-IBIS-1.5.0-
tx
nervous system
withdrawal from addiction
diagnoses
definition and etiology
definition:
The signs and symptoms that develop in a patient during the time he/she is abstaining from a drug he/she is physically dependent on.
etiology:
Drug dependence may be physiological (the state of adapting to a drug associated with the development of tolerance and clinically seen by a withdrawal or abstinence syndrome); or psychological (feelings of contentment while on the drug therefore creating a strong desire to experience repeated drug administrations to achieve pleasure or avoid pain). The withdrawal syndrome is defined as "unpleasant physiologic changes that occur when the drug is discontinued abruptly or when its effect is counteracted by a specific antagonist." (Merck).
The phenomena, therefore, may be metabolically or psychologically based.
signs and symptoms
signs and symptoms:
Most all patients undergoing withdrawal of their substance of abuse will crave that substance in the initial phases.
alcohol: The symptoms typically begin 12-28 hours after the last drink.
Mild signs and symptoms: Weakness, sweating, tremors, hyperreflexia, GI disturbances, epileptic seizures.
Alcoholic hallucinosis: This occurs only in drinkers who have imbibed vast quantities of alcohol over a long time. The hallucinations are often auditory and frightening to the patient, with themes of paranoia and accusations frequently experienced. The hallucinations are transient and last for 1-3 weeks.
Delirium tremens: This is the severe form of withdrawal syndrome recognized by anxiety attacks, poor sleep, significant sweating, depression, and confusion. The pulse and temperature may increase (this is a bad sign). Hallucinations occur: often of animals, or normal daily activities. The patient may experience the floor moving, room rotating, etc. and a tremor may begin in the hands that spreads to the trunk and head. The acute phase lasts about 2-10 days, although the DTs should begin to dissipate within 12-24 hours.
opiates: The signs and symptoms generally are the opposite of what the drug elicits; that is, there is typically CNS hyperactivity. There is anxiety and strong desire for the drug, followed by increased respiration; nausea and diarrhea; yawning; sweating; tearing from the eyes; nasal discharge; goose-bumps; tremors or muscle twitching; hot and cold flashes; anorexia; and aching muscles.
Symptoms usually begin within 4-6 hours after drug use and peak at 36-72 hours (in heroin). Although vastly uncomfortable, the withdrawal syndrome is not dangerous or fatal.
barbiturates: The syndrome may begin with sleeping problems such as bad dreams, insomnia, frequent waking, and waking unrefreshed and irritable. In a sudden withdrawal of large doses of barbiturates, the patient will experience a severe, scary, and potentially dangerous sickness like that of delirium tremens. The withdrawal from barbiturates necessitates the patient be under care in a hospital. The patient will become restless, weak and have tremors. The tremors then increase in severity as the patient progressively weakens, culminating in convulsions that can develop into status epilepticus and eventually cause death.
Associated symptoms include delirium, confusion, terrifying hallucinations, increased temperature and dehydration. The CNS may be labile for up to a month, even with close personal care of the patient.
amphetamines: Generally, the withdrawal is mild. Signs and symptoms include sleeplessness, fatigue, possibly severe anxiety and restlessness, and depression.
smoking: Withdrawal signs and symptoms include depression, anxiety, weight gain, irritability, sleep disturbances, and GI upset.
course and prognosis
The course of withdrawal syndromes varies with respect to the substance involved. Relapse is common when discomfort starts and the patient may experience an uncontrollable urge to resume substance abuse to ease the situation.
Generally, the course of withdrawal is steady or occasionally rapid onset of withdrawal crisis, which peaks in often intense symptoms before subsiding gradually as the physical effects wear off. Psychological addiction lasts much longer, and is the major obstacle to permanent withdrawal.
Prognosis is excellent if withdrawal is accomplished before extensive physical damage occurs.
differential diagnosis
diagnosis of the condition will normally be evident from history or examination, but otherwise rule out other psychogenic, metabolic, toxic or infectious causes for the presenting symptoms
footnotes