Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Addict. 2020 Nov;29(6):500-507. doi: 10.1111/ajad.13058. Epub 2020 Jun 3.
Despite the high incidence of alcohol withdrawal syndrome (AWS) in psychiatric inpatients, standardized methods for assessing and treating AWS have been studied only once before in this population. We evaluated a novel AWS assessment and treatment protocol designed for psychiatric inpatients.
This retrospective cohort study evaluated outcomes before and after implementation of the protocol. We collected consecutive data on patients (N = 138) admitted to inpatient psychiatric units at a single center. Participants were patients admitted for nonsubstance-related psychiatric reasons, who were also at risk for developing AWS. Those who developed AWS were treated with either (a) treatment as usual (TAU) or (b) a novel standardized protocol. The primary outcome was duration of benzodiazepine treatment for symptoms of alcohol withdrawal. Secondary outcomes included cumulative benzodiazepine dose administered, treatment duration, and incidence of complications.
Of 138 participants, 83 received TAU and 55 were assessed and treated with the novel protocol. Median duration of benzodiazepine treatment following protocol implementation was 19.7 hours (interquartile range [IQR], 0-46) prior to implementation (TAU) and 0 hours (IQR, 0-15) following protocol implementation (protocol group) (P < .0001). Median benzodiazepine dose (in diazepam equivalents) administered to participants was 30 mg (IQR, 0-65) for TAU and 5 mg (IQR, 0-30) for the protocol group (P < .001). Adverse events before and after implementation occurred in 4.8% and 0%, respectively (P = .15).
This study provides preliminary evidence for the efficacy and safety of a novel standardized AWS protocol for psychiatric inpatients. This is the first known study assessing an AWS assessment and treatment protocol designed for psychiatric inpatients. (Am J Addict 2020;29:500-507).
尽管精神科住院患者中酒精戒断综合征（AWS）的发病率很高，但针对该人群，AWS 的评估和治疗方法此前仅研究过一次。我们评估了一种专为精神科住院患者设计的新型 AWS 评估和治疗方案。
这项回顾性队列研究评估了方案实施前后的结果。我们连续收集了在单一中心住院精神科病房住院的患者（N=138）的数据。参与者为因非物质相关精神原因住院且有发生 AWS 风险的患者。发生 AWS 的患者接受以下治疗之一：（a）常规治疗（TAU）或（b）新的标准化方案。主要结局是用于治疗酒精戒断症状的苯二氮䓬类药物治疗时间。次要结局包括给予的累积苯二氮䓬类药物剂量、治疗时间和并发症发生率。
在 138 名参与者中，83 名接受 TAU，55 名接受新型方案评估和治疗。实施方案后，苯二氮䓬类药物治疗的中位时间为 19.7 小时（四分位距[IQR]，0-46），实施方案前（TAU）为 0 小时（IQR，0-15）（方案组）（P<.0001）。TAU 组参与者给予的苯二氮䓬类药物剂量（以地西泮当量计）中位数为 30mg（IQR，0-65），方案组为 5mg（IQR，0-30）（P<.001）。实施前后分别发生了 4.8%和 0%的不良事件（P=.15）。
本研究为一种专为精神科住院患者设计的新型标准化 AWS 方案的疗效和安全性提供了初步证据。这是第一项评估专为精神科住院患者设计的 AWS 评估和治疗方案的研究。（Am J Addict 2020；29：500-507）。
