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Chapter 7 - Drug withdrawal syndromes in psychiatric patients in the emergency department

from Section 2. - Evaluation of the psychiatric patient

Published online by Cambridge University Press:  05 April 2013

By
Paul Porter  and
Richard D. Shih
Edited by
Leslie S. Zun
Edited in association with
Lara G. Chepenik  and
Mary Nan S. Mallory
Leslie S. Zun
Affiliation:
Department of Emergency Medicine, Mt Sinai Hospital, Chicago
Lara G. Chepenik
Affiliation:
Yale University School of Medicine
Mary Nan S. Mallory
Affiliation:
University of Louisville, School of Medicine
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Summary

The emergency physician assessing and treating a patient with a psychiatric emergency will frequently encounter patients with withdrawal syndromes. Clinically, ethanol withdrawal manifests as increased autonomic symptoms, alcohol withdrawal hallucinosis, alcohol withdrawal seizures, and delirium tremens (DTs). Patients with minor symptoms of alcohol withdrawal without a history of DTs and who intend to continue drinking are often discharged without receiving any specific medications. Sedative hypnotic agents such as barbiturates and benzodiazepines, like ethanol, exert their effects by means of augmentation of GABA inhibitory neurotransmission. Therefore, symptoms of withdrawal from these agents are very similar to alcohol withdrawal. Withdrawal from Gamma-hydroxybutyrate and its precursors are similar to alcohol withdrawal and other sedative hypnotics. Opioid withdrawal is not life-threatening. However, it is very unpleasant and painful to endure. Due to cross-reactivity of the different opioids, any opioid can be administered to alleviate withdrawal symptoms.
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Behavioral Emergencies for the Emergency Physician , pp. 46 - 52
Publisher: Cambridge University Press
Print publication year: 2013

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