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Soumitra Sen, Philip Grgurich, Amanda Tulolo, Andrew Smith-Freedman, Yuxiu Lei, Anthony Gray, James Dargin
BACKGROUND: There are limited data on the efficacy of symptom-triggered therapy for alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU). OBJECTIVE: To evaluate the safety and efficacy of a symptom-triggered benzodiazepine protocol utilizing Riker Sedation Agitation Scale (SAS) scoring for the treatment of AWS in the ICU. METHODS: We performed a before-and-after study in a medical ICU. A protocol incorporating SAS scoring and symptom-triggered benzodiazepine dosing was implemented in place of a protocol that utilized the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale and fixed benzodiazepine dosing...
October 12, 2016: Annals of Pharmacotherapy
Gregory Gipson, Kim Tran, Cuong Hoang, Miriam Treggiari
We designed a study to evaluate the use of benzodiazepines and ethanol in patients being assessed for alcohol withdrawal and compare outcomes between the two agents. This is a retrospective chart review of patients admitted to neurocritical care or neurosurgical services who were at risk for ethanol withdrawal between June 2011 and September 2015. Patients were divided into two groups based on the first medication administered for alcohol withdrawal management, either benzodiazepine (n=50) or enteral ethanol (n=50)...
September 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Samuel B Holzman, Darius A Rastegar
AIMS: This study compared the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) and a newly devised 3-item "Anxiety Sweats Tremor" Scale (AST) to the Revised Clinical Institute Withdrawal Assessment Scale (CIWA-Ar)-the standard of care for symptom-triggered management of alcohol withdrawal syndrome. METHODS: Our study took place over 2 separate 1-week observational periods, and included 332 serial evaluations from 85 unique patients. All study participants were treated per hospital protocol based on CIWA-Ar, with supplemental scoring initially by GMAWS and later by AST in tandem...
May 2016: Journal of Addiction Medicine
K Girish, K Vikram Reddy, Lakshmi V Pandit, H P Pundarikaksha, R Vijendra, K Vasundara, R Manjunatha, Moulya Nagraj, R Shruthi
BACKGROUND: Alcohol withdrawal syndrome (AWS) is a distressing condition, generally controlled by benzodiazepines (BZD's). Baclofen, a gamma-aminobutyric acid-B (GABAB) agonist, has also shown promising results in controlling AWS. As there are few studies comparing the efficacy and tolerability of chlordiazepoxide with baclofen, the present study was taken up. The objective of this study was to compare efficacy and tolerability of baclofen with chlordiazepoxide in uncomplicated AWS. METHODS: Sixty subjects with uncomplicated AWS were randomized into two groups of 30 each, to receive baclofen (30 mg) or chlordiazepoxide (75 mg) in decremented fixed dose regime for 9 days...
February 2016: Biomedical Journal
Manu Jose, Jayanthi Mathaiyan, Shivanand Kattimani, Surendiran Adithan, Adithan Chandrasekaran
PURPOSE: Alcohol dependence is a public health problem worldwide, commonly associated with withdrawal symptoms for which diazepam is a frequently used drug. We studied the effect of CYP2C19 gene polymorphisms on diazepam loading dose requirement and time to reversal of acute alcohol withdrawal symptoms. We also studied the influence of the polymorphism in this gene on the persistent symptoms after loading dose of diazepam. METHODS: Sixty-nine patients who reported to the psychiatry department with symptoms of alcohol withdrawal diagnosed by DSM-IV criteria were included for the study...
July 2016: European Journal of Clinical Pharmacology
John J Mariani, Robert J Malcolm, Agnieszka K Mamczur, Jean C Choi, Ronald Brady, Edward Nunes, Frances R Levin
BACKGROUND: Benzodiazepine use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes. OBJECTIVES: To evaluate gabapentin for the outpatient treatment of benzodiazepine abuse or dependence in methadone maintenance patients. METHODS: Participants (n = 19) using benzodiazepines at least 4 days per week were enrolled into an 8-week randomized double-blind placebo-controlled outpatient pilot trial...
May 2016: American Journal of Drug and Alcohol Abuse
Alexander Owen James, Timothy R Nicholson, Robert Hill, Jennifer Bearn
Meprobamate, a benzodiazepine-like drug, was commonly prescribed for anxiety in the 1960s and 1970s, but fell out of favour, at least in part, due to the risk of dependence, for which there is little published evidence to guide clinical management. We discuss a 70-year-old man with a 45-year history of meprobamate dependency and multiple failed previous withdrawal attempts who was successfully withdrawn from meprobamate using diazepam during a 2-week inpatient stay on a specialist Addictions ward. An appropriate diazepam dose was established using the Clinical Institute Withdrawal Assessment scale for benzodiazepines (CIWA-B)...
2016: BMJ Case Reports
Nisha Dutta, Sarah G Helton, Melanie Schwandt, Xi Zhu, Reza Momenan, Falk W Lohoff
BACKGROUND: Alcohol withdrawal (AW) can be a serious consequence of alcohol dependence and consists of various neurochemical adaptations in the brain. One such neuroadaptation occurs in the monoamine neurotransmitter system. Recently, a functional variant in the presynaptic vesicular monoamine transporter gene (VMAT1/SLC18A1-Thr136Ile-rs1390938) was found to significantly increase transport of monoamines into synaptic vesicles in vitro. We hypothesize that the alteration of magnitude of monoamine release contributes to severity of AW symptoms...
March 2016: Alcoholism, Clinical and Experimental Research
Stephanie Pope, Kasia Gustaw-Rothenberg, Christina Delos Reyes
OBJECTIVE: The purpose of this study was to collect objective data concerning the prescription of vitamin supplementation treatment in hospitalized patients at risk for alcohol withdrawal. METHODS: This study compared the total number of orders for folate, thiamine, and multivitamins with assessments ordered using the revised Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) during 2 congruent time periods in a hospital system before and after these orders were linked to determine the effectiveness of the link...
January 2016: Journal of Psychiatric Practice
Parham Aarabi, Narges Norouzi, Taylor Dear, Sally Carver, Simon Bromberg, Sara Gray, Mel Kahan, Bjug Borgundvaag
This paper evaluates the relation between Alcohol Withdrawal Syndrome tremors in the left and right hands of patients. By analyzing 122 recordings from 61 patients in emergency departments, we found a weak relationship between the left and right hand tremor frequencies (correlation coefficient of 0.63). We found a much stronger relationship between the expert physician tremor ratings (on CIWA-Ar 0-7 scale) of the two hands, with a correlation coefficient of 0.923. Next, using a smartphone to collect the tremor data and using a previously developed model for obtaining estimated tremor ratings, we also found a strong correlation (correlation coefficient of 0...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
James Russell, Neal Richardson, Aglaja Dar
No abstract text is available yet for this article.
June 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
José R Maldonado, Yelizaveta Sher, Smita Das, Kelsey Hills-Evans, Anna Frenklach, Sermsak Lolak, Rachel Talley, Eric Neri
AIMS: The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients...
September 2015: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
Ranjani Ramanujam, Padma L, Swaminath G, Rohini S Thimmaiah
BACKGROUND: Currently, benzodiazepines are the preferred drugs in the management of alcohol withdrawal symptoms. Chlordiazepoxide and diazepam, the most frequently used drugs have a long duration of action and are converted to active metabolites in the liver, while lorazepam is shorter acting, with no active metabolites. OBJECTIVE: To compare and evaluate the safety and efficacy of lorazepam and chlordiazepoxide in patients with alcohol dependence syndrome with symptoms of alcohol withdrawal...
March 2015: Journal of Clinical and Diagnostic Research: JCDR
Jia Liu, Lu-Ning Wang
BACKGROUND: The treatment baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane review published in Issue 2, 2013. OBJECTIVES: To assess the efficacy and safety of baclofen for people with AWS. SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group Specialised Register (searched 13 January 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), and CINAHL (1982 to January 2015)...
2015: Cochrane Database of Systematic Reviews
Courtney Waye, Mark Wong, Shuko Lee
OBJECTIVES: The South Texas Veterans Health Care System (STVHCS) implemented a Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)-based alcohol-withdrawal protocol in June 2013. The aim of this study was to determine the efficacy and safety of the new protocol. The primary objective was the evaluation of whether implementation of the CIWA-Ar alcohol-withdrawal protocol decreased the average length of hospital stay for patients admitted with alcohol withdrawal syndrome (AWS) as compared with treatment before the introduction of the protocol...
January 2015: Southern Medical Journal
S Carver, N Norouzi, S Bromberg, S Gray, M Kahan, P Aarabi, B Borgundvaag
In this paper, we propose a signal processing method of assessing the severity tremors caused by alcohol withdrawal (AW) syndrome. We have developed an iOS application to calculate the Clinical Institute Withdrawal Assessment (CIWA) score which captures iPod movements using the built-in accelerometer in order to reliably estimate the tremor severity component of the score. We report on the characteristics of AW tremor, the accuracy of electronic assessment of tremor compared to expert clinician assessment, and the potential for using signal processing assessment to differentiate factitious from real tremor in patients seen in the emergency department, as well as in nurses mimicking a tremor...
2014: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Ming-Chyi Huang, Chiao-Chicy Chen, Chun-Hung Pan, Chun-Hsin Chen
BACKGROUND: Chronic and excessive alcohol consumption increases oxidative stress. We previously found that levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage, are elevated in alcohol-dependent patients without delirium tremens (DTs). The aim of this study was to compare serum 8-OHdG levels between alcohol-dependent patients with and without DTs. METHODS: We recruited 16 alcohol-dependent patients with DTs (DTs group) and 58 patients without DTs (non-DTs group)...
October 2014: Alcoholism, Clinical and Experimental Research
Vikram K Reddy, K Girish, Pandit Lakshmi, R Vijendra, Ajay Kumar, R Harsha
OBJECTIVES: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. MATERIALS AND METHODS: This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS...
July 2014: Indian Journal of Pharmacology
J Dyson, S McPherson
INTRODUCTION: The recent National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report 'Measuring the Units' found that hospitals are missing opportunities to save the lives of people with alcohol-related liver disease (ARLD) by failing to provide early intervention and specialist consultant input.(1) METHODS: We aimed to review the management of patients with decompensated liver disease in the first 24 h after admission to hospital. This was a region-wide audit including all Trusts in the Northern Deanery...
June 2014: Gut
Vss Wong, R Turner, J Pleming
INTRODUCTION: Alcohol-related harm costs NHS £3.5 billion a year. It has become a "top priority" for the NHS. Alcohol Concern reported 1.2 million alcohol-related admissions in 2011/12, an increase of 135% over the last 10 years, but more people are also seeking and completing treatment. Current standard treatment for those actively withdrawing from alcohol is for inpatient (IP) detoxification and concurrent assessment and intervention by an Alcohol Liaison Nurse (ALN) which usually takes, on average, 5-7 days as an IP...
June 2014: Gut
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