0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Dr. Kranzler and Colleagues Reply
HENRY R. KRANZLER, M.D.; DAVID HERSH, M.D.; ROGER E. MEYER, M.D.
Am J Psychiatry 1998;155:1626u-1626.
View Author and Article Information

Letters to the Editor

text A A A

To the Editor: We thank both of the authors who commented on our recently published clinical case conference. We agree that the literature on alcohol withdrawal delirium is inadequate to address a number of important clinical issues. As Dr. Adinoff correctly points out, data on the prevalence of delirium tremens are from an earlier time, and in light of therapeutic developments, the 5% figure quoted in the introduction would represent the upper bound for prevalence. As pointed out by Dr. Fink, the use of ECT to manage alcohol withdrawal delirium, although of potential value, lacks empirical evaluation. We are pleased that our case review has helped to highlight the need for systematic study of alcohol withdrawal delirium and delirium tremens.

We agree that although the distinction is often not made clinically, it is important to differentiate alcohol withdrawal delirium from other symptoms in delirium tremens, since autonomic hyperactivity does not follow the same time course as does the delirium. As regards the choice of a benzodiazepine for treatment of alcohol withdrawal, we believe that lorazepam or oxazepam, which have an intermediate duration of action, is preferable to longer-acting benzodiazepines for two reasons. First, they do not require hydroxylation, so that in the context of hepatic dysfunction, they will not accumulate to toxic levels. Second, and more important, since treatment of alcohol withdrawal is increasingly being done in an ambulatory setting, the use of a long-acting benzodiazepine may be problematic: it has a greater risk for additive sedation if alcohol is consumed concurrently. Finally, the clinical experience of Dr. Adinoff notwithstanding, it is not clear that in all cases, the aggressive treatment of early alcohol withdrawal can prevent the development of delirium tremens. The fact that delirium tremens can have its onset in the absence of early withdrawal symptoms argues against a simple progressive model for all cases of alcohol withdrawal. Clarification of these important clinical issues will also depend upon systematic empirical investigation.

+

References

+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 13.  >
Topic Collections
Psychiatric News
APA Guidelines