Proposal of a Comprehensive Clinical Typology of Alcohol Withdrawal—a Cluster Analysis Approach

Abstract

Our findings support a model of alcohol withdrawal clustering along the two dimensions of vegetative and psychopathological severity. Furthermore, the AWS may be useful to predict the course of alcohol withdrawal already at the first day of treatment.

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

“…Physical examination and investigations should be directed toward detecting common signs and symptoms of AWS that are listed in Table 1 6, 10, 14, 15, 16, 17, 18…”

“…Hallucinosis represents a unique form of withdrawal‐related psychosis which can begin even while the person is continuing to use alcohol or after cessation of drinking. The sensorium is clear in the beginning, but it often evolves into the syndrome of DT, a specific type of delirium typically associated with psychomotor agitation (hyperactive delirium) which emerges during the late withdrawal phase 14, 18. Delirium can also manifest as a hypoactive state with decreased arousal and psychomotor activity, which is associated with a worse prognosis, delayed diagnosis and treatment as well as later complications 6.…”

“…The Alcohol Withdrawal Scale is based on a factor‐analyzed version of the CIWA‐A‐Scale and consists of six vegetative (pulse rate, diastolic blood pressure, body temperature, breathing rate, sweating, and tremor), and five mental or psychopathological symptom items (agitation, anxiety, tactile disturbances, disorientation, and hallucinations) each of which are operationalized 14. Using these two dimensions of vegetative and psychopathological severity, a clustering of withdrawal symptoms in 5 categories (no relevant symptoms, mild vegetative symptoms only, additional anxiety, additional disorientation, and hallucinations) at the 1st d of treatment may be predictive of the course of alcohol withdrawal 14…”

Aplicabilidade da classificação de alcoolismo tipo A/tipo B

“…Da mesma forma que outros estudos [4][5][6][7][8][9][10][11][12] , que tentaram replicar a tipologia tipo A/tipo B, também se procurou, neste estudo, utilizar variáveis o mais semelhantes possível das originais de Babor et al 3 . Como os dados provenientes das avaliações rea lizadas no PADQ não permitem a extração de todas as medidas de forma idêntica às utilizadas no estudo original, fez-se necessário que algumas das variáveis disponíveis fossem adaptadas para que se assemelhassem -por artigo original adequação ou aproximação conceitual -àquelas utilizadas para a composição da tipologia aqui estudada.…”

“…A classificação tipo A/tipo B de Babor et al 3 está entre as principais tipologias de alcoolismo e tem sido avaliada por diversos pesquisadores que, todavia, encontraram diferentes resultados em termos de validades de construto e preditiva dessa classificação [4][5][6][7][8][9][10][11][12] .…”