Withdrawal syndrome
| Classification according to ICD-10 | |
|---|---|
| F10.3 | from alcohol |
| F11.3 | Opioids |
| F12.3 | Cannabinoids |
| F13.3 | Sedatives or hypnotics |
| F14.3 | cocaine |
| F15.3 | other stimulants including caffeine |
| F16.3 | Hallucinogens |
| F17.3 | tobacco |
| F18.3 | volatile solvents |
| F19.3 | multiple substance use and consumption of other psychotropic substances |
| ICD-10 online (WHO version 2019) | |
A withdrawal syndrome (also withdrawal symptom or abstinence syndrome ) is any physical and psychological phenomenon that occurs as a result of partial or complete withdrawal from psychotropic substances . In the case of medication (e.g. antidepressants), this is known as a " withdrawal phenomenon ".
Each group of substances creates specific withdrawal symptoms . Their occurrence is a criterion for diagnosing an addiction syndrome .
According to ICD-10 , mental and behavioral disorders caused by psychotropic substances are divided into substance-specific subgroups (F10-F19). If a withdrawal syndrome occurs , a 3 is added, e.g. F12 .3 for cannabinoids. If there is also delirium , a 4 is used, e.g. F10 .4 for alcohol-related delirium tremens . The distinction is made because delirium is a life-threatening event.
Substances
The most important substances that cause withdrawal symptoms when they are discontinued are:
alcohol
The alcohol withdrawal syndrome (AES) without Delirium is a complex, different serious state image usually 4-12 hours after the last alcohol intake (or the reduction in the amount of drinking) occurs, and may persist for several days acute. About a third of those affected require drug treatment, for which both European and US guidelines have been developed.
Benzodiazepines
The benzodiazepine withdrawal , for. B. Lorazepam , Diazepam or Flunitrazepam can cause a multitude of disturbing to dreaded symptoms. These include insomnia and other sleep disorders , e.g. B. with nightmares , intrusive memories , panic attacks , language disorders and rhetoric difficulties, generalized anxiety states and phobias , depression , aggression , obsessive-compulsive disorder , excessive sensory perception , depersonalization and derealization and other unpleasant phenomena. Since benzodiazepines are potent anticonvulsants as such , a withdrawal attack (in the sense of an occasional attack ) can occur.
Cannabinoids
Consumers of cannabinoids can develop a psychological dependence, and various studies as the Nuthatch Kovar study and the Roques report from a rather low dependence potential go out, but other studies identify a higher potential for addiction.
A study at the Martin Luther University Halle-Wittenberg in 2008 with around 200 inpatients during cannabis withdrawal gave a mixed picture of the severity of the expected withdrawal symptoms, whereby two groups were identified: one group had little or no physical and mental health Withdrawal symptoms, while the second group reported more severe symptoms.
According to their self-perception, members of the first group gave withdrawal symptoms on a scale from 0 to 4 (1 = mild, 4 = strong) between 0 (none) and 1 (mild); Physical complaints such as decreased appetite and sleep disorders, stomach problems and increased sweating, but also psychological withdrawal symptoms such as feelings of fear, irritation, aggression, irritability and excitability, and restlessness were reported. The second group described mild to moderate symptoms on average.
About 30% of the patients reported moderate to severe addictive pressure in the first four days; the less affected group only complained of mild to minor symptoms in the first two days. The authors came to the conclusion that "[...] even in highly stressed patients, cannabis withdrawal syndrome could only have been detected in some of the test subjects [...]".
GHB and GBL
4-Hydroxybutanoic acid ( GHB ) and γ-butyrolactone ( GBL ) produce a withdrawal similar to alcohol, with severe nausea, vomiting and delirium, but of much less duration. In most cases, the physical symptoms decrease after 12 to 96 hours, but it can last up to 2 weeks.
nicotine
Depending on the smoker's potential for addiction, the first symptoms of withdrawal can occur after a few hours' break from smoking (for example, after sleeping at night). These include a slowing of the pulse , a drop in diastolic blood pressure , aggressiveness , irritability , bad mood , depression , nervousness , restlessness or anxiety , reduced ability to concentrate , sweating or sleep disorders , increased appetite and, as a result, weight gain. Often there are also spontaneous mood swings and diffuse, unpleasant feelings. The withdrawal syndrome usually lasts 1–4 weeks, rarely months.
Opioids
After prolonged consumption, the absolute (complete) or relative (e.g. through a dose reduction) withdrawal from opioids (such as buprenorphine , codeine , dihydrocodeine , heroin , methadone or morphine ) leads to different degrees of opioid withdrawal syndrome. This is a (not absolutely necessary) criterion for diagnosing addiction to opioids .
Steroids
After an abrupt end of a lengthy steroid therapy , complications can arise due to insufficient production in the adrenal cortex.
See also
Individual evidence
- ↑ a b ICD-10 Classification of Mental and Behavioral Disorders ( Memento of the original from May 9, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ^ A b Mathias Berger, Jörg Angenendt (ed.): Mental illnesses: Klinik und Therapi e . 3., completely rework. and exp. Edition. Elsevier, Urban & Fischer, Munich, Jena 2009, ISBN 978-3-437-22481-2 .
- ↑ The Ashton Handbook: CHAPTER III: BENZODIAZEPINE WITHDRAWAL SYMPTOMS
- ^ Ridenour et al .: Factors associated with the transition from abuse to dependence among substance abusers: implications for a measure of addictive liability . In: Drug Alcohol Depend. . 80, No. 1, 2005, pp. 1-14. PMID 16157227 .
- ↑ Anna-Bettina Watzke: Cannabis withdrawal symptoms and indications of personality disorders in inpatients treated with cannabis withdrawal results of a longitudinal study . Halle (Saale) 2008, OCLC 436310810 ( online [PDF] dissertation).
- ↑ Friedemann Hagenbuch: GHB / GBL - the new kick? Leaflet of the State Medical Association. ( Memento of the original from September 29, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Ärzteblatt Baden-Württemberg, 02/2011, pp. 93–94.
- ↑ Rauch-Aufgabe.org: non-smoker facts (PDF; 600 kB) Archived from the original on June 16, 2012. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved May 2, 2011.
- ↑ University Clinic for Psychiatry and Psychotherapy of the University of Tübingen: Tobacco Withdrawal Syndrome
