Alcohol withdrawal symptoms can occur as soon as two hours after drinking cessation but usually happen about 8 hours after the last drink. The symptoms tend to peak at 24-72 hours after stopping alcohol. The symptoms include tremors, tachycardia, diaphoresis, agitation, anxiety, nausea/vomiting, seizures, and hallucinations (in severe cases). Other common symptoms in alcohol withdrawal are fatigue, depression, mood swings, confusion, nightmares, and irritability. The symptoms can escalate suddenly and may be life-threatening. Risk factors include consuming alcohol for a long period of time, having a history of delirium tremens, having intense alcohol cravings, and having been through detoxification in the past. These will predict a longer and more severe course of alcohol withdrawal. The symptoms as noted will cause intense distress and/or impairment in function. It can be misinterpreted, with other things in the differential diagnosis. Drug screening for other substances may need to be done to rule out intoxication from another substance. Encephalitis, meningitis, hypoglycemia, and delirium for other medical reasons should also be ruled out. Mental disorders like schizophrenia can mimic alcohol withdrawal. The goals of treatment are to keep symptoms to a low level and to prevent complications. This can be a medical emergency, with the main treatment being a long-acting benzodiazepine. A second-line treatment might be carbamazepine, which is less addicting. Antipsychotics might be necessary to reduce hallucinations and resultant agitation; Clonidine can be used for hypertension and beta blockers can be used for tachycardia. Phenytoin is used only if the person has an underlying seizure disorder.
CAFFEINE-RELATED DISORDERS Caffeine-related disorders include caffeine intoxication, caffeine abuse disorder, and caffeine withdrawal. With caffeine intoxication, there can be physical, psychomotor, and emotional/mental impairments after over-consumption. Most of the time, caffeine intake comes through coffee consumption but it can be seen in soda, energy drinks, analgesics, chocolate, tea, and cold medicine. The goals of taking are to improve cognitive function, alertness, concentration, and mood. It is consumed by 85 percent of adults in the US. 229
