Withdrawal state

Brunning J, Mumford JP and Keaney FP (1986). Lofexidine in alcohol withdrawal states. Alcohol and Alcoholism, 21, 167-170. 

Fig. 22.1 Mechanisms underlying substance abuse. Addictive behavior is seen as a cyclical process where anticipation of the pleasure resulting from use of the drug leads to failure of the psychological mechanisms that usually control consumption. Excess quantities of drug are taken and an unpleasant withdrawal state arises when drug levels fall. This leads to...

A range of cellular changes occurs following repeated drug administration and these processes may help to give rise to the withdrawal state [7]. New proteins that are synthesized include transcription factors in the Fos family, which increase responsiveness to the beneficial effects of drugs [8], These cellular changes coincide with the withdrawal state characterized by depression, irritability and anxiety. 

Drug withdrawal states (alcohol, ctj-adrenergic agonists, antidepressants, barbiturates, benzodiazepines, opiates)... 

In mice, somatic signs of withdrawal include wet dog shakes, front paw tremor, ataxia, hunched posture, tremor, ptosis, piloerection, mastication and decreased locomotor activity (Hutcheson et al. 1998). The CBl antagonist (SR141716A) has been used to precipitate a withdrawal state in THC-tolerant animals, and higher doses of THC produced a greater withdrawal syndrome (Aceto et al. 1995 Cook et al. 1998). Withdrawal from chronic cannabis use reduces mesolimbic dopaminer-... 

In this chapter, we will focus primarily on treatments for the substance use disorders. However, because detoxification during a substance-induced withdrawal is often the first step in treating a substance use disorder, we will discuss withdrawal states to some extent. The substance use disorders include both substance abuse and the more serious substance dependence. Substance abuse consists of a pattern of misuse that causes recurring problems in at least one aspect of life. This can be a failure to fulfill responsibilities at home or work, reckless use of the substance such as drunken driving, repeated substance-related arrests, and ongoing substance use despite resulting problems in family relationships. See Table 6.1 for the diagnostic criteria for substance abuse. 

It is indicated in organic brain syndrome, intellectual impairment of senility, encephalitis, alcohol withdrawal state and perinatal distress, cerebrovascular accidents, and organic psychosyndrome. 

Pharmacological treatments were used by nearly half of the 149 services which offered any treatment, with a wide range of medications directed at various features of cocaine usage. Fluoxetine and desipramine were the most frequently prescribed antidepressants, with benzodiazepines used to aid sleep and reduce distress in withdrawal states. Sedative antipsychotics were used, apparently in states of severe agitation as well as more directly for psychotic complications. 

Intoxication mimicking functional psychosis Pathoplastic reactions in functional psychosis Chronic hallucinosis ( flashbacks ) Drug-induced relapse of functional psychosis Withdrawal states Based on Poole and Brabbins (1996)... 

Benzodiazepines (BZDs) may be given to patients with moderate agitation. These agents also are the treatment of choice in alcohol withdrawal states, characterized by agitation, tremors, or change in vital signs (see also the section The Alcoholic Patient in Chapter 14) (156). 

Anticonvulsants such as valproate and CBZ are effective mood-stabilizing agents and may be useful in withdrawal states from alcohol, BZDs, and cocaine... 

Moss JH. Sedative and hypnotic withdrawal states in hospitalised patients [Letter], Lancet 1991 338 575. 

For control of ethanol or other sedative-hypnotic withdrawal states... 

As a component of balanced anesthesia (intravenous administration) For control of ethanol or other sedative-hypnotic withdrawal states For muscle relaxation in specific neuromuscular disorders... 

Maternal clomipramine use is associated with seizures in neonates but this case appears to have been caused by a withdrawal state that was relieved by clomipramine administration. 

The literature on a withdrawal syndrome (SEDA-10, 17) has been expanded by further reports. One of these (33) involved the development of an acute toxic delirium 3 days after withdrawal of phenelzine, and another (34) concerned patients who became manic after withdrawal of isocarboxazid. A withdrawal state similar to that caused by withdrawal from amphetamines has been described after withdrawal of tranylcypromine (SEDA-16, 8) (SEDA-18,14). 

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

Uses. Benzodiazepines are used for insomnia, anxiety, alcohol withdrawal states, muscle spasm due to a variety of causes, including tetanus and cerebral spasticity, epilepsy (clonazepam, see p. 421), anaesthesia and sedation for endoscopies and cardioversion. 

Article IX (Duration and withdrawal) states that the Treaty is of unlimited duration. 

Six cases of complications loosely related to the use of naltrexone pellet implantation during the highly controversial rapid and ultra-rapid opioid detoxification procedures have been reported (22). These included pulmonary edema, prolonged opioid withdrawal states, drug toxicity, withdrawal from cross-dependence to alcohol and benzodiazepines, aspiration pneumonia, and death. The risk of these controversial procedures and of naltrexone in this novel delivery system are high a robust scientifically validated program of research is needed to justify such treatment packages. 

Lader, M. (1983). Benzodiazepine withdrawal states. In M. R. Trimble (F,d.), Benzodiazepines divided A multidisciplinary rei iew(pp. 17-32). New York John Wiley. 

I Reduced DA concentrations are seen in withdrawal states and are likely to be associated with depression, irritability, dysphoria. 

Tryptophan is the most extensively studied amino acid in relation to alcohol and alcoholism. This is probably because it is the precursor of serotonin. Serotonin levels as altered by ethanol could have a role in disturbances in mood, clinical features of alcohol dependence, and alcohol withdrawal states. The control of alcohol consumption itself by serotonin has been considered.96 Accounts of the effects of ethanol on tryptophan and serotonin metabolism have been reviewed.9798 This section limits itself to selected aspects of ethanol and tryptophan metabolism in experimental animals and in humans. How these changes may secondarily affect serotonin metabolism is mentioned. 

Diazepam Anxiety, preop sedation, muscle relaxation, withdrawal states Longest-acting BZ, forms 3 active metabolites... 

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