小结
定义
病史和体格检查
关键诊断因素
- withdrawal
- tolerance
- increased/decreased liver size, jaundice, ascites
其他诊断因素
- insomnia
- erectile dysfunction
- nicotine use disorder
- gastrointestinal distress
- muscle cramps, pain, tenderness, altered sensory perception
- hypertension and tachycardia
- impaired nutritional status
- broad-based gait
危险因素
- family history of alcohol use disorder
- antisocial behavior (premorbid)
- high trait anxiety level
- lack of facial flushing on exposure to alcohol
- low responsivity to the effects of alcohol
- history of gastric bypass
诊断性检查
首要检查
- diagnostic interview
- alcohol level (breath and blood)
- Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)
需考虑的检查
- carbohydrate-deficient transferrin (CDT)
- gamma glutamyl transpeptidase (gamma-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
- CBC
- urinary ethyl glucuronide
治疗流程
at-risk drinking
alcohol use disorder: nonpregnant adult with no concurrent opioid use or mental health diagnosis
alcohol use disorder: nonpregnant adult with concurrent opioid use
alcohol use disorder: nonpregnant adult with concurrent mental health diagnosis
alcohol use disorder: nonpregnant adolescent
alcohol use disorder: pregnant
撰稿人
作者
Elisabeth Poorman, MD, MPH
Assistant Professor of Medicine
Department of Medicine
University of Illinois Chicago
Chicago
IL
利益声明
EP declares that she has no conflicting interests.
Marlene Martin, MD
Associate Professor of Clinical Medicine
Director, Addiction Care Team
San Francisco General Hospital
University of California, San Francisco
San Francisco
CA
Declarações
MM is a board member for the National Harm Reduction Coalition and has done consultancy work for the Society of Hospital Medicine.
Sarah Messmer, MD
Assistant Professor of Clinical Medicine and Pediatrics
University of Illinois Chicago
Chicago
IL
Declarações
SM declares that she has no conflicting interests.
Agradecimentos
Dr Elisabeth Poorman, Dr Marlene Martin, and Dr Sarah Messmer would like to gratefully acknowledge Dr Colin Drummond, Dr Julie R. Pittman, Dr Philip H. Chung, Dr Robert M. Swift, and Dr Lorenzo Leggio, previous contributors to this topic.
Declarações
CD, JRP, PHC, and RMS declare that they have no competing interests. LL is an author of a reference cited in this topic.
Revisores
Paul S. Haber, MD
Royal Prince Alfred Hospital and Discipline of Medicine
University of Sydney
Sydney
Australia
Declarações
PSH is an author of a reference cited in this topic.
Roberta Agabio, MD
Bernard B. Brodie Department of Neuroscience
University of Cagliari
Cagliari
Italy
Disclosures
RA is an author of a number of references cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018 Jan 1;175(1):86-90.Texto completo Resumo
Lingford-Hughes AR, Welch S, Peter L, et al. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction, and comorbidity: recommendations from BAP. J Psychopharmacol. 2012 Jul;26(7):899-952. Resumo
Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006 May 3;295(17):2003-17.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Other psychiatric disorders
- Other substance use disorders (especially sedatives)
Mais Diagnósticos diferenciaisDiretrizes
- Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR)
- International statistical classification of diseases and related health problems, 11th ed. (ICD-11)
Mais DiretrizesFolhetos informativos para os pacientes
Alcohol-use disorder
Mais Folhetos informativos para os pacientesCalculadoras
Alcohol Consumption Screening AUDIT Questionnaire
Mais CalculadorasConectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal