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Am J Emerg Med 2019 Jan 30. Epub 2019 Jan 30.

Community Regional Medical Center, P.O. Box 1232, Fresno, CA 93715, United States of America. Electronic address:

Objective: The purpose of this study was to evaluate the safety and efficacy of a single parenteral dose of phenobarbital in addition to symptom-triggered lorazepam for the acute management of alcohol withdrawal syndrome (AWS).

Methods: This was a retrospective chart review of adult patients who presented to the Emergency Department with moderate or severe symptoms of alcohol withdrawal. Patients were included if they received at least 4 mg of lorazepam through the hospital's Alcohol Withdrawal Order Set on hospital day one. Read More

J Addict Med 2019 Feb 6. Epub 2019 Feb 6.

Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD (BKL, VTG, RMK, ASJ); Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (AAHA, TN); Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (ESC); Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD (PM, KP); Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, Baltimore, MD (DAR); Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD (SY).

Objectives: The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol. Read More

Clin Toxicol (Phila) 2019 Feb 7:1-4. Epub 2019 Feb 7.

b Department of Surgery , University of California, Davis Medical Center , Sacramento , CA, USA.

Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Read More

Front Psychiatry 2018 22;9:773. Epub 2019 Jan 22.

Kershaw Unit, Gartnavel Royal Hospital, Glasgow, United Kingdom.

The Alcohol Withdrawal Syndrome (AWS), which may occur with or without delirium, is a frequent consequence of sudden alcohol cessation in patients with moderate to severe Alcohol Dependence Syndrome (ADS). Withdrawal as a result of habituation to alcohol is part of the definition of the Alcohol Dependence Syndrome (ICD10). Since the recognition of Delirium Tremens, in the early nineteenth century, the management of the syndrome, an acute medical emergency, has proven controversial. Read More

Alcohol Alcohol 2019 Feb 5. Epub 2019 Feb 5.

Centre for Addiction Medicine, Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, India.

Aim: To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)-(ICD10).

Methods: Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017.

Results: Out of 2947, 31 (1%) were diagnosed with pellagra. Read More

Acta Psychiatr Scand 2019 Jan 29. Epub 2019 Jan 29.

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Objective: Associations of amount of alcohol intake and beverage type with the risk of delirium tremens (DT) have not been studied. This longitudinal study investigated if the average number of drinks per day and beverage type predict DT.

Methods: A cohort of 3 582 alcohol-dependent men and women aged 19-82 without previous DT were interviewed about alcohol intake and beverage type at baseline in 1994-2005 and followed through record linkage in Danish nationwide registers to identify incident DT. Read More

J Am Geriatr Soc 2019 Jan 21. Epub 2019 Jan 21.

Indiana University Center for Aging Research, Indianapolis, Indiana.

Objective: Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes.

Design: Multisite randomized clinical trial. Read More

Psychiatry J 2018 16;2018:4829389. Epub 2018 Dec 16.

Institute of Clinical Sciences Lund, Department of Psychiatry, Lund University, Baravägen 1, 221 85 Lund, Sweden.

Background: Alcohol use disorders are a major health problem, often with a chronic course. Studies on remission from alcohol use disorders are sparse.

Objective: The aim of this study was to analyse the rate of remission from AUD and the possible influence of other mental disorders and sociodemographic factors on the remission in the Lundby Cohort. Read More

J Clin Exp Hepatol 2018 Dec 5;8(4):460-470. Epub 2018 May 5.

Assistant Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Delirium Tremens (DT) falls in the most severe spectrum of alcohol withdrawal, which could potentially result in death, unless managed promptly and adequately. The prevalence of DT in general population is <1% and nearly 2% in patients with alcohol dependence. DT presents with a combination of severe alcohol withdrawal symptoms and symptoms of delirium with agitation and sometimes hallucination. Read More

Crit Care Nurs Q 2019 Jan/Mar;42(1):12-29

Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Ohio (Drs Foertsch, Winter, Droege, and Ernst); University of Cincinnati James L. Winkle College of Pharmacy, Ohio (Drs Foertsch, Winter, Rhoades, Martin, Droege, and Ernst); Department of Pharmacy Services, The Christ Hospital Health Network, Cincinnati, Ohio (Dr Rhoades); and Department of Pharmacy Services, St Elizabeth Healthcare, Edgewood, Kentucky (Dr Martin).

Alcohol withdrawal syndrome (AWS) is a complex neurologic disorder that develops after an acute reduction in or cessation of chronic alcohol consumption that alters neurotransmitter conduction. The incidence of AWS in the intensive care unit varies, but has been associated with poor outcomes. This is primarily driven by downregulation of gamma-aminobutyric acid (GABA) leading to autonomic excitability and psychomotor agitation. Read More

Am J Emerg Med 2018 Oct 11. Epub 2018 Oct 11.

School of Pharmacy, University of Sydney, Royal Prince Alfred Hospital, Pharmacy and Bank Building (A15), Camperdown Campus, Sydney, New South Wales 2006, Australia. Electronic address:

Objectives: To compare a phenobarbital-adjunct versus benzodiazepine-only approach for the management of alcohol withdrawal syndrome in the emergency department (ED) with regard to the need for intensive care unit (ICU) admission, severity of symptoms on ED discharge, and complications.

Methods: This was a retrospective cohort study conducted in two academic EDs in the United States. Adult patients seen in the ED with a diagnosis of alcohol withdrawal syndrome were included. Read More

Asian J Psychiatr 2018 Dec 24;38:29-30. Epub 2018 Oct 24.

Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India. Electronic address:

Rev Med Brux 2018;39(4):241-245

Service de Psychiatrie-Addictologie, CHU Brugmann, ULB.

This article proposes an update and summary of current knowledge in the management of alcohol withdrawal, based on a review of recent literature. The issues open to debate and the areas whith new developments will be addressed, such as: the entry into treatment, the withdrawal setting, the withdrawal medications, the various possible protocols and the introduction of relapse prevention treatments. Read More

Clin Nurse Spec 2018 Nov/Dec;32(6):307-312

Author Affiliations: Clinical Nurse Specialists (Mss Davis and Keen), Indiana University Health, University Hospital, Indianapolis; Clinical Nurse Specialist (Mr Holly), Indiana University Health, Bloomington Hospital; Clinical Nurse Specialist (Ms Balaguras), Indiana University Health, Bloomington Hospital; and Assistant Professor (Dr Miller), Indiana University School of Nursing, Indianapolis.

Purpose/aims: The purpose of this study was to validate a tool to assess alcohol withdrawal in acute care patients. Study aims included (1) establish content validity, (2) examine criterion-related validity, (3) test interrater reliability, and (4) assess nurse usability.

Design: A psychometric research study was designed to evaluate the Alcohol Withdrawal Assessment Tool. Read More

Curr Opin Support Palliat Care 2018 Dec;12(4):489-494

Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, USA.

Purpose Of Review: To provide an evidence-based synopsis on the role of benzodiazepines in patients with agitated delirium.

Recent Findings: Existing evidence supports the use of benzodiazepines in two specific delirium settings: persistent agitation in patients with terminal delirium and delirium tremens. In the setting of terminal delirium, the goal of care is to maximize comfort, recognizing that patients are unlikely to recover from their delirium. Read More

Rehabil Psychol 2018 Nov 13;63(4):588-594. Epub 2018 Sep 13.

Department of Physical Medicine and Rehabilitation.

Purpose: To compare recovery experienced during inpatient rehabilitation among individuals with traumatic brain injury (TBI) based on whether their acute care included the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol.

Design: Participants included 234 individuals with TBI who completed inpatient rehabilitation at a TBI Model Systems site. Of these, 67 patients were treated using the CIWA protocol (TBI + CIWA); 167 patients were treated for TBI alone (TBI only). Read More

Intern Emerg Med 2019 Jan 5;14(1):143-160. Epub 2018 Sep 5.

Regional Centre on Alcohol, Genoa, Italy.

The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3-5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. Read More

Eur Rev Med Pharmacol Sci 2018 Aug;22(16):5371-5376

Department of Anesthesia, Anesthesia and Chronic Pain, McMaster University, Hamilton, Ontario, Canada

Objective: Delirium Tremens (DT) is the most severe complication of alcohol withdrawal syndrome (AWS), and has a mortality rate of 1-5%. Baclofen is recommended for spasticity treatment, but it has recently been used for alcohol withdrawal symptoms reduction and alcohol abstinence.

Case Report: A cervical spinal cord injury patient was treated for two years with oral baclofen 80 mg/day for spasticity. Read More

JAMA 2018 08;320(8):825-833

British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.

Importance: Although severe alcohol withdrawal syndrome (SAWS) is associated with substantial morbidity and mortality, most at-risk patients will not develop this syndrome. Predicting its occurrence is important because the mortality rate is high when untreated.

Objective: To assess the accuracy and predictive value of symptoms and signs for identifying hospitalized patients at risk of SAWS, defined as delirium tremens, withdrawal seizure, or clinically diagnosed severe withdrawal. Read More

JAMA 2018 08;320(8):766-768

Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.

Adv Clin Exp Med 2018 Aug 7. Epub 2018 Aug 7.

Department of Psychiatry, Faculty of Medicine, Pomeranian Medical University, Szczecin, Poland.

Background: Numerous studies have investigated the association between the OPRM1 A118G polymorphism (rs1799971) and alcohol dependence, but the results have been inconsistent. The endogenous opioid system has been implicated in the development of alcohol dependence for its prominent role in the central rewarding mechanism.

Objectives: The aim of this study was to evaluate the role of the A118G polymorphism of the OPRM1 gene in the pathogenesis of alcohol dependence syndrome (ADS). Read More

J Formos Med Assoc 2018 Dec 19;117(12):1124-1127. Epub 2018 Jun 19.

Taipei City Psychiatric Center, Taipei City Hospital, Addiction Psychiatry Department, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Gamma-hydroxybutyrate (GHB) is a synthetic drug used mainly for recreational purpose. Although the prevalence of GHB abuse is low in Taiwan, GHB has become increasingly popular in certain subpopulations such as clubbers and men who have sex with men (MSM). GHB dependence could be associated with severe withdrawal syndrome including hallucinations and delirium. Read More

Riv Psichiatr 2018 May-Jun;53(3):118-122

Centro Riferimento Alcologico Regione Lazio (CRARL), Sapienza University of Rome, Italy.

Alcohol withdrawal syndrome (AWS) is a medical emergency, rare in the general population, but very common among alcoholic individuals, which can lead to severe complications when unrecognized or late treated. It represents a clinical condition which can evolve in few hours or days following an abrupt cessation or reduction of alcohol intake and is characterized by hyperactivity of the autonomic nervous system resulting in the development of typical symptoms. According to DSM-5 criteria, the alcohol withdrawal syndrome is defined as such: if patients present at least two of typical signs and symptoms. Read More

Pharmacotherapy 2018 May 25. Epub 2018 May 25.

Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut.

Study Objective: Alcohol use disorders are prevalent and put patients at risk for developing alcohol withdrawal syndrome (AWS). Treatment of AWS with a symptom-triggered protocol standardizes management and may avoid AWS-related complications. The objective of this study was to evaluate whether implementation of a specific intensive care unit (ICU) symptom-triggered protocol for the management of AWS was associated with improved clinical outcomes and, in particular, would reduce the risk of patients with AWS requiring mechanical ventilation. Read More

J Med Toxicol 2018 Sep 10;14(3):229-236. Epub 2018 May 10.

Department of Emergency Medicine, Advocate Christ Medical Center, 4440 95th St., Oak Lawn, IL, 60453, USA.

Introduction: Benzodiazepine (BZD)-resistant alcohol withdrawal remains a challenge for most institutions due to limited evidence with available agents. One published study currently exists utilizing the N-methyl-D-aspartate antagonist, ketamine, for alcohol withdrawal.

Objective: The purpose of our study was to evaluate the effect of adjunctive ketamine continuous infusion on symptom control and lorazepam infusion requirements for BZD-resistant alcohol withdrawal patients in the intensive care unit. Read More

Crit Care Med 2018 Aug;46(8):e768-e771

Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA.

Objectives: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal.

Design: Retrospective observational cohort study. Read More

Psychosomatics 2018 Nov 12;59(6):622. Epub 2018 Mar 12.

Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY. Electronic address:

Asian J Psychiatr 2018 Jan 12;31:137-141. Epub 2018 Feb 12.

Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Background And Aims: Delirium Tremens (DT) is the most severe form of alcohol withdrawal syndrome, with a potential risk of mortality. Search for the predictors of DT led to study of candidate genes, with inconsistent and inconclusive results. This study aimed to explore the association of various candidate gene polymorphisms and DT in a case-control design. Read More

J Intensive Care Med 2018 Jan 1:885066617754187. Epub 2018 Jan 1.

1 Orlando Health, Orlando, FL, USA.

Objective: To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients.

Design: Prospective, observational cohort study.

Setting: Single-center community teaching hospital. Read More

Psychosomatics 2018 May - Jun;59(3):293-297. Epub 2017 Nov 24.

Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Neuropsychiatry and Clinical Ethics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.

Alcohol Alcohol 2018 Jan;53(1):71-77

University Hospital of Psychiatry, University of Bern, Switzerland.

Aims: As there are only a few existing experimental studies on symptom-triggered therapy for patients with alcohol withdrawal, we investigated the effectiveness of symptom-triggered detoxification regarding the use and dosage of benzodiazepine and withdrawal complications in a naturalistic clinical setting of a specialized treatment center for alcohol use disorder.

Methods: In total, 301 charts of patients who entered residential treatment for alcohol withdrawal were included in the retrospective analysis. Charts of 176 patients treated with the Alcohol Withdrawal-Scale (AWS) were compared to the charts of 125 patients treated with treatment as usual (TAU) before the implementation of AWS. Read More

Hosp Pharm 2017 Oct 17;52(9):607-616. Epub 2017 Jul 17.

University of Pittsburgh School of Pharmacy, PA, USA.

Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using ["phenobarbital" or "barbiturate"] and ["alcohol withdrawal" or "delirium tremens. Read More

Med Clin (Barc) 2018 Aug 21;151(3):103-108. Epub 2017 Dec 21.

Servicio de Epidemiología y Estadística, Complejo Universitario Hospitalario de A Coruña, A Coruña, España.

Background: There are no data on the incidence of admissions associated with alcohol withdrawal syndrome (AWS) or about its trend over time in Spain.

Objective: To analyze the characteristics, incidence rates and trends over time of hospital admissions associated with AWS in Spanish public hospitals.

Material And Method: Analysis from the Spanish public hospitals minimum basic data set of hospital admissions with AWS (CIE9-MC 291. Read More

Indian J Psychol Med 2017 Sep-Oct;39(5):665-667

Antara Psychiatric Centre, Sri Aurobindo Seva Kendra, Kolkata, West Bengal, India.

Opioid withdrawal is very rarely characterized by delirium unlike alcohol or benzodiazepine withdrawal. PubMed search through October 2016 reveals only two case series on delirium as feature of withdrawal in opioid dependence syndrome. We report two cases of opioid withdrawal (heroin) presenting with delirium when low-dose buprenorphine (2 mg/day) was added. Read More

J Addict Nurs 2017 Oct/Dec;28(4):E1-E2

Alcohol withdrawal syndrome (AWS) is commonly encountered in the intensive care unit population. Currently, the mainstay treatment for AWS is the use of benzodiazepines. However, some patients are refractory to benzodiazepine treatment due to heavy alcohol abuse. Read More

J Addict Nurs 2017 Oct/Dec;28(4):188-195

Tarenne A. Ferenchak, BA, BSN, MSN, RN, College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania.

Alcohol withdrawal syndrome (AWS) is commonly encountered in the intensive care unit population. Currently, the mainstay treatment for AWS is the use of benzodiazepines. However, some patients are refractory to benzodiazepine treatment due to heavy alcohol abuse. Read More

J Arthroplasty 2018 04 13;33(4):1171-1176. Epub 2017 Nov 13.

The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.

Background: Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event. Read More

J Investig Med High Impact Case Rep 2017 Oct-Dec;5(4):2324709617742166. Epub 2017 Nov 13.

University of California Los Angeles, CA, USA.

The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. Read More

Alcohol Alcohol 2018 May;53(3):259-267

Betsi Cadwaladr University Health Board (BCUHB), Heddfan Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, UK.

Aims: To evaluate the effectiveness of evidence based treatments for alcohol-induced psychotic disorder (AIPD) as described by ICD-10 and DSM-5, a condition that is distinct from schizophrenia and has a close relationship with alcohol withdrawal states.

Method: Systematic review using PRISMA guidelines.

Results: Of 6205 abstracts found, fifteen studies and ten case reports met criteria and were examined. Read More

Indian J Psychiatry 2017 Jul-Sep;59(3):300-305

Department of Psychiatry, Jawaharlal Nehru Institute of Medical Sciences, Imphal, India.

Introduction: Alcohol withdrawal delirium (AWD) or delirium tremens (DT) is associated with severe complications and high mortality. Prospectively identifying patients with increased risk of developing DT would have important preventive and therapeutic implications. Thus, the present study aimed to identify clinical risk factors predicting the development of DT. Read More

Indian J Psychiatry 2017 Jul-Sep;59(3):293-299

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.

Background: Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the initial emergency management. Read More

JAMA 2017 Oct;318(15):1441-1442

Oregon Health & Science University, Division of General Internal Medicine, Portland, Oregon.

BMJ Case Rep 2017 Oct 15;2017. Epub 2017 Oct 15.

Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA.

A 60-year-old African-American man with a medical history significant for heavy alcohol abuse, hypertension, delirium tremens, nephrolithiasis and seizure disorder was brought to the hospital with altered mental status. He was found to have high anion gap metabolic acidosis with significantly elevated lactate along with an elevated osmolal gap and calcium oxalate crystals in his urine. With this combination of findings, ethylene glycol poisoning was high in the differential. Read More

Am J Emerg Med 2017 Dec 29;35(12):1956-1957. Epub 2017 Sep 29.

The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas 75390, TX, United States.

Am J Emerg Med 2017 Dec 29;35(12):1956. Epub 2017 Sep 29.

Alcohol treatment unit, University hospital, 80000 Amiens, France. Electronic address: