Alcohol withdrawal diagnostic criteria: Difference between revisions

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'''For patient information click [[Alcohol withdrawal (patient information)|here]].'''
'''For patient information click [[Alcohol withdrawal (patient information)|here]].'''


{{PleaseHelp}}
{{CMG}}; {{AE}} {{ADI}}; {{KS}}


== Diagnosis ==
==Overview==
The Diagnostic and Statistical Manual of Mental Disorders ([[DSM-5]]) criteria is used to diagnose [[alcohol]] withdrawal and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) scale is used to assess the severity of [[alcohol]] withdrawal.


=== Criteria ===
==Diagnosis==
===Diagnostic Criteria===
===DSM-V Diagnostic Criteria for Alcohol Withdrawal<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>==={{cquote|


# History of cessation or reduction in heavy and prolonged alcohol use.
*A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
# 2 or more of:
 
#:* Autonomic hypereactivity
'''''AND'''''
#:* Hand [[tremor]]
 
#:* [[Insomnia]]
*B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A:
#:* [[Nausea ]]and [[vomiting]]
:*1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
#:* Visual or auditory [[hallucinations]]
:*2. Increased hand tremor.
#:* Psychomotor agitation
:*3. [[Insomnia]].
#:* [[Anxiety]]
:*4. Nausea or vomiting.
#:* [[Grand mal seizures]]
:*5. Transient visual, tactile, or [[auditory hallucinations]] or illusions.
#:*:* Note history of [[blackouts]], morning shakes, prior detoxifications or [[DT]]s and frequency, amount and type of alcohol.
:*6. [[Psychomotor agitation]].
:*7. [[Anxiety]].
:*8. Generalized tonic-clonic seizures.
 
'''''AND'''''
 
*C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
 
'''''AND'''''
 
*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.
 
Specify if:
 
* With perceptual disturbances: This specifier applies in the rare instance when [[hallucinations]](usually visual or tactile) occur with intact reality testing, or auditory, visual,
}}


=== Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) ===
=== Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) ===
The CIWA (Clinical Institute Withdrawal Assessment)<ref name="pmid16115538">{{cite journal |author=Puz CA, Stokes SJ |title=Alcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised |journal=Crit Care Nurs Clin North Am |volume=17 |issue=3 |pages=297–304 |year=2005 |month=September |pmid=16115538 |doi=10.1016/j.ccell.2005.04.001 |url=}}</ref> is a common measure used in North American hospitals to assess and treat alcohol withdrawal syndrome and for alcohol detoxification. This clinical tool assesses 10 common withdrawal signs.<ref name="pmid15029927">{{cite journal |author=McKay A, Koranda A, Axen D |title=Using a symptom-triggered approach to manage patients in acute alcohol withdrawal |journal=Medsurg Nurs |volume=13 |issue=1 |pages=15–20, 31; quiz 21 |year=2004 |month=February |pmid=15029927 |doi= |url=}}</ref> A score of more than '''15''' points is associated with increased risk of alcohol withdrawal effects such as [[confusion]] or [[seizures]].
The CIWA (Clinical Institute Withdrawal Assessment)<ref name="pmid16115538">{{cite journal |author=Puz CA, Stokes SJ |title=Alcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised |journal=Crit Care Nurs Clin North Am |volume=17 |issue=3 |pages=297–304 |year=2005 |month=September |pmid=16115538 |doi=10.1016/j.ccell.2005.04.001 |url=}}</ref> is a common measure used in North American hospitals to assess and treat alcohol withdrawal syndrome and for alcohol detoxification. This clinical tool assesses 10 common withdrawal signs.<ref name="pmid15029927">{{cite journal |author=McKay A, Koranda A, Axen D |title=Using a symptom-triggered approach to manage patients in acute alcohol withdrawal |journal=Medsurg Nurs |volume=13 |issue=1 |pages=15–20, 31; quiz 21 |year=2004 |month=February |pmid=15029927 |doi= |url=}}</ref> A score of more than '''15''' points is associated with increased risk of alcohol withdrawal effects such as [[confusion]] or [[seizures]].


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===Other Assessment Scales===
===Other Assessment Scales===
; Alcohol Assessment Scale
; Alcohol Assessment Scale
[[Image:AWS.PNG|550px|thumb|center|Alcohol Withdrawal Scale]]
[[Image:AWS.PNG|550px|thumb|center|Alcohol Withdrawal Scale]]


===Level of Evidence===
===Level of Evidence===
{|border ="1"
{|border ="1"
|-
|-
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| Alcohol Assessment Scale (AWS) || align="center" | IV
| Alcohol Assessment Scale (AWS) || align="center" | IV
|}
|}
===Alcohol Withdrawal Calculator===
{{#widget:Alcohol_Withdrawal_Calc}}


==References==
==References==
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[[Category:Toxicology]]
[[Category:Toxicology]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:DSM-V Diagnostic Criteria]]
[[Category:Psychiatric Disease]]
[[Category:Psychiatry]]

Latest revision as of 17:10, 12 November 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Kiran Singh, M.D. [3]

Overview

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria is used to diagnose alcohol withdrawal and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) scale is used to assess the severity of alcohol withdrawal.

Diagnosis

Diagnostic Criteria

DSM-V Diagnostic Criteria for Alcohol Withdrawal[1]

“
  • A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

AND

  • B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A:

AND

  • C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • 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.

Specify if:

  • With perceptual disturbances: This specifier applies in the rare instance when hallucinations(usually visual or tactile) occur with intact reality testing, or auditory, visual,
 ”

Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar)

The CIWA (Clinical Institute Withdrawal Assessment)[2] is a common measure used in North American hospitals to assess and treat alcohol withdrawal syndrome and for alcohol detoxification. This clinical tool assesses 10 common withdrawal signs.[3] A score of more than 15 points is associated with increased risk of alcohol withdrawal effects such as confusion or seizures.

Alcohol withdrawal

Other Assessment Scales

Alcohol Assessment Scale
Alcohol Withdrawal Scale

Level of Evidence

Assessment Scale Level of Evidence
The Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-Ar) I
Alcohol Assessment Scale (AWS) IV

References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  2. ↑ Puz CA, Stokes SJ (2005). "Alcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised". Crit Care Nurs Clin North Am. 17 (3): 297–304. doi:10.1016/j.ccell.2005.04.001. PMID 16115538. Unknown parameter |month= ignored (help)
  3. ↑ McKay A, Koranda A, Axen D (2004). "Using a symptom-triggered approach to manage patients in acute alcohol withdrawal". Medsurg Nurs. 13 (1): 15–20, 31, quiz 21. PMID 15029927. Unknown parameter |month= ignored (help)
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