Abstinence syndrome withdrawal alcohol

The abstinence syndrome (synonym, withdrawal symptom) is observed after withdrawal of a dtug to which a person is addicted. For example, the abstinence syndrome after alcohol withdrawal is characterized by tremor, nausea, tachycardia, sweating and sometimes hallucinations. 

Ethanol also reduces the activity of the noradrenergic system in the locus coeruleus, and alterations in norepinephrine activity may account for some aspects of intoxication and the abstinence syndrome. The 0.2 antagonist clon-idine and the P-receptor antagonist propranolol reduce some symptoms of alcohol withdrawal (Bailly et al. 1992 Carlsson and Fasth 1976 Dobrydnjov et al. 2004 Kahkonen 2003 Petty et al. 1997 Wong et al. 2003). 

One major reason for the movement away from the medical use of barbiturates involves tolerance and dependence. Tolerance develops fairly rapidly to many effects of the barbiturates. Whereas a given dose may be effective at inducing sleep for a while, if the drug is used regularly the patient soon may require a higher dose in order to sleep. If doses escalate too much and regular use persists, the patient will experience an abstinence syndrome when he or she attempts to withdraw from barbiturates. The symptoms of the barbiturate withdrawal syndrome are similar to those of alcohol— shakes, perspiration, confusion, and in some cases full-blown delirium tremens (DTs) (see Chapter 9)—but convulsions and seizures are more likely to occur in barbiturate... 

Observational studies Tincture of opium is a preparation of powdered opium, which contains morphine, codeine, papaverine, and alcohol. It is used as an antidiarrheal agent, to treat neonatal abstinence syndrome, in the management of pain, and traditionally for the management of opioid dependency in some Asian countries. In an open study, opium-dependent subjects were allocated to three different doses of tincture of opium twice a day 10 ml (6.66 mg morphine equivalents n = 13), 20 ml (13.3 mg morphine equivalents n = 8), and 30 ml (20 mg morphine equivalents n = 11) [1 j. In all the subjects tincture of opium effectively suppressed withdrawal symptoms without causing significant adverse effects. 

The immediate concern in the treatment of alcoholics is detoxification and management of the ethanol withdrawal syndrome. Once the patient is detoxified, longterm treatment requires complete abstinence, psychiatric treatment, family involvement, and frequently support from lay organizations such as Alcoholics Anonymous. 

This condition may emerge after a period of relative or absolute abstinence, with the cause being unknown. The duration of drinking and quantity of alcohol required to produce noticeable symptoms vary widely. Abstinence may also result from intercurrent illness, hospitalization for an unrelated illness, or lack of money to buy alcohol. The full spectrum of this syndrome, which ranges from an early, mild withdrawal picture to delirium is frequently seen in large urban hospital emergency room settings. 

The treatment of alcohol withdrawal incorporates general supportive measures, as well as management of specific symptoms. Supportive measures include abstinence from alcohol, ample rest, adequate general nutrition, and reality orientation. It is important to treat the syndrome vigorously and, when appropriate, to prevent it by using sufficient doses of medication. 

After the alcohol withdrawal syndrome has been treated acutely, sedative-hypnotic medications must be tapered slowly over several weeks. Complete detoxification is not achieved with just a few days of alcohol abstinence. Several months... 

Psychiatric symptoms are very common in alcohol intoxication and withdrawal, but studies by Schuckit show that most of these symptoms improve greatly within one to four weeks of abstinence and are likely to abate over several months (Brown and Schuckit 1988 Schuckit, Irwin, and Brown 1990). The three diagnoses associated with increased risk of alcoholism are schizophrenia, mania, and antisocial personality disorder. As a depressant, alcohol tends to produce depressive symptoms during intoxication and anxiety symptoms during withdrawal and abstinence. These syndromes often mimic major depression or an anxiety disorder, but they will usually resolve within two weeks of abstinence and do not require prolonged treatment. 

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