ◽  
Author(s):  
Alexander Thompson ◽  
Andrea Weber
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Sustained Remission ◽  
Opioid Agonist ◽  
Dsm 5 ◽  
Cannabis Withdrawal ◽  
Withdrawal Syndromes

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal 

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

2017 ◽  
Author(s):  
Alexander Thompson ◽  
Andrea Weber
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Sustained Remission ◽  
Opioid Agonist ◽  
Dsm 5 ◽  
Cannabis Withdrawal ◽  
Withdrawal Syndromes

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 12 tables, and 100 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal 

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

2021 ◽  
Author(s):  
Alexander Thompson ◽  
Andrea Weber
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Sustained Remission ◽  
Opioid Agonist ◽  
Dsm 5 ◽  
Cannabis Withdrawal ◽  
Withdrawal Syndromes

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal 

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

2021 ◽  
Author(s):  
Alexander Thompson ◽  
Andrea Weber
Keyword(s):  
Alcohol Withdrawal ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Sustained Remission ◽  
Opioid Agonist ◽  
Dsm 5 ◽  
Cannabis Withdrawal ◽  
Withdrawal Syndromes

Withdrawal syndromes are clusters of signs and symptoms that occur with cessation or decrease in use of a substance. All substance withdrawal syndromes are classified and diagnosed based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). All withdrawal syndromes range in their ability to cause significant medical and/or psychiatric consequences. Alcohol withdrawal remains a medically serious syndrome that can occur within hours to days of decreased use and result in hallucinations, delirium, seizures, and death. Despite increasing research into the type, frequency, dose, and route of administration, benzodiazepines remain the first-line treatment in preventing alcohol withdrawal complications. Although typically not medically severe, opioid withdrawal is often associated with relapse even after successful detoxification. Opioid-agonist therapy, including methadone and buprenorphine, remains the treatment of choice for both opioid withdrawal and relapse prevention. Stimulant withdrawal from cocaine or amphetamines can cause significant psychiatric symptoms within minutes to hours of cessation and may require psychiatric hospitalization for suicidal ideation or attempts. There are no current medications approved by the Food and Drug Administration (FDA) for treatment of stimulant withdrawal. Cannabis withdrawal, although not medically dangerous, has recently been adopted as a discrete syndrome in the DSM-5. Its severity correlates significantly with the amount of cannabis used, functional impairment, and ability to achieve sustained remission. There are no current medications approved by the FDA for treatment of cannabis withdrawal. This review contains 6 figures, 13 tables, and 101 references. Key words: alcohol, amphetamine, benzodiazepines, buprenorphine, cannabis, clonidine, cocaine, dexmedetomidine, methadone, opioid, phenobarbital, stimulant, withdrawal 

Drugs Used to Treat Withdrawal Syndromes

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Side Effects ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Opioid Withdrawal ◽  
Baclofen Withdrawal ◽  
Withdrawal Syndromes

This chapter covers the treatment of withdrawal syndromes associated with alcohol, opioids, stimulants, baclofen, and nicotine. The approach to refractory withdrawal delirium is discussed, as well as the management of serious withdrawal syndromes that are neurology-specific, such as baclofen withdrawal. Withdrawal syndromes are serious and may require extensive pharmacotherapy. The safety of the patient must be balanced against the risks and side effects of the medications administered to control the agitation. Prior alcoholism accounts for the overwhelming proportion of patients with withdrawal syndromes. The drugs used for treatment of alcohol withdrawal syndrome include benzodiazepines, dexmedetomidine, and propofol. The prevalence of opioid withdrawal is increasing.

Patients Admitted for Treatment of Alcohol Withdrawal Syndromes; An Epidemiological Study

1971 ◽  
Vol 32 (1) ◽  
pp. 104-115 ◽  
Author(s):  
S. M. Rosenblatt ◽  
M. M. Gross ◽  
Melinda Broman ◽  
Eastlyn Lewis ◽  
Beverly Malenowski
Keyword(s):  
Epidemiological Study ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndromes

Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates

2015 ◽  
Vol 22 (3) ◽  
pp. 163-175 ◽  
Author(s):  
Gilberto Gerra ◽  
Matteo Manfredini ◽  
Lorenzo Somaini ◽  
Icro Maremmani ◽  
Claudio Leonardi ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Psychiatric Symptoms ◽  
Clinical History ◽  
Hormonal Changes ◽  
Opioid Agonist ◽  
Healthy Control ◽  
Methadone Patients

Abstract: A variety of studies evidenced a relationship between drug use disorders and sexual dysfunction. In particular, heroin and opioid agonist medications to treat heroin dependence have been found to be associated with erectile dysfunction and reduced libido. Controversial findings also indicate the possibility of factors other than the pharmacological effects of opioid drugs concurring to sexual dysfunction. With the present study, we investigated the link between sexual dysfunction and long-term exposure to opioid receptor stimulation (heroin dependence, methadone maintenance treatment, methadone dosage), the potentially related hormonal changes reflecting hypothalamus-pituitary-gonadal axis function and prolactin (PRL) pituitary release, the role of adverse childhood experiences in the clinical history and the concomitant symptoms of comorbid mental health disorders in contributing to sexual problems. Forty male patients participating in a long-term methadone treatment program were included in the present study and compared with 40 healthy control subjects who never used drugs nor abused alcohol. All patients and controls were submitted to the Arizona Sexual Experiences Scale (ASEX), Child Experiences of Care and Abuse-Questionnaire (CECA-Q) and the Symptom Check List-90 Scale. A blood sample for testosterone and PRL assays was collected. Methadone dosages were recorded among heroin-dependent patients on maintenance treatment. Methadone patients scored significantly higher than controls on the 5-item rating ASEX scale, on CECA-Q and on Symptoms Check List 90 (SCL 90) scale. Testosterone plasma levels were significantly lower and PRL levels significantly higher in methadone patients with respect to the healthy control group. ASEX scores reflecting sexual dysfunction were directly and significantly correlated with CECA-Q neglect scores and SCL 90 psychiatric symptoms total score. The linear regression model, when applied only to addicted patients, showed that methadone dosages were not significantly correlated with sexual dysfunction scores except for ‘erectile dysfunction', for which an inverse association was evidenced. Testosterone values showed a significant inverse correlation with ASEX sexual dysfunction scores, CECA-Q neglect scores and psychiatric symptom at SCL 90 among methadone patients. PRL levels were directly and significantly correlated with sexual dysfunction scores, psychiatric symptoms at SCL 90 and CECA-Q neglect scores. Both testosterone and PRL did not correlate with methadone dosages. The present findings appear to support the view of childhood adversities and comorbid psychiatric symptoms contributing to sexual dysfunction and related hormonal changes among methadone patients, challenging the assumption that attributes sexual problems entirely to the direct pharmacological effects of opioid agonist medications.

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms

2018 ◽  
Vol 49 (16) ◽  
pp. 2709-2716 ◽  
Author(s):  
Ronald J. Gurrera
Keyword(s):  
Nmda Receptor ◽  
Clinical Features ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Signs And Symptoms ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Unexplained Fever ◽  
Study Inclusion

AbstractBackgroundAnti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder.MethodsA systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains.ResultsTwo hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals.ConclusionsClinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

scholarly journals DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults

2019 ◽  
Vol 195 ◽  
pp. 170-177 ◽  
Author(s):  
Ofir Livne ◽  
Dvora Shmulewitz ◽  
Shaul Lev-Ran ◽  
Deborah S. Hasin
Keyword(s):  
Withdrawal Syndrome ◽  
Clinical Correlates ◽  
Dsm 5 ◽  
Cannabis Withdrawal

scholarly journals Psychiatric Symptomatology in Medical Students in Lebanon: What about us?

2021 ◽  
Author(s):  
Alfred Chabbouh ◽  
Carmen Al Haddad ◽  
Grace El Bejjani ◽  
Vanessa Daou ◽  
Michele Chahoud
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Psychiatric Symptoms ◽  
Healthcare Providers ◽  
Private University ◽  
Additional Stress ◽  
Psychiatric Symptomatology ◽  
Dsm 5 ◽  
Being Bullied ◽  
Level 1

Medical students are an at-risk population to develop mental health disorders, especially students in Lebanon who are facing constant additional stress due to the volatile situation in the country. The present study used the APA’s DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult to screen for psychiatric symptoms in 12 different domains. Out of the sample of 364 students from all universities in Lebanon, only 5.2% had already a psychiatric diagnosis. Of the non-diagnosed subpopulation, a massive percentage of 92.75% screened positive and subsequently, were in need of further mental health evaluation. Roughly half of the participants described the existence of barriers for them to seek mental health services, finances and stigma being major reasons. Predictors of a more severe screen were being from a private university and previously being bullied. The situation in medical schools in Lebanon is profoundly alarming. Shouldn’t the health of future healthcare providers be a priority?

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