The Relationship of Alcohol Withdrawal Delirium and Alcohol Withdrawal Symptoms in Patients with Alcohol Dependence

OBJECTIVE: This study was performed to analyze the clinical variables associated with occurrence of delirium tremens (DT) in inpatients with alcohol dependence initially admitted with diseases unrelated to alcohol. METHODS: This study included 132 inpatients seeking treatment for medical problem with acute alcohol withdrawal. The cases were divided into two groups : with DT group (n=44), without DT group (n=88). We compared the epidemiologic data, alcohol withdrawal symptoms and serum analysis data between two groups. We used the logistic regression to predict risk factors for DT. RESULTS: The DT group had more severe alcohol withdrawal symptoms, more amount of drinking alcohol, more number of drinking per month, higher blood urea nitrogen (BUN), creatinine, amylase, C-reactive protein and lower serum total protein than the without-DT group. According to the result of a logistic regression, occurrence of DT showed correlation with the following factors : sweating, hallucination, agitation, amount of alcohol consumption, number of drinking per month. CONCLUSION: Our study suggests development of DT was correlated with severe alcohol withdrawal symptoms, high BUN, creatinine and low total serum protein. Therefore, during assessment of alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent DT.

Recuperación de la adicción al alcohol: una transformación para promover la salud / Recovering from Alcohol Addiction: A Transformation to Promote Health / Recuperação do vício no álcool: uma transformação para promover a saúde

Se presenta una metasíntesis cuyo objetivo es establecer las características del proceso de recuperación en las personas que tienen adicción al alcohol. La metodología metasintética se fundamenta en la integración e interpretación de los hallazgos de algunos estudios cualitativos que permiten reconocer elementos sustanciales en la creación de nuevas interpretaciones en el fenómeno de recuperación de la adicción al alcohol. Para ubicar las fuentes se realizó una búsqueda en las bases de datos Ovid, Medline, Cinalh, Psych Info, Lilacs y Scielo, que comprendió el periodo 1988 a 2008, y en el que se ubicaron once artículos mediante las palabras clave: abuso de alcohol, adicción, dependencia, recuperación, experiencia e investigación cualitativa; de estos únicamente seis cumplieron con los criterios de calidad para ser incluidos en la metasíntesis. Los hallazgos permiten señalar que la recuperación es concebida como una trasformación con movimiento ascendente, conceptualización que implica reconocer la potencialidad de los aspectos positivos de las personas, alcanzar la madurez psicológica y espiritual, y lograr la paz y la libertad para actuar. En conclusión, este proceso de transformación inmerso en la recuperación debe ser reconocido por el profesional de enfermería para establecer, entre ese otro y ella, una fructífera interacción que permita el desarrollo del cuidado.

A meta-synthesis is presented to determine the features of the recovery process in persons who are addicted to alcohol. The metasynthesis method is founded on the integration and interpretation of findings from certain qualitative studies that shed light on substantial elements in the creation of new interpretations of the phenomenon of recovery from alcoholism. A search of the Ovid, Medline, Cinalh, PsychInfo, Lilacs and Scielo databases, covering the period from 1988 to 2008, was conducted to locate these sources and eleven (11) articles were found using the key words: alcohol abuse, addiction, dependency, recovery, experience and qualitative research. Only six of these words met the quality criteria to be included in the meta-synthesis. The findings indicate recovery is perceived as a transformation with an upward movement, a notion that implies recognizing the potential of a person's positive aspects, achieving psychological and spiritual maturity, and acquiring the peace and freedom to act. In conclusion, nursing professionals must recognize this process of transformation immersed in the recovery process, so as to establish fruitful interaction between themselves and the other person that allows care to develop.

Este artigo apresenta metassíntese, cujo objetivo é estabelecer as características do processo de recuperação nas pessoas que são viciadas no álcool. A metodologia metassintética se fundamenta na integração e interpretação dos descobrimentos de alguns estudos qualitativos que permitem reconhecer elementos substanciais na criação de novas interpretações no fenômeno de recuperação do vício no álcool. Para localizar as fontes, realizou-se uma busca nas bases de dados Ovid, Medline, Cinalh, Psych Info, Lilacs e SciELO, que compreendeu o período de 1988 a 2008, na qual se localizaram onze artigos a partir das palavras-chave: abuso de álcool, vício, dependência, recuperação, experiência e pesquisa qualitativa; destes onze, unicamente seis cumpriam os critérios de qualidade para serem incluídos na metassíntese. Os descobrimentos indicam que a recuperação é concebida como uma transformação com movimento ascendente, conceptualização que implica reconhecer a potencialidade dos aspectos positivos das pessoas, atingir a maturidade psicológica e espiritual, bem como a paz e a liberdade para agir. Em conclusão, esse processo de transformação imerso na recuperação deve ser reconhecido pelo profissional de enfermagem para estabelecer, entre este outro e ela, uma frutífera interação que permita o desenvolvimento do cuidado.

Risk Factors Associated with the Development and the Course of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: The aim of this study was to analyze the clinical variables associated with the occurrence, duration, and severity of alcohol withdrawal delirium (AWD) in patients with alcohol dependence. METHODS: We conducted a retrospective case-control study in alcohol dependent inpatients admitted to the psychiatric department, between 2006 and 2012 (n=863). Multivariable logistic and linear regression models were used for analysis of risk factors associated with development of AWD and the duration of illness, respectively. And multivariable logistic regression models were applied for assessment of risk factors associated with seclusions or physical restraints, which reflect the severity of AWD. RESULTS: Significant predictors for the occurrence of AWD included higher body temperature, lower platelet count, lower serum potassium, higher drinking amount, history of AWD, and history of head trauma or structural brain lesion. Variables associated with prolongation of delirium included higher body temperature, higher drinking amount, and less use of benzodiazepine during the AWD episode. Significant predictors for severe AWD included higher systolic blood pressure, longer duration of harmful alcohol use, and higher drinking amount. CONCLUSION: Easily determinable parameters, such as vital signs and past history related to drinking are significantly associated with not only development of AWD, but also its severity and duration. Therefore, when initially assessing alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent occurrence of risky withdrawal delirium and behavioral problems.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.