2,620 results match your criteria Delirium Tremens


Delirium Tremens and Central Pontine Myelinolysis in a Patient with Alcohol Use Disorder and Pneumonia: a Case Report and a Narrative Review.

Fortschr Neurol Psychiatr 2022 Apr 28. Epub 2022 Apr 28.

Department of Psychiatry, University of Health Science-Gulhane Teaching and Research Hospital, Ankara, Turkey.

Introduction: Delirium tremens (DT) is a serious condition occurring in alcohol withdrawal syndrome. Alcohol consumption may also cause additional health problems, such as respiratory infections or neuropsychiatric conditions such as central pontine myelinolysis. In this clinical scenario, managing DT can be expected to be more compelling and complex. Read More

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Pneumonia is a common and early complication of the Severe Alcohol Withdrawal Syndrome (SAWS).

Heart Lung 2022 Apr 22;55:42-48. Epub 2022 Apr 22.

Valleywise Medical Center, Phoenix, AZ, United States.

Background: Pneumonia (PNA) may complicate the Severe Alcohol Withdrawal Syndrome (SAWS), with ICU admission, mechanical ventilation (MV), prolonged length of stay (LOS), and adverse events.

Objectives: To examine the onset, features and courses of PNA in patients with SAWS to aid management.

Methods: A 33 month contiguous review of SAWS and PNA was conducted at an urban public hospital. Read More

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Association Between Sedative Medication Administration and Delirium Development in a Medical Intensive Care Unit.

J Pharm Pract 2022 Apr 23:8971900221096978. Epub 2022 Apr 23.

Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.

Background: Delirium develops frequently in intensive care unit (ICU) patients. Societal guidelines have suggested that benzodiazepines may cause delirium. This study investigates if a change in sedation administration use over time is associated with changes in delirium incidence. Read More

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Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes: Results From a Single-Center Study.

Pancreas 2022 02;51(2):177-182

From the Division of Gastroenterology, Department of Internal Medicine.

Objective: Patients with acute pancreatitis (AP) are at risk for extrapancreatic complications (EPCs) when admitted to the intensive care unit (ICU). We assessed the prevalence of EPCs in non-ICU AP patients and their outcomes.

Methods: We retrospectively studied EPCs in non-ICU AP patients between 2008 and 2018. Read More

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February 2022

Dexmedetomidine: a magic bullet on its way into palliative care-a narrative review and practice recommendations.

Ann Palliat Med 2022 Apr 6;11(4):1491-1504. Epub 2022 Apr 6.

Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland IOSI-EOC, Lugano, Switzerland.

Background And Objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and holding analgesic properties fosters the interest for this drug in the palliative care field. Read More

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Efficacy of tiapride in the treatment of psychiatric disorders: A systematic review.

Hum Psychopharmacol 2022 Mar 21:e2842. Epub 2022 Mar 21.

Department of Health Sciences, University of Milan, Milan, Italy.

Background: Tiapride is an atypical antipsychotic used to treat alcohol withdrawal, aggressiveness and agitation, headache, dyskinesias, tic and Tourette's disorder. More recently, it has been proposed for the treatment of delirium and agitation in hospitalised patients with COVID-19. Although its safety profile makes it suitable for use in vulnerable populations, the use of tiapride for psychiatric disorders is limited. Read More

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Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: a systematic review and network meta-analysis.

Addiction 2022 Feb 22. Epub 2022 Feb 22.

Department of Community Health Sciences, School of Public Health, Boston University School of Public Health, Boston, MA, USA.

Background And Aims: There have been few head-to-head clinical trials of pharmacotherapies for alcohol withdrawal (AW). We, therefore, aimed to evaluate the comparative performance of pharmacotherapies for AW.

Methods: Six databases were searched for randomized clinical trials through November 2021. Read More

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February 2022

Clinical characteristics and health outcomes in patients with alcohol withdrawal syndrome: an observational study from Oman.

Ann Saudi Med 2022 Jan-Feb;42(1):52-57. Epub 2022 Feb 3.

From the Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.

Background: Globally, alcohol withdrawal syndrome (AWS) is considered a serious medical diagnosis associated with increasing morbidity and mortality. Little information has been reported on the scope of the problem in Oman.

Objective: Study clinical characteristics, management, quality of care, and health outcomes of patients managed for AWS. Read More

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February 2022

How should dexmedetomidine and clonidine be prescribed in the critical care setting?

Rev Bras Ter Intensiva 2022 24;33(4):600-615. Epub 2022 Jan 24.

Hôpital d'Instruction des Armées Desgenettes - Lyon, França.

Cardiac, ventilatory and kidney management in the critical care setting has been optimized over the past decades. Cognition and sedation represent one of the last remaning challenges. As conventional sedation is suboptimal and as the sedation evoked by alpha-2 adrenergic agonists ("cooperative" sedation with dexmedetomidine, clonidine or guanfacine) represents a valuable alternative, this manuscript covers three practical topics for which evidence-based medicine is lacking: a) Switching from conventional to cooperative sedation ("switching"): the short answer is the abrupt withdrawal of conventional sedation, immediate implementation of alpha-2 agonist infusion and the use of "rescue sedation" (midazolam bolus[es]) or "breakthrough sedation" (haloperidol bolus[es]) to stabilize cooperative sedation. Read More

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January 2022

Phenobarbital for the management of severe acute alcohol withdrawal (the PHENOMANAL trial): a pilot randomized controlled trial.

Pilot Feasibility Stud 2022 Jan 22;8(1):14. Epub 2022 Jan 22.

Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada.

Background: Benzodiazepines are considered first-line treatment for patients experiencing severe acute alcohol withdrawal syndrome (sAAWS). Although several medications have been evaluated as potential adjuvant treatments for sAAWS, barbiturates show particular promise.

Objective: In the PHENOMANAL trial, we will assess the feasibility of conducting an allocation-concealed, quadruple-blinded, randomized controlled trial (RCT) comparing symptom-triggered benzodiazepine therapy with either a single dose of adjuvant intravenous (IV) phenobarbital (7. Read More

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January 2022

Refractory delirium tremens treated with ketamine.

J Psychopharmacol 2022 02 11;36(2):245-246. Epub 2022 Jan 11.

Department of Anesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy.

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February 2022

Alcohol withdrawal syndrome in ICU patients: Clinical features, management, and outcome predictors.

PLoS One 2021 20;16(12):e0261443. Epub 2021 Dec 20.

Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France.

Background: Alcohol withdrawal syndrome (AWS) is a common condition in hospitalized patients, yet its epidemiology in the ICU remains poorly characterized.

Methods: Retrospective cohort of patients admitted to the Nantes University Hospital ICU between January 1, 2017, and December 31, 2019, and coded for AWS using ICD-10 criteria. The objective of the study was to identify factors associated with complicated hospital stay defined as ICU length of stay ≥7 days or hospital mortality. Read More

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January 2022

Acute Colonic Pseudo-Obstruction Following the Use of Dexmedetomidine.

Cureus 2021 Nov 11;13(11):e19465. Epub 2021 Nov 11.

Pulmonology and Critical Care, Veterans Affairs New York Harbor Health Care (VA NYHHS), Brooklyn, USA.

Dexmedetomidine is a preferred agent for light sedation with minimal adverse effects. We report a case of acute colonic pseudo-obstruction following dexmedetomidine use in a patient with alcohol withdrawal. He was treated with benzodiazepines first to control the withdrawal symptoms, then escalated to dexmedetomidine once delirium tremens ensued. Read More

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November 2021

Clinical guideline highlights for the hospitalist: 2020 American Society of Addiction Medicine clinical practice guideline on alcohol withdrawal management.

J Hosp Med 2022 Jan;17(1):47-49

Medical Service, VA Boston Healthcare System, West Roxbury, Massachusetts.

Guideline Title: The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management RELEASE DATE: May 2020 PRIOR VERSION: 2004 American Society of Addiction Medicine guideline on management of alcohol withdrawal delirium DEVELOPER: American Society of Addiction Medicine FUNDING SOURCE: American Society of Addiction Medicine TARGET POPULATION: Adults hospitalized with alcohol withdrawal syndrome of any severity. Read More

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January 2022

Differentiation of hepatic encephalopathy from delirium tremens: A case series and review.

Ind Psychiatry J 2021 Oct 22;30(Suppl 1):S214-S220. Epub 2021 Oct 22.

Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.

Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Read More

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October 2021

Impact of Adjuvant Anticonvulsant Medications on Benzodiazepine Use and Delirium in Alcohol Withdrawal Syndrome.

Prim Care Companion CNS Disord 2021 Oct 21;23(5). Epub 2021 Oct 21.

Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland.

To assess the benefits of anticonvulsant medications on benzodiazepine (BZD) use and delirium in patients with alcohol dependence at risk of alcohol withdrawal and admitted to the hospital without delirium.

This was a resident-led retrospective study of prospectively collected data for patients admitted to the monitored unit of a general medical ward between June 2016 and March 2017 for a variety of medical conditions. Patients were assigned to the usual care group (BZD as needed) or the intervention group (scheduled anticonvulsants and BZD as needed) based on admission census and order of arrival. Read More

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October 2021

[The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry].

Z Kinder Jugendpsychiatr Psychother 2021 Oct 20. Epub 2021 Oct 20.

Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg.

The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry Emergencies in child and adolescent psychiatry are highly prevalent and often pose significant challenges to physicians, since substantial danger to the patient or others must be avoided through the application of largely moderate interventions. Besides using de-escalating strategies and exploiting psychotherapeutic options, the physician frequently employs psychopharmacological interventions. because of a lack of systematically assessed data, however, in emergencies in child and adolescent psychiatry most administrations of psychotropic drugs occur "off label. Read More

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October 2021

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement.

Am J Respir Crit Care Med 2021 10;204(7):e61-e87

Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T-T continuum to advance the care of hospitalized patients who experience SAWS. Read More

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October 2021

Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review.

Drug Alcohol Depend 2021 11 24;228:109052. Epub 2021 Sep 24.

Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States.

Background: Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First.

Methods: A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Read More

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November 2021

Quantity of phenibut in dietary supplements before and after FDA warnings.

Clin Toxicol (Phila) 2022 Apr 22;60(4):486-488. Epub 2021 Sep 22.

Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, CA, USA.

Introduction: Phenibut is used to treat anxiety, insomnia, alcohol withdrawal and other conditions in Russia. The drug, however, has abuse potential and may cause lethargy, delirium, psychosis and coma. In the United States (US), the US Food and Drug Administration (FDA) has never approved the use of phenibut as a prescription medication, but the drug is available over-the-counter in dietary supplements. Read More

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Alcohol Withdrawal Syndrome: Outpatient Management.

Am Fam Physician 2021 Sep;104(3):253-262

Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

Approximately one-half of patients with alcohol use disorder who abruptly stop or reduce their alcohol use will develop signs or symptoms of alcohol withdrawal syndrome. The syndrome is due to overactivity of the central and autonomic nervous systems, leading to tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation. If untreated or inadequately treated, withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death. Read More

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September 2021

Closed-Eye Visual Hallucinations Preceding Severe Alcohol Withdrawal.

Cureus 2021 Aug 9;13(8):e17040. Epub 2021 Aug 9.

Department of Neurology, Brookdale University Hospital Medical Center, Brooklyn, USA.

Few existing cases of closed-eye visual hallucinations have been reported. These rare perceptual disturbances are distinct from open-eye visual hallucinations, as observed in Charles Bonnet syndrome. This case report discusses a 35-year-old male who presented with closed-eye visual hallucinations 24 hours before severe alcohol withdrawal. Read More

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[Clinical and metabolic predictors for delirium tremens].

Authors:
S I Utkin

Zh Nevrol Psikhiatr Im S S Korsakova 2021 ;121(7):64-69

Moscow Research and Practical Centre for Narcology, Moscow, Russia.

Objective: To search for objective diagnostic criteria for the development of delirium tremens (DT) based on physiological and metabolic parameters.

Material And Methods: The total number of patients was 506, including 393 patients with DT and 113 patients with uncomplicated alcohol withdrawal syndrome (UAWS). Twenty clinical and metabolic indicators were analyzed statistically using comparison of means, logistic regression and ROC-analysis. Read More

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September 2021

Efficacy and Safety of Anticonvulsants for the Inpatient Treatment of Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis.

Alcohol Alcohol 2022 Mar;57(2):155-164

Institute of Medical Research, Grupo Académico de Epidemiología Clínica (GRAEPIC), School of Medicine, Universidad de Antioquia, Medellín, Colombia.

Aim: To examine the efficacy and safety of antiepileptic drugs (AED) for the inpatient treatment of patients with moderate to severe alcohol withdrawal syndrome (AWS).

Methods: We searched in databases and gray literature to include randomized controlled clinical trials in adults that compare the use of AED versus placebo or any other medication. Studies that did not specify severity or were performed on an outpatient basis were excluded. Read More

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A multifaceted quality improvement intervention to improve management of alcohol withdrawal on a general medicine ward: impact on benzodiazepine use.

J Addict Dis 2022 Apr-Jun;40(2):179-182. Epub 2021 Aug 6.

Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.

Objective: To measure the effects of a quality improvement intervention on length of stay and benzodiazepine use among patients admitted for alcohol use disorder.

Methods: This retrospective cohort study was performed at the Salt Lake City Veterans Affairs Medical Center. Patients 18 years and older admitted to a general medical ward with a diagnosis of alcohol related disorders who were treated for alcohol withdrawal were included. Read More

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Clinical management of the alcohol withdrawal syndrome.

Authors:
Ed Day Chris Daly

Addiction 2022 03 22;117(3):804-814. Epub 2021 Aug 22.

Addiction Psychiatry, Greater Manchester Mental Health FT, Chapman Barker Unit, Prestwich Hospital, Manchester, UK.

Up to half of individuals with a history of long-term, heavy alcohol consumption will experience the alcohol withdrawal syndrome (AWS) when consumption is significantly decreased or stopped. In its most severe form, AWS can be life-threatening. Medically assisted withdrawal (MAW) often forms the first part of a treatment pathway. Read More

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[Treatment of alcohol withdrawal syndrome].

Authors:
Y P Sivolap

Zh Nevrol Psikhiatr Im S S Korsakova 2021 ;121(6):139-144

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

Alcohol withdrawal arises in result of long-lasting or short, but massive, alcohol abuse, manifests itself with oppressive symptoms and in some cases is complicated by seizures, hallucinosis and delirium tremens that may be life-threatening for patients. The leading neurochemical factors underlying alcohol withdrawal syndrome and its complications are lack of GABA and excessive glutamate activity, which is important for therapy choice. The first-line drugs in the treatment of alcohol withdrawal syndrome and alcoholic delirium are benzodiazepines, which have the maximum pharmacological similarity with ethanol. Read More

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Iatrogenic Delirium in Patients on Symptom-Triggered Alcohol Withdrawal Protocol: A Case Series.

Cureus 2021 Jun 1;13(6):e15373. Epub 2021 Jun 1.

Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA.

In this report, we present a case series involving four patients placed on the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) protocol for alcohol or sedative-hypnotic withdrawal syndromes, who developed delirium on sustained or increasing symptom-triggered benzodiazepine dosages. In each of the four cases, delirium was not present on admission and resolved in the hospital itself with fixed benzodiazepine tapers. Cases were selected from an electronic medical record database of patients admitted to a United States-based university hospital and placed on CIWA-Ar between 2017 and 2018. Read More

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Factors affecting hallucinations in patients with delirium.

Sci Rep 2021 06 21;11(1):13005. Epub 2021 Jun 21.

Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.

Delirium develops through a multifactorial process and include multiple subtypes with different pathological factors. To refine the treatment and care for delirium, a more detailed examination of these subtypes is needed. Therefore, this study aimed to explore the factors affecting delirium in cases in which hallucinations are conspicuous. Read More

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