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Comparison between Fixed-dosed Therapy and Symptom-triggered Therapy for Alcohol Detoxification in a Psychiatric Setting

Chiung-Yueh Fan, Chiao-Chicy Chen, Ming-Chi Huang

Objective:Benzodiazepine is the drug of choice in treating alcohol with-drawal syndrome (AWS). Fixed-dosed therapy (FDT) and Symptom-triggered therapy (STT) are the commonly used treatment strategies. In this study, we in-tended to assess the benefits of the newly introduced STT compared to FDT for AWS management in a psychiatric setting. Methods:We retrospectively reviewed the medical records of 60 admitted patients fulfilling DSM-IV-TR criteria for alco-hol dependence. They were divided into two groups based on the alcohol detoxifi-cation regimen they received (30 patients each in STT and FDT). AWS severity was measured using a Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C). We also compared the total loraze-pam dosages and the changes in CIWA-Ar-C scores. Results:We found that de-spite the first-day AWS severity being more severe in the STT group (CIWA-Ar-C 15.2 vs. 9.4, p < 0.001), patients in the STT group received significantly less loraz-epam dosage compared to the FDT group during detoxification (10.3 ± 4.5 vs. 23.1 ± 9.0 mg for Day 1-3; 18.0 ± 6.9 vs. 47 ± 18.8 mg for Day 1-7, p < 0.001). Conclusion:Being consistent with previous reports that supported the advantage of STT in medical wards when managing AWS, our study provides evidence that STT is as effective as FDT for alcohol detoxification in psychiatric settings and associated with less doses of lorazepam.
Key Word fixed-dosed, symptom-triggered, alcohol detoxification, psychiatric setting, benzodiazepine
Editorial Committe, Taiwanese Journal of Psychiatry
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