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 psychiatric clinics, 1975-1980.

A clinical analysis of 476 cases of delirium tremens is presented. The sample covers virtually all cases of delirium tremens that occurred in the Helsingborg Health Service District during the period 1975-1980. A retrospective analysis of the incidence of delirium tremens over the observation period shows that there was an increase in the number and severity of cases developing delirium tremens when non-cross-tolerant drugs, such as carbamazepine and neuroleptics, were used as first-line treatment for acute alcohol withdrawal. The results also show that when chlormethiazole (a drug exhibiting a certain degree of cross-tolerance with ethanol) was used either as the first-line treatment for all cases or as the first-line treatment for predetermined "high risk" patients, the incidence of delirium tremens was greatly reduced. The favourable findings when chlormethiazole treatment was initiated at an early stage in the "high risk" patients suggest that chlormethiazole has a protective action against delirium tremens. Moreover, in the occasional case in which delirium tremens occurred during chlormethiazole treatment, the disorder was milder and relatively easy to treat.