Editing Mental Health and Psychosocial Nursing (section)

=== Alcohol ===
Withdrawal timeline after last drink:
* 6 to 12 hours: tremor, anxiety, nausea, diaphoresis, tachycardia, hypertension
* 12 to 24 hours: alcoholic hallucinosis (usually visual, sensorium otherwise clear)
* 24 to 48 hours: withdrawal seizures (generalized tonic-clonic)
* 48 to 96 hours: '''delirium tremens''' - clouded sensorium, disorientation, severe autonomic hyperactivity, hallucinations, fever. This is a medical emergency with meaningful mortality even when treated.

Management: CIWA-Ar symptom-triggered '''benzodiazepines''' (lorazepam is preferred in hepatic impairment because it does not require oxidative metabolism), quiet well-lit room, frequent orientation, seizure precautions, fluids and electrolytes, and '''thiamine before glucose''' to prevent precipitating Wernicke encephalopathy.

Wernicke encephalopathy is the acute triad of confusion, ataxia, and ophthalmoplegia or nystagmus; it is reversible with thiamine. Korsakoff syndrome is the chronic sequel with anterograde amnesia and confabulation, and it is largely irreversible.

Maintenance pharmacotherapy: '''disulfiram''' causes flushing, throbbing headache, vomiting, and hypotension if alcohol is ingested; teach avoidance of hidden alcohol in mouthwash, cough syrup, sauces, aftershave, and hand sanitizer. '''Naltrexone''' reduces craving and reward but is contraindicated with current opioid use because it precipitates withdrawal. '''Acamprosate''' supports abstinence and is renally cleared.