Withdrawal symptoms definition

Similarly opioid peptides are important in nicotine addiction and may have a role in causing nicotine withdrawal symptoms in some smokers [35]. Opioid antagonists such as naltrexone are licensed treatments for dependence syndromes arising from other addictive drugs and could also be of use in some smokers to aid nicotine withdrawal [59] although there is no definitive evidence overall that they are beneficial [60]. 

The first definition of MCS was created by Theron Randolph in 1962. Randolph described MCS as a condition that (1) is acquired (2) includes physical and mental symptoms that can be triggered by chemical exposure (3) has a specific adaptation syndrome (i.e., adaptation to chemicals is followed by chronic illness, withdrawal symptoms upon removal, and shock upon re-exposure) (4) is characterized by a spreading phenomena (i.e., an intolerance to an increasing number of environmental chemicals) and (5) may be resolved by avoidance of chemicals. 

Evidence does not exclude the participation of psychogenic factors in the modification of the opiate abstinence syndrome (6). The reaction of the subject to his discomfort and to the meaning of withdrawal of drugs certainly contributes to the total picture of abstinence. Addicts with the same degree of physical habit react to the discomfort of withdrawal with widely different degrees of mental intensity. The hypothesis that withdrawal symptoms are entirely psychic is not tenable in view of the definite abstinence syndromes which have been produced in various lower animals and in view of the work of Wilder with chronic spinal and decorticated dogs. Wikler s results indicate that some components of physical dependence still develop under conditions where they can have no symbolic significance for the animal. These components are definitely nonmental (noncerebral). 

Attention has been drawrn previously to reports of withdrawal symptoms when certain benzodiazepine compounds were stopped (39 ). The question of whether benzodiazepine dependence occurs has remained unsettled. Difficulty has arisen because concepts of addiction have traditionally related to the clinical picture associated with withdrawal of narcotic compounds this is the problem of definition. The consideration of benzodiazepine dependence is particularly hampered because possible withdraw symptoms closely resemble the clinical features of anxiety for which the compoimd was given, leading to confusion between a withdrawal syndrome and a relapse of anxiety (41 ). This may well have led to an overacceptance of benzodiazepines as safe from dependency problems recognized in other minor tranquillizers. 

If an antidepressant is discontinued too early, rapid and serious relapse may result. This indicates that, whereas antidepressants may shorten or curb a depressive episode, they cannot definitely end and hence cure it. The attenuation of depressive symptoms is thus not a sufficient criterion for withdrawing drug therapy (Chapter 8). The decision as to when an antidepressant may be discontinued is often difficult and also dependent on the chronicitv of the patient s depression and the number of episodes of depression experienced. 

The beneficial effects were related to these plasma concentrations, as were the time to the first bout of atrial fibrillation, the frequency of bouts of atrial fibrillation, and the time between episodes. However, when atrial fibrillation occurred there was no difference in the ventricular rate in the different groups. Adverse effects necessitated drug withdrawal in four patients one had heart failure and two had gastrointestinal symptoms. These effects were not dose-related, although there were too few occurrences for a definitive conclusion. The authors suggested that this stepwise approach, with increasing doses of propafenone and increasing doses of quinidine could be beneficial in the treatment of paroxysmal atrial fibrillation. 

In addition to the previous definition, withdrawal can be further described as the development of a substance-specific syndrome after cessation of or reduction in intake of a substance that was used regularly by the individual to induce a state of intoxication. Withdrawal causes significant distress to the individual and is associated with impairment in social, occupational, or other areas of functioning. Withdrawal is usually associated with substance dependence. Withdrawal generally is also associated with a craving to readminister the drug to relieve the symptoms. 

The DSM-IV-TR definition of alcohol withdrawal includes two main components The first component is a history of cessation or reduction in heavy and prolonged alcohol use. The second includes the presence of two or more of the symptoms of alcohol withdrawal. Signs and symptoms of alcohol withdrawal as weU as acute alcohol intoxication are shown in Table 65-3. 

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