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Most common withdrawal syndrome is haneover next morning (mild tremors, nausea, vomiting, insomnia, anxiety, irritability may occur)

Severe withdrawal causes­

1. Delirium Tremens (DT)
: Most severe withdrawal syndrome, occurs after 2-4 days of complete abstinence

& characterized by­

  1. Clouding of consciousness.
  2. Disorientation in time and place, poor attention span
  3. Visual and auditory hallucinations.
  4. Marked autonomic disturbances like fever, sweating, tachycardia, HTN, pupillary dilation.
  5. Agitation, Insomnia

2. Rum fits: Tonic clonic seizures. Occurs after 12-48 hrs of alcohol withdrawal.



3. Alcoholic hallucinosis: Characterized by presence of hallucinations during abstinence following regular alcohol intake.


Drugs which can be used for its anti craving potential in patients of Alcohol dependence syndrome (ADS) are:- 

  1. Acamprosate,  Naltrexone,  fluoxetine , Topiramate & Baclofen
  2. Acamprosate and topiramate acts on the craving circuits in brain and se the craving.
  3. Naltrexone is a opioid antagonist and decreases the please and also craving for alchohol
  4. Fluoxetine exact mechanism not known but it is a effective for alcohol craving.
  5. Baclofen – recently approved for alcohol craving. This drug is advantageous as it can be given in detoxification state & can also be given to clients with liver dysfunction. 

Antabuse drug for alcohol is disulfiram acts by blocking enzyme acetal dehydrogenase.

Opioid abuse

  1. Opium is obtained from dried exudate of papaver somniferum
  2. Most imp. dependence producing derivatives are morphine and heroin.
  3. Acute intoxication is chart by depression of CVS (bradycardia, hypotension), resp. depression, subnormal temperature and pinpoint pupils (remember with funda everything decreases, i.e. CVS, Resp. temp, pupil size, reflexes in intoxication and i es in opiod withdrawl)
  4. Withdrawal Symptoms
  5. Occur within 12-24 hours and symptoms and signs are opposite like i secretions, tachycardia, mydriasis, piloerection etc.
  6. Tit

a. T/t of overdose by antagonists (naloxone, naltrexone)

b. Detoxification (m/m of withdrawal symptoms)

c. Maintenance phase - when detoxification phase is over patient is maintained on agonist methadone (most widely used), across the world buprenorphine in India or on antagonists (naltrexone)

Some Points of Special Mention

  1. In AIDS sub-cortical dementia
  2. Hypothyroidism most common cause of reversible dementia in India.
  3. Amphetamines : are used to produce model psychoses resembling paranoid schizophrenia in experimental animals. (Cocaine and LSD also)
  4. Anabolic steroids produces mania and their withdrawal produces depression. While gluco-corticoids and ACTH are known to produce depression
  5. Angel dust à phencyclidine produces acute schizophrenic reaction (catatonia synd.) & dissociate anesthesia
  6. Most child psychiatric disorders (e.g. ADHD, conduct, GDT Synd., Tics, Enuresis, autism) are more common in males except mutism (more common in girls).
  7. Patients of anorexia nervosa are vulnerable to sudden death from ventricular tachyarrhythmias.

Some Imp. Negative Points

  1. Bleuler 4 'A's in Schizophrenia does NOT includes - Automatism & auditory hallucination
  2. Dementia is NOT seen in – Schizophrenia
  3. NOT true about paranoid schizophrenia - Rapid deterioration of personality
  4. NOT seen in schizophrenia - Intellectual impairment
  5. Hallucinations are NOT seen in - Personality disorders, anxiety
  6. Physical withdrawal symptoms are NOT commonly associated with - LSD, Cannabis
  7. Muscle hypotonia is most characteristic of REM sleep which differentiate it from wakefulness.
  8. NREM stage four parasomnias are - Sleep walking (somnapulism) sleep terrors or night terrors (pavor nocturnus), bedwetting, tooth-grinding (bruxism), sleepwalking (somniloquy)



  1. Excessive day time sleepiness
  2. Hallmark is REM latency (REM sleep occurs within 10 minutes of the onset of sleep in place of normal 90 min)
  3. Classic tetrad is ­

  i. Sleep attacks (most common) & sleep paralysis

  ii. Cataplexy (loss of muscle tone but clear consciousness)

  1. Hypnagogic (Hallucination while going to sleep)  hallucinations and hypnopompic hallucination (Hallu. While waking up form sleep)
  2. T/t - forced naps and amphetamines, modafinil

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