Acute detox for alcohol

Question 1

What is the diagnosis of the patient’s condition and name the DSM-5 criteria that are being met? (6 marks)

Answer 1

Alcohol Withdrawal

Criteria A: Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
Criteria B: Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol:
* Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
* Increased hand tremor.
* Nausea or vomiting.
* Transient visual, tactile, or auditory hallucinations or illusions.
* Anxiety
* Psychomotor agitation.
Criteria C: The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criteria D: The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance
Students should diagnose the condition for 1 mark, include Criteria A, B, and C for 3 marks, and state at least 2 symptoms of Criteria B of the DSM 5 for 2 marks.

Question 2

2. Provide 2 psychosocial management plans for the patient to aid in alcohol use reduction. Discuss each management plan in 1 sentence. (4 Marks)

Answer 2

• Motivational Interviewing: Interviewing techniques to enhance the patient’s readiness and commitment to change. Ultimately the patient is empowered to make the change in behaviour.
• Support Groups: Engage in peer-support programs like Alcoholics Anonymous (AA) for ongoing emotional and psychological support.

Question 3

3. Explain why patients may experience signs and symptoms such as agitation, tachycardia, and tremor when they suddenly reduce alcohol intake after prolonged use. (1 mark)

Answer 3

Patients may experience these symptoms because alcohol has an inhibitory effect on the central nervous system (CNS). When alcohol intake is suddenly reduced after prolonged use, this inhibitory effect is removed, leading to CNS excitation. This results in signs and symptoms of alcohol withdrawal.

Question 4

4. Discuss the approach to managing patients presenting with alcohol withdrawal, including the assessment of disease severity, risk stratification, and appropriate pharmacological treatment options. (6 marks)

Answer 4

• Use a standardized tool like the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) scale to assess the severity of withdrawal symptoms. (1 mark)
• Determine the risk of severe withdrawal symptoms and complications. Patients are categorised based on their symptom severity and risk factors for complications. (1 mark)
• Patients with minimal to mild symptoms and low risk for complications can be discharged home with oral medications. For mild withdrawal, anticonvulsants such as gabapentin or carbamazepine are preferred. (1 mark)
• For patients with moderate withdrawal symptoms and low risk of complications, oral benzodiazepines can be prescribed. (1 mark)
• Patients with moderate to severe withdrawal features or significant risk factors for complications should be admitted to the hospital for close monitoring. These patients should receive intravenous benzodiazepine therapy. (1 mark)
• In severe cases, patients may require ICU admission and treatment with phenobarbital. Additionally, thiamine should be administered to prevent or treat Wernicke encephalopathy. (1 mark)

Question 5

Name 4 other substances of abuse (2 marks)

Answer 5

Benzodiazepines, Stimulants (Cocaine/Amphetamines), Cannabis, Opioids.

Question 6

What is the antidote for benzodiazepine intoxication (1 mark)

Answer 6

Flumazenil