The Role of Somatic Disorders and Physical Injury in the Development and Course of Alcohol Withdrawal Delirium

Abstract

In a retrospective study, we evaluated the role of somatic disease and physical injury in the development and course of alcohol withdrawal delirium. Medical records of 1179 patients treated for alcohol withdrawal in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Development, symptoms' severity, and the course of alcohol withdrawal delirium were assessed in possible relation to the somatic state of patients and other variables of alcohol dependence. Development of the first episode of delirium tremens (DT) was associated with the incidence of somatic disease or injury in 19% of cases. Somatic disorders directly preceded the second episode of DT in 73% and the third in 57% of cases. A positive correlation was found between the greater severity and/or longer duration of DT symptoms, and occurrence of pneumonia, coronary heart disease, alcohol liver disease, and anemia, as well as daily amount of alcohol consumed during the last drinking bout. There was no relationship of severity of DT with the duration of alcohol abuse. Early development and severe course of alcohol withdrawal delirium correlated with the late beginning of excessive drinking (over the age of 40) and concomitant abuse of benzodiazepines or barbiturates. We concluded that somatic disorders or physical injury might trigger delirium during alcohol withdrawal, and have essential influence on the symptoms' severity and duration of DT. A more severe course of DT is also correlated with the quantity of alcohol consumed and concomitant abuse of sedatives.

Efficacy and Safety of Outpatient Alcohol Detoxification with a Combination of Tiapride/Carbamazepine: Additional Evidence

“…Generally ambulatory detoxification can be recommended for less severe withdrawal syndromes [6]. Patients with serious psychiatric disorders, concurrent acute illness, polysubstance abuse and severe AWS including those at risk for developing alcohol delirium are best detoxified in inpatient settings [27,56]. Still taking the large number of patients suitable for outpatient detoxification into account surprisingly few studies have been published on this issue [8,55].…”

Sucht im Alter Ein unterschätztes Problem in der klinischen Versorgung älterer Menschen?

“…Die vorgestellten Ergebnisse zeigen weiter, dass der Prozentsatz der alkoholbedingten neuropsychiatrischen Komplikationen (insbesondere Delir, amnestisches Syndrom und Demenz) mit dem Alter deutlich ansteigt. Ein Grund hierfür sind die v. a. bei den Konsilpatienten gleichzeitig bestehenden schweren kör-perlichen Erkrankungen, denn diese beeinflussen insbesondere die Schwere der Alkoholentzugssymptomatik erheblich [34]. Die berechnete Inzidenzrate für ein alkoholinduziertes Delirium tremens lag deutlich unter der der einzig vergleichbaren deutschen Untersuchung [28].…”

Delirium tremens - ein lebensgefährliches Krankheitsbild?

“…Das Alkoholentzugssyndrom wird heute entsprechend der Symptomatologie in drei Schweregrade eingeteilt [1,4,5 15 % im unbehandelten und von 1 ± 8 % im behandelten Stadium [5,12,14].…”

“…Wojner et al beschreiben eine Korrelation zwischen einem späten Beginn des exzessiven Alkoholabusus (> 40 J.) und einer frühen Delirentwicklung [12].…”