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inpatient alcohol withdrawal protocol

Hannah L Brooks, Shehzad Kassam, Ginetta Salvalaggio, Elaine Hyshka
ISSUES: People with severe alcohol use disorders are at increased risk of poor acute-care outcomes, in part due to difficulties maintaining abstinence from alcohol while hospitalised. Managed alcohol programs (MAP), which administer controlled doses of beverage alcohol to prevent withdrawal and stabilise drinking patterns, are one strategy for increasing adherence to treatment, and improving health outcomes for hospital inpatients with severe alcohol use disorders. APPROACH: Minimal research has examined the implementation of MAPs in hospital settings...
January 18, 2018: Drug and Alcohol Review
Darius A Rastegar, Dinah Applewhite, Anika A H Alvanzo, Christopher Welsh, Timothy Niessen, Edward S Chen
BACKGROUND: The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. METHODS: A 6-item withdrawal scale developed at another institution was piloted...
October 2017: Substance Abuse
Uwe Verthein, Silke Kuhn, Katrin Gabriel, Ulrich Mautsch, Jens Reimer, Klaus Behrendt
Whilst internationally benzodiazepines are first choice for treatment of alcohol withdrawal syndrome, Germany has a long tradition with clomethiazole. This study explores effectiveness of clomethiazole versus oxazepam in the treatment of alcohol withdrawal syndrome within an observational, stratified, non-inferiority study in routine care. Main outcome criterion was severity of the alcohol withdrawal syndrome (Alcohol Withdrawal Syndrome [AWS]) Scale in the first five days. Additionally, the association between the detoxification protocol (five vs...
March 2018: Psychiatrische Praxis
Kim Donoghue, Abigail Rose, Simon Coulton, Joanna Milward, Kylie Reed, Colin Drummond, Hilary Little
BACKGROUND: Increased levels of cortisol during acute alcohol withdrawal have been linked to cognitive deficits and depression. Preclinical research found that the glucocorticoid Type II receptor antagonist, mifepristone, prevented some of the neurotoxic effects of withdrawal and memory loss. Clinical trials have shown mifepristone effective in the treatment of depression. This study aims to examine the extent to which the glucocorticoid Type II receptor antagonist, mifepristone, when given to alcohol dependent males during the acute phase of alcohol withdrawal, will protect against the subsequent memory loss and depressive symptoms during abstinence from alcohol...
February 24, 2016: BMC Psychiatry
Ursula Running Bear, Heather Anderson, Spero M Manson, Jay H Shore, Allan V Prochazka, Douglas K Novins
BACKGROUND: This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group. METHODS: We sought to predict readmission using a retrospective cohort study...
July 1, 2014: Drug and Alcohol Dependence
Elise M Weerts, Gary S Wand, Hiroto Kuwabara, Xiaoqiang Xu, J James Frost, Dean F Wong, Mary E McCaul
Persons with a history of alcohol dependence are more likely to use tobacco and to meet criteria for nicotine dependence compared with social drinkers or non-drinkers. The high levels of comorbidity of nicotine and alcohol use and dependence are thought to be related to interactions between nicotinic, opioid and dopamine receptors in mesolimbic regions. The current study examined whether individual differences in regional μ-opioid receptor (MOR) availability were associated with tobacco use, nicotine dependence and level of nicotine craving in 25 alcohol-dependent (AD) subjects...
July 2014: Addiction Biology
Anton Manasco, Shannon Chang, Joseph Larriviere, L Lee Hamm, Marcia Glass
Alcohol withdrawal is a common clinical condition that has a variety of complications and morbidities. The manifestations can range from mild agitation to withdrawal seizures and delirium tremens. The treatments for alcohol withdrawal include benzodiazepines, anticonvulsants, beta-blockers and antihypertensives. Although benzodiazepines are presently a first-line therapy, there is controversy regarding the efficacies of these medications compared with others. Treatment protocols often involve one of two contrasting approaches: symptom-triggered versus fixed-schedule dosing of benzodiazepines...
November 2012: Southern Medical Journal
Jeffrey Sankoff, Julie Taub, David Mintzer
The use of Lean tools for quality improvement and process refinement is gaining acceptance in many health care institutions. Traditionally, these tools are used to apply incremental changes to established processes in order to reduce waste and improve quality. In this article, the authors describe a novel Lean methodology, the Rapid Improvement Event (RIE), used in a unique way to develop a new treatment protocol for a specific medical condition: alcohol withdrawal. The RIE allowed for the collaboration of a multidisciplinary group of providers invested in the success of a new protocol for alcohol withdrawal that spans areas from the emergency department to the inpatient ward at an inner-city safety net hospital...
March 2013: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Karen Ng, Karen Dahri, Ivy Chow, Michael Legal
BACKGROUND: Alcohol withdrawal protocols involving symptom-triggered administration of benzodiazepine have been established to reduce the duration of treatment and the cumulative benzodiazepine dose (relative to usual care). However, the effects of a protocol combining fixed-schedule and symptom-triggered benzodiazepine dosing are less clear. OBJECTIVE: To assess the efficacy and safety of a combination fixed-scheduled and symptom-triggered benzodiazepine dosing protocol for alcohol withdrawal, relative to usual care, for medical inpatients at a tertiary care hospital...
November 2011: Canadian Journal of Hospital Pharmacy
Jeffrey E Lyon, Raza A Khan, Charles E Gessert, Pamela M Larson, Colleen M Renier
BACKGROUND: Abrupt cessation of alcohol intake causes habituated drinkers to experience symptoms of alcohol withdrawal syndrome (AWS). OBJECTIVE: To determine the effect of the gamma-aminobutyric acid (GABA)-B agonist baclofen on the course of acute symptomatic AWS. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical study. SETTING: Two tertiary-care hospitals in Duluth, Minnesota. PATIENTS: Inpatient adults admitted for any reason (including AWS) judged to be at high risk for AWS...
October 2011: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Elise M Weerts, Gary S Wand, Hiroto Kuwabara, Cynthia A Munro, Robert F Dannals, John Hilton, J James Frost, Mary E McCaul
BACKGROUND: The endogenous opioid system plays a significant role in alcohol dependence. The goal of the current study was to investigate regional brain mu-opioid receptor (MOR) and delta-opioid receptor (DOR) availability in recently abstinent alcohol-dependent and age-matched healthy control men and women with positron emission tomography (PET) imaging. METHODS: Alcohol-dependent subjects completed an inpatient protocol, which included medically supervised withdrawal and PET imaging on day 5 of abstinence...
December 2011: Alcoholism, Clinical and Experimental Research
Thomas Paparrigopoulos, Elias Tzavellas, Dimitris Karaiskos, Georgia Kourlaba, Ioannis Liappas
BACKGROUND: GABAergic anticonvulsants have been recommended for the treatment of alcohol dependence and the prevention of relapse. Several studies have demonstrated topiramate's efficacy in improving drinking behaviour and maintaining abstinence. The objective of the present open-label controlled study was to assess efficacy and tolerability of low-dose topiramate as adjunctive treatment in alcohol dependence during the immediate post-detoxification period and during a 16-week follow-up period after alcohol withdrawal...
March 14, 2011: BMC Psychiatry
Udo Bonnet, Reza Hamzavi-Abedi, Michael Specka, Jens Wiltfang, Bodo Lieb, Norbert Scherbaum
AIMS: Anticonvulsants are increasingly being advocated for the treatment of acute alcohol withdrawal syndrome (AWS) to avoid the addictive properties of established medications. Because earlier works showed that moderate gabapentin doses were too low to clearly ameliorate severe AWS, we tested a higher gabapentin entry dose. METHODS: Inpatients (n = 37) with severe alcohol withdrawal symptoms (Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-AR) score > or =15 points) were given gabapentin 800 mg, and if their symptom score reduced within 2 h, they were termed 'early responders' and were then treated for 2 days with 600 mg gabapentin q...
March 2010: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
G Sances, N Ghiotto, F Galli, E Guaschino, C Rezzani, V Guidetti, G Nappi
To investigate factors influencing prognosis in medication-overuse headache (MOH), we conducted a 12-month follow-up of patients with probable MOH. We recruited 215 patients consecutively admitted to our headache centre for an inpatient detoxification treatment. We analysed likely predictor factors for headache resolution (sex, age, primary headache, psychiatric comorbidity, type and timing of overuse). Mann-Whitney U-test and chi-squared test were used. One year after withdrawal, we had complete data on 172 patients (80%): 38 of these patients (22%) had relapsed into overuse and 134 (78%) had not...
March 2010: Cephalalgia: An International Journal of Headache
D Mennecier, M Thomas, P Arvers, D Corberand, L Sinayoko, S Bonnefoy, F Harnois, C Thiolet
OBJECTIVE: In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management. METHODS: Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients...
August 2008: Gastroentérologie Clinique et Biologique
Kathleen A Hecksel, J Michael Bostwick, Thomas M Jaeger, Stephen S Cha
OBJECTIVE: To determine if hospitalized medical and surgical patients were placed inappropriately on symptom-triggered therapy (STT) for alcohol withdrawal syndrome (AWS) and if certain conditions were more likely to be associated with inappropriate STT use or adverse events. PATIENTS AND METHODS: We randomly selected 124 (25%) of the 495 Mayo Clinic inpatients who received STT according to the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) protocol in 2003 and assessed them for STT appropriateness, defined as having both intact verbal communication and recent alcohol use...
March 2008: Mayo Clinic Proceedings
Keith H Berge, Robert M Morse
No abstract text is available yet for this article.
March 2008: Mayo Clinic Proceedings
Elise M Weerts, Yu Kyeong Kim, Gary S Wand, Robert F Dannals, Jae Sung Lee, J James Frost, Mary E McCaul
Blockade of brain mu-opioid receptor (mu-OR) and delta-opioid receptor (delta-OR) was investigated in recently abstinent alcohol-dependent subjects (N=21) maintained on naltrexone. Subjects completed a 19-day inpatient protocol, which included alcohol abstinence followed by naltrexone treatment (50 mg) on days 15-19. Blood samples were collected after the first administration of naltrexone to evaluate serum levels of naltrexone and 6-beta-naltrexol. Regional brain mu-OR binding potential (BP) and delta-OR Ki was measured using [11C]carfentanil (CAR) positron emission tomography (PET) and [11C]methyl naltrindole ([11C]MeNTI) PET, respectively, before (day 5) and during naltrexone treatment (day 18)...
February 2008: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Ioannis Liappas, Elias O Tzavellas, Caterina Kariyannis, Christina Piperi, Cleopatra Schulpis, Ioannis Papassotiriou, Constantin R Soldatos
BACKGROUND: Chronic alcohol consumption has been associated with both liver dysregulation and neurotoxic effects in the central nervous system of human beings and experimental animals. Serum levels of S100B protein have been extensively studied in several conditions of neural tissue injury but not in alcohol abuse. The aim of this study was to evaluate the serum levels of S100B in alcohol-dependent individuals and to further investigate the effect of alcohol detoxification on the levels of S100B...
September 2006: In Vivo
Michael F Weaver, Heather J Hoffman, Robert E Johnson, Kimberly Mauck
Studies show that symptom-triggered dosing is best for treatment of alcohol withdrawal in patients on chemical dependence wards without other illness. On general medical hospital wards, withdrawal may be affected by comorbid medical illness. A clinical trial was undertaken to determine whether there is a difference between symptom-triggered (ST) and fixed-schedule (FS) dosing of lorazepam in patients hospitalized on general medical wards at a university medical center. One hundred eighty-three subjects were assessed by their nurses with the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale...
2006: Journal of Addictive Diseases
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