A syndrome that appears when the patient is in the alcohol withdrawal phase.
Delirium tremens encompasses a series of neuropsychological symptoms , and appears in alcoholic subjects when they abruptly stop consuming, that is, during withdrawal syndrome.
In this article we will know what this syndrome consists of, what symptoms it causes, what its causes are, risk factors, mortality and treatments that are applied.
Delirium tremens: characteristics
Delirium tremens appears as a symptom of alcohol withdrawal syndrome , that is, as a consequence of abruptly stopping drinking in alcoholic patients. It lasts from days to weeks, and is generally accompanied by disorientation, fever, tachycardia and visual hallucinations (kinesthetic-microzoopsia type), among others.
One-third of patients with delirium tremens also have seizures. The onset of delirium is gradual, appearing on the second or third day after stopping consumption, and the moment of maximum expression being on the fourth or fifth day of abstinence.
Delirium tremens is classified as an acute disorder within the so-called uncomplicated withdrawal syndrome due to alcohol. It can be fatal, and affects between 5-10% of patients hospitalized for alcohol withdrawal.
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Symptoms
The most frequent symptoms of delirium tremens are the following.
1. Hallucinations
The hallucinations that usually appear are visual and cenesthetic-microzoopsias. These hallucinations are usually very vivid, causing significant affective repercussions, psychomotor agitation and intense anguish.
2. verbiage
Verbiage is a quantitative alteration that affects the flow of language, that is, the person speaks rapidly and is difficult to interrupt.
3. Confusion
The patient with delirium tremens feels disoriented, confused and out of place in space and time.
4. Agitation
Another symptom is agitation behaviors that include agitated body movements, raising the voice, aggression, extreme nervousness, etc.
5. Autonomic hyperactivity
Autonomic hyperactivity is manifested with signs such as tachycardia, sweating, hypertension, etc.
6. Tremor
The patient may show this type of impaired movement, especially affecting the hands and arms.
7. Fever
Fever may also appear, including hyperpyrexia (very high fever).
Causes
Delirium tremens appears mainly when alcohol intake is interrupted in people addicted to this substance, that is, during its withdrawal syndrome. It usually appears after a period of excessive alcohol consumption , and especially if not enough food has been taken.
However, although it usually appears after abruptly stopping alcohol consumption (72 hours after the last drink), it can also manifest itself without a change in the pattern of drinking or consumption.
There are other causes that can cause a delirium tremens, such as a head injury (TBI), an infection or a disease, always in people with a history of heavy alcohol consumption.
In addition, it also appears more frequently in people who already have a history of alcohol withdrawal. Specifically, it occurs more in people who consume 1.8 to 2.4 liters of wine daily, or between 3.3 and 3.8 liters of beer, for several months. If in addition the person has consumed alcohol frequently for more than 10 years, it is also more likely to appear.
a kind of delusion
Delirium tremens is a type of delirium. The DSM-IV-TR (Diagnostic Manual of Mental Disorders) defines delirium as an acute and reversible neuropsychiatric syndrome caused by a medical illness or by the consumption (or cessation) of some substance. That is, it always has an organic origin .
Thus, delirium can be caused by a great multitude of organic causes (or due to substances), but the symptoms are always the same.
The symptoms of delirium mainly include impaired consciousness and attention. In addition, there are also changes in cognitive functions (memory, orientation, language, perception,…). The disturbance is fluctuating and occurs over a period of time, usually hours to days.
Risk
The risk of developing delirium tremens is related to some variables , such as history of previous episodes of delirium, daily consumption, being over 30 years of age, social exclusion, and the presence of an underlying medical illness that motivates withdrawal.
Mortality
Mortality from delirium tremens is more closely related to mortality from alcohol withdrawal syndrome. There are some factors that influence, such as age, previous diseases (such as liver cirrhosis and acute alcoholic hepatitis), infections and trauma.
On the other hand, mortality can also be caused by the secondary effects of the treatment applied to the withdrawal syndrome; one of these effects can be excessive sedation, especially if the patient already had previous respiratory problems.
Associated risk factors for mortality include pre-existing lung disease, liver disease, older age, and hyperpyrexia (excessively high fever). A mortality of 2.4% is estimated in patients with alcohol withdrawal syndrome.
Treatment
Treatment of delirium tremens must be immediate; hospitalization is generally required to avoid future complications and to be able to administer the corresponding drugs.
However, the ideal is not to reach the development of delirium tremens; For this reason, in the event of a withdrawal syndrome, priority should be given to relieving symptoms and preventing progression to seizures or delirium itself. When faced with a withdrawal syndrome, the first psychopharmacological option is benzodiazepines (diazepam, lorazepam…), although they can alter cognitive functions and the motor system.
Bibliographic references
- American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR . Barcelona: Mason.
- Celina, H. and Grove, P. (2006). Pathophysiology and treatment of alcohol withdrawal syndrome. Medical Universities, 47(2): 113-119.
- Cushman P Jr. Delirium tremens. (1987). Update on an old disorder. Postgraduate Med.
- Ferguson JA, Suelzer CJ, Eckert GJ. (nineteen ninety six). Risk factors for delirium tremens development. J Gen Intern Med.
- Santolaria, F. and González-Reimers, E. (2006). Mortality in alcohol withdrawal syndrome. An. Internal Med. (Madrid) 23(7).
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.
