Alcohol Withdrawal Delirium

The essential diagnostic feature of this disorder is a delirium that develops after recent cessation of or reduction in alcohol consumption. Traditionally referred to as delirium tremens, this withdrawal state typically begins 72-96 hours after the last drink, so it is uncommon within the normal span of detention in police custody. The delirium is characterized by impaired attention and memory, disorganized thinking, disorientation, reduced level of consciousness, perceptual disturbances, and agitation. Vivid, and often terrifying, hallucinations may occur. Usually these are visual, but other sensory modalities (e.g., auditory or tactile) may be involved. The disorder usually coexists with other features of alcohol withdrawal, for example, autonomic hyperac-tivity, which is usually severe.

Alcohol withdrawal delirium is a medical emergency with a mortality rate of approx 5%. Once diagnosed, the detained person with delirium requires urgent hospitalization.

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