Introduction
A 45-year-old male with a history of chronic alcohol abuse presents to the emergency department showing signs of hallucinations, confusion, and disorientation. The patient’s concerned wife reports that her husband has been drinking heavily for the past few weeks and has had problems sleeping. She also states that her husband had a seizure earlier that day. On examination, the patient appears restless, paranoid, and agitated and is unable to respond to questions coherently. His vital signs are stable, and a neurological assessment indicates no focal deficits. In addition, a blood alcohol of 0.2% is detected in the patient.
Clinical Question
In adult patients with alcohol-induced psychotic disorder and delirium, does the use of benzodiazepines improve symptoms, the incidence of complications, and the length of hospitalization compared to other treatments?
Summary of Evidence
Several articles were reviewed to provide a wide range of information on the chosen PICOT statement. Alcohol-induced psychotic disorder and delirium a severe health complications often linked with long hospital stays and high morbidity and mortality rates. The disorder can be managed using pharmacological and non-pharmacological interventions. Pharmacotherapy involves the use of benzodiazepines or other antipsychotics in managing the conditions. Alternatively, the non-medication approaches include supportive care and abstinence. One article shows that benzodiazepines were found to be efficient in lessening the severity of symptoms and decreasing hospitalization lengths for patients with alcohol-induced psychotic disorder and delirium (Li et al., 2020). Benzodiazepines are recommended for patients with psychosis because they have proven effective in managing severe agitated behaviors (Dubovsky & Marshall, 2022). In addition, these medications have been found effective in easing the symptoms of anxiety, restlessness, hallucinations, and paranoia among patients and in treating seizures. Therefore, it can be viewed that benzodiazepines may result in improved results among patients with alcohol-induced psychotic disorder and delirium.
Supportive care was also found effective in managing alcohol-induced psychotic disorder and delirium. The approach incorporates hydration, sleep, and nutrition support, which helps patients recover from alcohol-related disorders and reduces the incidents of relapse. Nevertheless, supportive care alone cannot improve patients’ symptoms or decrease hospital stays. Although abstinence is associated with a lower risk of alcohol-induced psychotic disorder and delirium recurrence, it may trigger alcohol withdrawal syndrome (AWS), which has adverse effects on patients. AWS increases hospitalization stays and may advance to delirium tremens, whose mortality rate is 1-4% (Wolf et al., 2020). Similarly, AWS is accompanied by various symptoms, including hallucinations, seizures, delusions, and paranoia. Thus, it can be viewed that abstinence in patients with alcohol-induced psychotic disorder and delirium can exacerbate their symptoms resulting in increased hospitalization lengths and mortality rates.
There are significant risks associated with the use of benzodiazepines on patients. This is discussed in an article that researched the effects of benzodiazepines and realized that they could result in sedation, dependence, and respiratory depression (Edinoff et al., 2021). Sedation has been linked as a trigger for cognitive impairment among some patients (Dubovsky & Marshall, 2022). However, despite these risks, benzodiazepines were shown to be effective in improving symptoms, the incidence of complications, and hospital stays for patients with alcohol-induced psychotic disorder and delirium compared to supportive care and abstinence. Nevertheless, the information presented highlighted the need to assess the benefits and risks of benzodiazepines on patients and to develop an individualized treatment approach based on the patient’s clinical situation.
Clinical Bottom Line
The bottom line is that early detection of alcohol-use-related disorders can result in effective treatment reducing morbidity and mortality rates. The use of benzodiazepines on patients with alcohol-induced psychotic disorder and delirium improves health outcomes compared to other treatment approaches, such as supportive care and abstinence alone. These medications are critical in managing agitation and easing the signs of hallucination and paranoia. They are also effective in treating seizures which are greatly associated with delirium. Nevertheless, clinically, the impacts of these medications need to be assessed from one patient to another to ensure that no adverse outcomes result from their use.
There is a need for multiple interventions in the treatment of alcohol-induced psychotic disorder and delirium. While benzodiazepines are effective in managing the disorder’s symptoms, combining them with supportive care, counseling, and abstinence may result in better patient outcomes. Integrating different treatment strategies has been proven to yield more positive health outcomes than using one intervention alone. Multiple techniques ensure a more holistic approach to treatment, increasing a patient’s chances of recovery.
In this specific clinical context, the male adult requires several assessments and screenings to determine the severity of his disorder. Depending on the outcomes of the examinations, there is a need for education detailing the risks of the condition to the patient’s health. In addition, more explanations regarding the recommended treatment interventions as well as the risks and benefits involved in each strategy, should be provided to the patient.
Implications of Practice
In clinical practice, it is crucial to identify the symptoms of alcohol-induced psychotic disorder and delirium among patients with a history of acute alcohol abuse. This may be achieved through incorporating routine assessment and screening for the disorder into all clinical settings. Early detection and effective interventions can assist in averting further complications and enhancing a patient’s overall health. It may also reduce hospital stays readmission, and mortality rates. In addition, there is a need for extensive patient education to inform individuals about the risks of their conditions and the benefits and side effects of the recommended treatment methods. Through patient education, the affected people can acknowledge the need for frequent screenings to detect any anomalies in their health and prevent further complications.
Conclusion
From the research findings, it is evident that benzodiazepines are efficient in improving the symptoms of alcohol-induced psychotic disorder and delirium, resulting in reduced incidences of complications and hospital stays. As a result, they should be used as the first line of treatment for the disorder to increase better health outcomes. Nevertheless, the use of these medications should be carefully assessed from one case to another to ensure that patients do not develop an addiction or experience other risks, such as sedation or respiratory depression. Despite the efficacy of benzodiazepines in managing alcohol-induced psychotic disorder and delirium, multiple interventions are needed to adequately address the condition. A comprehensive treatment approach encompassing the use of medications, support care, abstinence, and counseling can offer better patient outcomes than each intervention alone. It can also reduce the incidents of relapse, assisting the patients to fully recover from the disorder and resume their lives. Furthermore, healthcare practitioners need to refer patients to substance abuse programs to solve the underlying causes of their addiction. Such a multidisciplinary approach can guarantee the patients positive health outcomes and low relapse rates.
References
Dubovsky, S. L., & Marshall, D. (2022). Benzodiazepines remain important therapeutic options in psychiatric practice. Psychotherapy and Psychosomatics, 91, 307–334. Web.
Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, dangers, and clinical considerations. Neurology International, 13(4), 594–607. Web.
Elliott, D. Y. (2019). Caring for hospitalized patients with alcohol withdrawal syndrome. Nursing Critical Care, 14(5), 18–30. Web.
Li, Y., Ma, J., Jin, Y., Li, N., Zheng, R., Mu, W., Wang, J., Si, J. H., Chen, J., & Shang, H. C. (2020). Benzodiazepines for treatment of patients with delirium excluding those who are cared for in an intensive care unit. Cochrane Database of Systematic Reviews, (2), 1-50. Web.
Wolf, C., Curry, A., Nacht, J., & Simpson, S. A. (2020). Management of alcohol withdrawal in the emergency department: Current perspectives. Open Access Emergency Medicine, 12, 53–65. Web.