Post-acute-withdrawal syndrome
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Post-acute-withdrawal syndrome | |
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Other names | Post-withdrawal syndrome, protracted withdrawal syndrome, prolonged withdrawal syndromes |
Specialty | Psychiatry, Toxicology |
Post-acute withdrawal syndrome (PAWS) is a hypothesized set of persistent impairments that occur after withdrawal from alcohol,[1][2] opiates, benzodiazepines, antidepressants, and other substances.[3][4][5] Infants born to mothers who used substances of dependence during pregnancy may also experience a PAWS.[6][7] While PAWS has been frequently reported by those withdrawing from opiate and alcohol dependence, the research has limitations. Protracted benzodiazepine withdrawal has been observed to occur in some individuals prescribed benzodiazepines.[8][9]
Drug use, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and during the
Signs and symptoms
Symptoms can sometimes come and go with wave-like re-occurrences or fluctuations in severity of symptoms. Common symptoms include impaired cognition, irritability, depressed mood, and anxiety; all of which may reach severe levels which can lead to relapse.[11][12]
The protracted withdrawal syndrome from benzodiazepines, opioids, alcohol and other addictive substances can produce symptoms identical to generalized anxiety disorder as well as panic disorder. Due to the sometimes prolonged nature and severity of benzodiazepine, opioid and alcohol withdrawal, abrupt cessation is not advised.[13]
Hypothesized symptoms of PAWS are:[14][15][16][17]
- Psychosocial dysfunction
- Anhedonia[18]
- Depression
- Impaired interpersonal skills
- Obsessive-compulsive behaviour
- Feelings of guilt
- Autonomic disturbances
- Pessimisticthoughts
- Impaired attentional control
- Lack of initiative
- Craving
- Inability to think clearly
- Memory problems
- Emotional overreactions or numbness
- Sleep disturbances
- Extreme fatigue
- Physical coordination problems
- Stress sensitivity
- Increased sensitivity to pain
- Panic disorder[13]
- Psychosis
- Generalized anxiety disorder[13]
- Sleep disturbance (dreams of using, behaviors associated with the life style)
- Mourning (the change in lifestyle)
Symptoms occur intermittently, but are not always present. They are made worse by stress or other triggers and may arise at unexpected times and for no apparent reason. They may last for a short while or longer. Any of the following may trigger a temporary return or worsening of the symptoms of PAWS:[citation needed]
- Stressful and/or frustrating situations
- Multitasking
- Feelings of fearfulness or anger
- Social conflicts
- Unrealistic expectations of oneself
Post-acute benzodiazepine withdrawal
Disturbances in mental function can persist for several months or years after
A clinical trial of patients taking the benzodiazepine alprazolam (
Dopamine agonist protracted withdrawal
After long-term use of
Cause
The syndrome may be in part due to persisting physiological adaptations in the central nervous system manifested in the form of continuing but slowly reversible
Treatment
The condition gradually improves over a period of time which can range from six months to several years in more severe cases.[29][30]
Flumazenil was found to be more effective than placebo in reducing feelings of hostility and aggression in patients who had been free of benzodiazepines for 4 to 266 weeks.[31] This may suggest a role for flumazenil in treating protracted benzodiazepine withdrawal symptoms.
Acamprosate has been found to be effective in alleviating some of the post acute withdrawal symptoms of alcohol withdrawal.[32][33] Carbamazepine or trazodone may also be effective in the treatment of post acute withdrawal syndrome in regards to alcohol use.[34][35][36] Cognitive behavioral therapy can also help the post acute withdrawal syndrome especially when cravings are a prominent feature.[37]
See also
- Alcohol withdrawal syndrome
- Antidepressant discontinuation syndrome
- Benzodiazepine withdrawal syndrome
- Opioid use disorder
References
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