Identification and Management of Alcohol Withdrawal Syndrome

Mirijello, Antonio; D’Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Massimo; Caputo, Fabio; Leggio, Lorenzo; Addolorato, Giovanni

doi:10.1007/s40265-015-0358-1

Cited by 147 publications

(146 citation statements)

References 111 publications

(150 reference statements)

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“…These findings, and the high levels of substance misuse and intellectual disability which have been described in the sample, are also consistent with the existing literature (e.g. Baksheev, Thomas & Ogloff, 2010;McKinnon, Srivastava, Kaler & Grubin, 2013;Young, Goodwin, Sedgwick & Gudjonsson, 2013), and they confirm a need for rapid access to medical services to review comorbidities, and to prevent serious deterioration, or mortality, arising from alcohol withdrawal in particular (Mirijello, D'Angelo, Ferrulli, Vassallo, Antonelli, Caputo, Leggio, Gasbarrini & Addolorato, 2015). In other jurisdictions where people who are severely intoxicated with alcohol are no longer held in police custody, there has been a substantial (75%) reduction in deaths (Aasebo, Orskaug & Erikssen, 2016); there is an argument for a similarly vigilant approach in England and Wales.…”

Section: *Insertsupporting

confidence: 90%

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

Forrester

Samele

Slade

et al. 2016

The Journal of Forensic Psychiatry & Psychology

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The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have so far only been developed in patches, and the literature in this area is limited. Referrals (n=1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/13. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), selfharm, suicide risk and vulnerability, with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs.Abstract word count = 145

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Section: *Insertsupporting

confidence: 90%

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

Forrester

Samele

Slade

et al. 2016

The Journal of Forensic Psychiatry & Psychology

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“…In mice chronically exposed to ethanol, pregabalin (50–200 mg/kg) dose-dependently reduced the severity of behavioral convulsions upon ethanol withdrawal compared with vehicle-treated animals [49]. Since seizures are a potential serious manifestation of alcohol withdrawal [12, 13], an anticonvulsant such as pregabalin that can ameliorate withdrawal symptoms may be particularly beneficial in this case…”

Section: Alcohol Withdrawal Symptomsmentioning

confidence: 99%

“…Between 15 and 44% of long-term benzodiazepine users may experience moderate to severe symptoms upon withdrawal, including ~40% of individuals using benzodiazepines for more than 6 months [9]. Alcohol withdrawal syndrome may arise within 24–48 h after abrupt cessation or reduced alcohol consumption, with symptoms including sweating, tachycardia, insomnia, nausea, transient hallucinations, anxiety, agitation, and tremor, and in severe cases seizures or delirium tremens [12, 13]. Nicotine withdrawal symptoms peak within the first week after ceasing tobacco use, and may include anxiety and depression, anger, impatience, difficulty concentrating, and insomnia, amongst others [14].…”

Section: Introductionmentioning

confidence: 99%

Pregabalin for the Treatment of Drug and Alcohol Withdrawal Symptoms: A Comprehensive Review

et al. 2016

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Treatments for physical dependence and associated withdrawal symptoms following the abrupt discontinuation of prescription drugs (such as opioids and benzodiazepines), nicotine, alcohol, and cannabinoids are available, but there is still a need for new and more effective therapies. This review examines evidence supporting the potential use of pregabalin, an α2δ voltage-gated calcium channel subunit ligand, for the treatment of physical dependence and associated withdrawal symptoms. A literature search of the MEDLINE and Cochrane Library databases up to and including 11 December 2015 was conducted. The search term used was ‘(dependence OR withdrawal) AND pregabalin’. No other date limits were set and no language restrictions were applied. Works cited in identified articles were cross-referenced and personal archives of references also searched. Articles were included based on the expert opinions of the authors. There is limited evidence supporting the role of pregabalin for the treatment of physical dependence and accompanying withdrawal symptoms associated with opioids, benzodiazepines, nicotine, cannabinoids, and alcohol, although data from randomized controlled studies are sparse. However, the current evidence is promising and provides a platform for future studies, including appropriate randomized, placebo- and/or comparator-controlled studies, to further explore the efficacy and safety of pregabalin for the treatment of withdrawal symptoms. Given the potential for pregabalin misuse or abuse, particularly in individuals with a previous history of substance abuse, clinicians should exercise caution when using pregabalin in this patient population.

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“…Since prolonged glucose supplementation without the addition of thiamine can be a risk factor for the development of Wernieke’s Encephalopathy, thiamine supplementation should be given promptly(36). …”

Section: Management Of Patients With Alcohol Use Disorder Who Are Canmentioning

confidence: 99%

“…Finally, several other medications have been investigated for use in this population to treat alcohol withdrawal syndrome such as clonidine, atenolol, carbamazepine, valporic acid, topiramate, baclofen, gabapentin and pregabalin(36). Among them, gabapentin, topiramate and baclofen have the advantages of having no or little hepatic metabolism and being able to be continued through the post-withdrawal period to prevent relapse [reviewed in:(10)].…”

Section: Management Of Patients With Alcohol Use Disorder Who Are Canmentioning

confidence: 99%

Management of Alcohol Use Disorder in Patients Requiring Liver Transplant

Lee

Leggio

2015

AJP

Self Cite

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Alcoholic liver disease is the second most common indication for orthotopic liver transplantation in western countries. The majority of patients with alcoholic liver disease, however, are not referred for transplant evaluation. If evaluated, a 6 month period of sobriety is required before waitlisting for transplant. The consequences of relapse to alcohol use in patients on the waitlist are usually removal from the list. Therefore, identification and treatment of alcohol use disorder in patients with end-stage liver disease greatly impacts quality of life, treatment options and survival in patients’ course with this grave illness. Psychosocial and behavioral interventions prior to transplant appear to reduce drinking in the period before the surgery as well as reduce relapse rates post-transplant. Only one of the three medications approved by the Food and Drug Administration, acamprosate, seems feasible for use in patients with end-stage liver disease, while several other medications currently under investigation for the treatment of alcohol use disorder can be considered for use in this population. While only baclofen has been formally studied in alcoholic patients with end-stage liver disease with positive results for safety and efficacy, other medications also hold promise to treat alcohol use disorder in this population. Transplant programs with addictions specialists who function as an integral part of the treatment team may offer better outcomes to patients in terms of success of maintaining sobriety both pre- and post-transplant.

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Identification and Management of Alcohol Withdrawal Syndrome

Cited by 147 publications

References 111 publications

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

Pregabalin for the Treatment of Drug and Alcohol Withdrawal Symptoms: A Comprehensive Review

Management of Alcohol Use Disorder in Patients Requiring Liver Transplant

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