Delirium Tremens (DTS): A Comprehensive Review
Delirium tremens (DTS) is a severe medical condition associated with alcohol withdrawal syndrome. It is characterized by sudden onset of confusion, agitation, visual and auditory hallucinations, and autonomic hyperactivity. DTS is considered a life-threatening medical emergency and effective management requires early recognition and treatment. This paper reviews the epidemiology, pathophysiology, diagnosis, and treatment of this condition.
Epidemiology
Worldwide, alcohol misuse accounts for 3.8% of all deaths and 5.1% of disability-adjusted life years (DALYs). In the United States, the prevalence of alcohol use disorder is estimated to be 8.5%. Delirium tremens is a serious complication of alcohol withdrawal and can occur in up to 35% of individuals with alcohol use disorder. The incidence of DTS is highest in individuals who are dependent on alcohol for more than 10 years, and in those who consume more than 150 g of alcohol per day.
Pathophysiology
Alcohol withdrawal syndrome is caused by abrupt cessation or decrease in alcohol consumption after prolonged use. The main physiological mechanism underlying this syndrome is the rebound of excitatory neurotransmitters, including gamma-aminobutyric acid (GABA) and glutamate. This leads to increased excitation and decreased inhibition of neurons, resulting in the development of DTS.
Diagnosis
The diagnosis of DTS is based on clinical evaluation. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for delirium include acute onset of confusion, disorientation, inattention, and significant fluctuation in mental status. The patient may also present with other symptoms such as agitation, restlessness, auditory and visual hallucinations, seizures, and autonomic hyperactivity. Laboratory tests may be used to rule out other conditions with similar symptoms, such as hypoglycemia, infection, or substance use disorder.
Treatment
The treatment of delirium tremens includes supportive care, medical management, and psychiatric interventions. Supportive care includes providing a quiet and safe environment for the patient, as well as adequate hydration and nutrition. Benzodiazepines, such as lorazepam and diazepam, are the medications of choice for management of alcohol withdrawal syndrome, and are usually initiated in a hospital setting. Antipsychotics may be used for agitation or psychotic symptoms, while thiamine and other vitamins are recommended to prevent Wernicke’s encephalopathy. Psychiatric interventions, such as cognitive-behavioral therapy, can help the patient cope with the psychological aspects of alcohol withdrawal syndrome.
Conclusion
Delirium tremens is a severe complication of alcohol withdrawal syndrome and is associated with significant morbidity and mortality. Early recognition and management is essential for successful treatment of this condition. The goals of treatment include providing supportive care and medical management with benzodiazepines, antipsychotics, and vitamins. Psychiatric interventions can also be beneficial in the management of DTS.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association.
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