Psychiatrie und Psychotherapie up2date 2007; 1(6): 393-400
DOI: 10.1055/s-2007-986171
Organische psychische Störungen
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des Alkoholdelirs

Michael  Soyka
Further Information

Publication History

Publication Date:
28 September 2007 (online)

Also available at
    Permissions and Reprints All articles of this category

Kernaussagen

Das Alkoholdelir ist eine relativ häufige und vital bedrohliche Komplikation des chronischen Alkoholismus. Die Mortalität ist heute jedoch gering.

Leitsymptome des Alkoholdelirs sind Angst, Bewusstseins- und Orientierungsstörungen sowie Halluzinationen.

Somatische (z. B. Pankreatitis) und neurologische Begleiterkrankungen spielen beim Alkoholdelir eine große Rolle. Alkoholiker sind oft multimorbide erkrankt, was zu einer hohen Rate an Komplikationen und Folgeerkrankungen beim Alkoholdelir führt. Es ist wichtig, differenzialdiagnostisch Alkoholfolgeerkrankungen auszuschließen.

Eine Vitamin-B-Prophylaxe ist wichtig zur Vorbeugung eines Morbus Wernicke.

Das Alkoholdelir muss stationär behandelt werden. Benzodizapine und Chlomethiazol sind bei der medikamentösen Behandlung die Mittel der Wahl.

Literatur

  • 1 Leentjens A F, Diefenbacher A. A survey of delirium guidelines in Europe.  J Psychosom Res. 2006;  61 123-128
    CrossrefGoogle Scholar
  • 2 Schuchardt V, Hacke W. Klinik und Therapie alkoholassoziierter neurologischer Störungen. In: Seitz H, Lieber KCS, Simanowski UA (Hrsg) Handbuch Alkohol, Alkoholismus, alkoholbedingte Organschäden. Heidelberg; Johann Ambrosius Barth 2000
    Google Scholar
  • 3 Schuchardt V. et al .Leitlinien Neurologie: Alkoholdelir. AWMF-Online http://leitlinien.net 2005
    Google Scholar
  • 4 Sullivan J T, Sykora K, Schneidermann J, Naranjo C A, Sellers E M. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).  Br J Addict. 1989;  84 1353-1357
    CrossrefGoogle Scholar
  • 5 Cuculi F, Kobza R, Ehmann T, Erne P. ECG changes amongst patients with alcohol withdrawal seizures and delirium tremens.  Swiss Med Wkly. 2006;  136 223-227
    Google Scholar
  • 6 Heinz A, Mann K. Neurobiologie der Alkoholabhängigkeit.  Dt Ärztebl. 2001;  98 2279-2283
    Google Scholar
  • 7 van Munster B C, Korevaar J C, de Rooij S E, Levi M, Zwinderman A H. Genetic polymorphisms related to delirium tremens: a systematic review.  Alcohol Clin Exp Res. 2007;  31 177-184
    CrossrefGoogle Scholar
  • 8 Soyka M. Alkoholhalluzinose und Eifersuchtswahn.  Fortschr Neurol Psychiat. 2006;  74 346-357
    Article in Thieme ConnectGoogle Scholar
  • 9 Mayo-Smith M F. et al . Pharmacological management of alcohol withdrawal.  JAMA. 1997;  278 144-151
    Google Scholar
  • 10 Mayo-Smith M F, Beecher L H, Fischer T L. et al . Management of alcohol withdrawal delirium. An evidence-based practice guideline.  Arch Intern Med. 2004;  164 1405-1412
    CrossrefPubMedGoogle Scholar
  • 11 Jaeger T M, Lohr R H, Pankratz V S. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients.  Mayo Clin Proc. 2001;  76 695-701
    Google Scholar
  • 12 Lineaweaver W C, Anderson K, Hing D N. Massive doses of midazolam infusion for delirium tremens without respiratory depression.  Crit Care Med. 1988;  16 294-295
    Google Scholar
  • 13 Williams D, McBride A J. The drug treatment of alcohol withdrawal symptoms: a systematic review.  Alcohol and Alcoholism. 1998;  33 103-115
    Google Scholar
  • 14 Weaver M F, Hoffman H J, Johnson R E, Mauck K. Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity.  J Addict Dis. 2006;  25 17-24
    CrossrefGoogle Scholar
  • 15 Pfitzer F, Schuchardt V, Heitmann R. Die Behandlung schwerer Alkoholdelirien.  Nervenarzt. 1988;  59 229-236
    Google Scholar
  • 16 Sellers E M, Naranjo C A. New strategies for the treatment of alcohol withdrawal.  Psychopharmacol Bull. 1986;  22 88-92
    Google Scholar
  • 17 Schaffer A, Naranjo C A. Recommended drug treatment strategies for the alcoholic patient.  Drug. 1998;  56 571-585
    CrossrefGoogle Scholar
  • 18 Saitz R, Lawrence S, Friedman M D. et al . Alcohol withdrawal: A nationwide survey of inpatient treatment practices.  J Gen Intern Med. 1995;  10 479-487
    CrossrefGoogle Scholar
  • 19 Litten R Z, Allen J, Fertig J. Pharmacotherapies for alcohol problems: A review of research with focus on developments since 1991.  Alcohol Clin Exp Res. 1996;  20 859-876
    CrossrefGoogle Scholar
  • 20 Holbrook A M, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal.  CMAJ. 1999;  160 649-655
    Google Scholar
  • 21 Majumdar S K. Chlormethiazole: current status in the treatment of the acute ethanol withdrawal syndrome.  Drug Alcohol Depend. 1991;  3 201-207
    Google Scholar
  • 22 Athen D. Comparative investigation of chlomethiazole and neuroleptic agents in the treatment of alcoholic delirium.  Acta Psychiatr Scand. 1986;  329 Suppl 167-170
    Google Scholar
  • 23 Palsson A. The efficacy of early chlormethiazole medication in the prevention of delirium tremens. A retrospective study of the outcome of different drug treatment strategies at the Helsingborg psychiatry clinics, 1975 - 1980.  Acta Psychiatr Scand. 1986;  Suppl 329 140-145
    Google Scholar
  • 24 Finzen C, Kruse G. Kombinationstherapie des Alkoholdelirs mit Haloperidol und Chlomethiazol.  Psychiat Prax. 1980;  7 50-56
    Google Scholar
  • 25 Malcolm R, Ballenger J C, Sturgis E T, Anton R. Double-blind controlled trial comparing carbamazepine to oxacepam treatment of alcohol withdrawal.  Am J Psychiatry. 1989;  146 617-621
    Google Scholar
  • 26 Ritola E, Malinen L. A double-blind comparison of carbamazepine and chlomethiazole in the treatment of alcohol withdrawal syndrome.  Acta Psychiatr Scand. 1981;  64 254-259
    CrossrefGoogle Scholar
  • 27 Seifert J, Peter E, Jahn K. et al . Treatment of alcohol withdrawal: Chlormethiazole vs. carbamazepine and the effect on memory performance - a pilot study.  Addict Biol. 2004;  9 43-51
    CrossrefGoogle Scholar
  • 28 Polycarpou A, Papanikolaou P, Ioannidis J P, Contopoulos-Ioannidis D G. Anticonvulsants for alcohol withdrawal.  Cochrane Database Syst Rev. 2005;  20: CD005064
    Google Scholar
  • 29 Bjorkqvist S E, Isohanni M, Makela R, Malinen L. Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: a formal multicentrre double-blind comparision with placebo.  Acta Psychiatr Scand. 1976;  53 333-342
    Google Scholar
  • 30 Soyka M, Schmidt F, Schmidt P. Efficacy and safety of outpatient alcohol detoxification with a combination of tiapride/ carbamazepine: Additional evidence.  Pharmacopsychiatry. 2006;  39 30-34
    Article in Thieme ConnectGoogle Scholar
  • 31 Heuzeroth L, Grünklee D. Clonidine - alternative therapy in the treatment of delirium tremens.  Med Klin. 1988;  83 783-789
    Google Scholar
  • 32 Baumgärtner G R. Clonidine vs. Chlordiazepoxide in the management of acute alcohol withdrawal: A preliminary report.  Southern Med J. 1988;  81 56-60
    CrossrefGoogle Scholar
  • 33 Hell T, Martens D, Eyrich K. Postoperative alcohol withdrawal syndrome - prophylaxis versus therapy.  Anaesthesiology. 1990;  102 A254
    Google Scholar
  • 34 Verner L, Hartmann M, Seitz M. Clonidinsupplementierte Analgosedierung zur postoperativen Delirprophylaxe.  Anästh Intensivther Notfallmed. 1990;  25 274-280
    Google Scholar
  • 35 Fauler J, Verner L. The pharmakokinetics of clonidine in high dosage.  Eur J Pharmacol. 1993;  45 165-167
    Google Scholar
  • 36 Spies C D, Otter H E, Huske B. et al . Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU.  Intensive Care Med. 2003;  29 2230-2238
    CrossrefPubMedGoogle Scholar
  • 37 Spies C D, Dubicz N, Neumann T. et al . Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial.  Crit Care Med. 1996;  24 414-422
    Google Scholar
  • 38 Hansbrough J F, Zapata-Sirvent R L, Carroll W J. et al . Administration of intravenous alcohol for prevention of withdrawal in alcoholic burn patients.  Am J Surg. 1984;  148 266-269
    CrossrefGoogle Scholar
  • 39 Hodges B, Mazur J E. Intravenous ethanol for the treatment of alcohol withdrawal syndrome in critically ill patients.  Pharmacotherapy. 2004;  24 1578-1585
    CrossrefGoogle Scholar
  • 40 Lee J H, Jang M K, Lee J Y. et al . Clinical predictors for delirium tremens in alcohol dependence.  J Gastroenterol Hepatol. 2005;  20 1833-7
    CrossrefGoogle Scholar
  • 41 Fiellin D A, O'Connor P G, Holmboe E S, Horwitz R I. Risk for delirium tremens in patients with alcohol withdrawal syndrome.  Subst Abus. 2002;  23 83-94
    CrossrefGoogle Scholar
  • 42 Wright T, Myrick H, Henderson S, Peters H, Malcolm R. Risk factors for delirium tremens: a retrospective chart review.  Am J Addict. 2006;  15 213-219
    Google Scholar
  • 43 Ferguson J A, Suelzer C J, Eckert G J, Zhou X H, Dittus R S. Risk factors for delirium tremens development.  J Gen Intern Med. 1996;  11 410-414
    CrossrefGoogle Scholar

Prof. Dr. med. Michael Soyka

Privatklinik Meiringen

Postfach 612, CH-3860 Meiringen

Phone: + 41-33-9728295

Email: michael.soyka@pm-klinik.ch

      >