The recognition and management of protracted alcohol withdrawal may improve and modulate the pharmacological treatment of alcohol use disorder
The recognition and management of protracted alcohol withdrawal may improve and modulate the pharmacological treatment of alcohol use disorder
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DOI：
10.1177/0269881120936483
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发表时间：
2020-07-10
影响因子：
4.1
通讯作者：
Zoli, Giorgio
中科院分区：
文献类型：
--
作者：
Caputo, Fabio;Cibin, Mauro;Zoli, Giorgio
大约50%的酒精使用障碍患者在减少或停止饮酒时可能会出现酒精戒断综合征（AWS）的症状。丙醇酒精戒断（PAW）是一种被低估且尚未明确定义的AWS急性期后的临床状况，其特征在于存在急性AWS常见的物质特异性体征和症状（即焦虑、易怒、情绪不稳定、失眠、渴望），但持续时间超过通常预期的急性AWS时间范围。考虑到PAW症状主要与GABA和NMDA系统的神经适应性改变有关，纳洛酮、纳美芬和双硫仑可能不能抑制PAW症状。在治疗AWS的急性期后，可能可以更早地使用能够抑制PAW症状的更特异性的药理学治疗，并且可能更有助于预防酒精复发的风险，在治疗的最初几个月内酒精复发的风险仍然较高。鉴于此，可以联合使用作用于GABA和NMDA神经递质系统以平衡NMDA上调和GABA下调的药物，并尽快开始。
About 50% of persons with an alcohol use disorder may have symptoms of alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption. Protracted alcohol withdrawal (PAW), an underestimated and not yet clearly defined clinical condition that follows the acute stage of AWS, is characterized by the presence of substance-specific signs and symptoms (i.e. anxiety, irritability, mood instability, insomnia, craving) common to acute AWS, but persisting beyond the generally expected acute AWS time frames. Considering that PAW symptoms are mainly related to the neuro-adaptive changes of gamma-aminobutyric acid (GABA) andN-methyl-d-aspartate (NMDA) systems, naltrexone, nalmefene, and disulfiram may not be able to suppress the symptoms of PAW. After treatment of the acute phase of AWS, a more specifically pharmacological therapy able to suppress PAW symptoms could perhaps be used earlier and may be more helpful in preventing the risk of alcohol relapse, which remains higher during the first months of treatment. In light of this, medications acting on GABA and NMDA neurotransmitter systems to counterbalance the up-regulation of NMDA and the down-regulation of GABA could be employed in combination and started as soon as possible.