Delirium tremens. Some clinical features. Part I.

Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as "Predelirium" (grade 2). The material was found to be representative for the condition under discussion. Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed. The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro-intestinal disturbances for 12-24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours. Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood--several even concentrations about 2 g/l--at the time of admission compared to patients with a less severe clinical state. This lack of "latency period", which previously has been described as a typical feature in the development of delirium tremens, is discussed. It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed delirium tremens.