Alcoholic psychosis

Delirium tremens (DTs; lit. 'mental disturbance with shaking') is a rapid onset of confusion usually caused by withdrawal from alcohol. When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days. Physical effects may include shaking, shivering, irregular heart rate, and sweating. People may also hallucinate. Occasionally, a very high body temperature or seizures (colloquially known as "rum fits") may result in death.

Delirium tremens typically occurs only in people with a high intake of alcohol for more than a month, followed by sharply reduced intake. A similar syndrome may occur with benzodiazepine and barbiturate withdrawal. (Withdrawal from stimulants, such as cocaine and amphetamines, does not have major medical complications.) In a person with delirium tremens it is important to rule out other associated problems such as electrolyte abnormalities, pancreatitis, and alcoholic hepatitis.

Prevention is by treating withdrawal symptoms using similarly acting compounds to taper off the use of the precipitating substance in a controlled fashion. If delirium tremens occurs, aggressive treatment improves outcomes. Treatment in a quiet intensive care unit with sufficient light is often recommended. Benzodiazepines are the medication of choice with diazepam, lorazepam, chlordiazepoxide, and oxazepam all commonly used. They should be given until a person is lightly sleeping. Non-benzodiazepines are often used as adjuncts to manage the sleep disturbance associated with condition. The antipsychotic haloperidol may also be used, as a major tranquilizer, in order to combat the overactivity and possible excitotoxicity caused by the withdrawal from a GABA-ergic sedative. The vitamin thiamine is recommended to be given intramuscularly, because long term high alcohol intake and the often attendant nutritional deficit damages the small intestine, and so leads to a thiamine deficiency which sometimes cannot be rectified by supplement pills alone.

Mortality without treatment is between 15% and 40%. Currently death occurs in about 1% to 4% of cases.

About half of people with alcoholism will develop withdrawal symptoms upon reducing their use. Of these, 3% to 5% develop DTs or have seizures.

The name delirium tremens was first used in 1813; however, the symptoms were well described since the 1700s. The word "delirium" is Latin for "going off the furrow," a plowing metaphor for disordered thinking. It is also called the shaking frenzy and Saunders-Sutton syndrome. There are numerous nicknames for the condition, including "the DTs" and "seeing pink elephants".