Delirium tremens is an acute episode of
deliriumDelirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
that is usually caused by
withdrawalWithdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
from
alcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
, first described in 1813.
BenzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s are the treatment of choice for delirium tremens (DT).
Withdrawal from sedative-hypnotics other than alcohol, such as
benzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s, or
barbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s, can also result in seizures, delirium tremens, and death if not properly managed. Withdrawal from other drugs which are not sedative-hypnotics such as
caffeineCaffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
,
cocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, etc. does not have major medical complications, and is not life-threatening. Withdrawal reactions as a result of physical dependence on alcohol is the most dangerous and can be fatal. It often creates a full blown effect which is physically evident through shivering, palpitations, sweating and in some cases, convulsions and death if not treated.
When caused by alcohol, it occurs only in patients with a history of
alcoholismAlcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
. Occurrence of a similar syndrome due to
benzodiazepinesBenzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or during dosage reductions...
does not require as long a period of consistent intake of such drugs. Benzodiazepines are relatively safe in overdose when taken alone; however, if the overdose includes the use of other sedative drugs, alcohol in particular, it could lead to dangerous side effects.
In the U.S., fewer than about 50% to 60% of alcoholics will develop any significant withdrawal symptoms upon cessation of alcohol intake, and of these, only 5% of cases of acute
ethanol withdrawal-Protracted withdrawal:A protracted alcohol withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to...
progress to DT. Unlike the withdrawal syndrome associated with
opiateIn medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...
dependence, DT (and alcohol withdrawal in general) can be fatal. Mortality was as high as 35% before the advent of intensive care and advanced
pharmacotherapyPharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....
; in the modern era of medicine, death rates range from 5-15%.
Similar hyperirritability and hallucinosis can be caused by
magnesium deficiencyHypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood. Usually a serum level less than 0.7 mmol/L is used as reference. The prefix hypo- means low . The middle 'magnes' refers to magnesium...
.
Symptoms
The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, nightmares, disorientation and agitation and other signs of severe
autonomicThe autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...
instability (
feverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
,
tachycardiaTachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
,
hypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
). These symptoms may appear suddenly but can develop 2–3 days after cessation of drinking heavily with its highest peak/ intensity on the fourth or fifth day. Also, these "symptoms are characteristically worse at night". Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats. These may be hallucinations, or illusions related to the environment, e.g., patterns on the wallpaper or in the peripheral vision that the patient falsely perceives as a resemblance to the morphology of an insect. Unlike hallucinations associated with
schizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, delirium tremens hallucinations are primarily visual, in the peripheral field of vision, but are also associated with tactile hallucinations such as sensations of something crawling on the subject — a phenomenon known as
formicationFormication is the medical term for a sensation that resembles that of insects crawling on the skin. It is one specific form of a set of sensations known as paresthesia, which also include the more common prickling, tingling sensation of "pins and needles"...
. Delirium Tremens usually includes extremely intense feelings of "impending doom". Severe anxiety and feelings of imminent death are symptomatic of DT.
DT can sometimes be associated with severe, uncontrollable
tremorA tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...
s of the extremities and secondary symptoms such as anxiety, panic attacks and
paranoiaParanoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
. Confusion is often noticeable to onlookers as patients will have trouble constructing simple sentences or making basic logical calculations. In many cases, people who rarely speak out of turn will have an increased tendency for gaffes even though they are sober.
DT should be distinguished from
alcoholic hallucinosisAlcoholic hallucinosis is a complication of alcohol withdrawal in alcoholics. This develops about 12 to 24 hours after drinking stops and involves auditory and visual hallucinations, most commonly accusatory or threatening voices...
, the latter occurring in approximately 20% of hospitalized alcoholics and not carrying a significant mortality. In contrast, DT occurs in 5-10% of alcoholics and carries up to 5% mortality with treatment and up to 35% mortality without treatment. DT is characterized by the presence of altered
sensoriumThe term sensorium refers to the sum of an organism's perception, the "seat of sensation" where it experiences and interprets the environments within which it lives. The term originally enters English from the Late Latin in the mid-17th century, from the stem sens-...
; that is, a complete hallucination without any recognition of the real world. DT has extreme autonomic hyperactivity (high pulse, blood pressure, and rate of breathing), and 35-60% of patients have a fever. Some patients experience
seizureAn epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...
s.
Causes
Delirium tremens is mainly caused after a long period of drinking, being stopped abruptly and experiencing withdrawal. It may also be triggered by head injury, infection, or illness in people with a history of heavy use of alcohol. Yet another cause of delirium tremens is abrupt cessation of tranquilizer drugs of the barbiturate or benzodiazepine classes in a patient with a relatively strong addiction to them.
Because these tranquilizers' primary pharmacological and physiological effects stem from their manipulation of the
GABA chemicalγ-Aminobutyric acid is the chief inhibitory neurotransmitter in the mammalian central nervous system. It plays a role in regulating neuronal excitability throughout the nervous system...
and transmitter somatic system, the same endogenous neurotransmitter system affected by alcohol, delirium tremens can occur upon abrupt cessation of dosage in heavily dependent patients. These DTs are much the same as those caused by alcohol and so is the attendant withdrawal syndrome of which they are a manifestation. That is the primary reason benzodiazepines are such an effective treatment for DTs, despite also being the cause of them in many cases. Because the primary psychoactive chemical constituent of both ethanol and the tranquilizers of the barbiturate and benzodiazepine class both mimic GABA so effectively that the brain mistakes them for GABA, the brain, in its desire to equalize an unbalanced chemical system, 'orders' the abrupt cessation of the production of endogenous GABA, (this cessation becoming more and more marked as the addiction becomes stronger and higher and higher doses are needed to cause intoxication) which in addition to its sedative effects, is an immensely important regulatory neurotransmitter that controls the heart rate, blood pressure, and seizure threshold among myriad other important autonomic nervous subsystems.
Delirium tremens is most common in people who have a history of alcohol withdrawal, especially in those who drink the equivalent of 7 to 8 US pints (3310–3790 ml or 5.83–6.66 imp pt) of beer or 1 US pint (473 ml or 16.65 imp fl oz) of
distilled beverageA distilled beverage, liquor, or spirit is an alcoholic beverage containing ethanol that is produced by distilling ethanol produced by means of fermenting grain, fruit, or vegetables...
daily. Delirium tremens also commonly affects those with a history of habitual alcohol use or alcoholism that has existed for more than 10 years.
The exact
pharmacologyPharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
of ethanol is not fully understood; however, it is theorized that delirium tremens is caused by the effect of alcohol on the
benzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
-
GABAGabâ or gabaa, for the people in many parts of the Philippines), is the concept of a non-human and non-divine, imminent retribution. A sort of negative karma, it is generally seen as an evil effect on a person because of their wrongdoings or transgressions...
A-chloride receptor complex for the inhibitory
neurotransmitterNeurotransmitters are endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to...
GABAγ-Aminobutyric acid is the chief inhibitory neurotransmitter in the mammalian central nervous system. It plays a role in regulating neuronal excitability throughout the nervous system...
. Constant consumption of
alcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
s (and the consequent chronic sedation) causes a counterregulatory response in the brain in attempt to regain
homeostasisHomeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
.
This causes downregulation of these
receptorIn biochemistry, a receptor is a molecule found on the surface of a cell, which receives specific chemical signals from neighbouring cells or the wider environment within an organism...
s, as well as an up-regulation in the production of excitatory neurotransmitters, primarily glutamate, and also such as
norepinephrineNorepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
,
dopamineDopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
,
epinephrineEpinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...
, and
serotoninSerotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
, all of which further the drinker's tolerance to alcohol. When alcohol is no longer consumed, these down-regulated GABA
A receptor complexes are so insensitive to GABA that the typical amount of GABA produced has little effect; compounded with the fact that GABA normally inhibits
action potentialIn physiology, an action potential is a short-lasting event in which the electrical membrane potential of a cell rapidly rises and falls, following a consistent trajectory. Action potentials occur in several types of animal cells, called excitable cells, which include neurons, muscle cells, and...
formation, there are not as many receptors for GABA to bind to — meaning that
sympatheticThe sympathetic nervous system is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's nervous system fight-or-flight response...
activation is unopposed. This is also known as an "
adrenergic stormAn adrenergic storm is a sudden and dramatic increase in serum levels of the catecholamines adrenalin and noradrenalin , with a less significant increase in dopamine transmission. It is a life-threatening condition because of extreme tachycardia and hypertension, and is especially dire for those...
"; the effects of which can include (but are not limited to)
tachycardiaTachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
,
hypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
,
hyperthermiaHyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate...
,
hyperreflexiaHyperreflexia is defined as overactive or overresponsive reflexes. Examples of this can include twitching or spastic tendencies, which are indicative of upper motor neuron disease as well as the lessening or loss of control ordinarily exerted by higher brain centers of lower neural pathways...
,
diaphoresisDiaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
,
heart attackMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, cardiac arrhythmia,
strokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
,
anxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, panic attacks,
paranoiaParanoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
, and
agitationPsychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one's hands, pulling off clothing and putting it back on and other similar actions...
.
This is all made worse by excitatory neurotransmitter up-regulation, so not only is sympathetic nervous system over-activity unopposed by GABA, there is also more of the
serotoninSerotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
,
norepinephrineNorepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
,
dopamineDopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
,
epinephrineEpinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...
, and particularly glutamate. Excitory
NMDA receptorThe NMDA receptor , a glutamate receptor, is the predominant molecular device for controlling synaptic plasticity and memory function....
s are also up-regulated, contributing to the delirium and
neurotoxicityNeurotoxicity occurs when the exposure to natural or artificial toxic substances, which are called neurotoxins, alters the normal activity of the nervous system in such a way as to cause damage to nervous tissue. This can eventually disrupt or even kill neurons, key cells that transmit and process...
(by
excitotoxicityExcitotoxicity is the pathological process by which nerve cells are damaged and killed by excessive stimulation by neurotransmitters such as glutamate and similar substances. This occurs when receptors for the excitatory neurotransmitter glutamate such as the NMDA receptor and AMPA receptor are...
) of withdrawal. Direct measurements of central norepinephrine and its
metabolitesMetabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
are in direct correlation to the severity of the alcohol withdrawal syndrome. It is possible that psychological (i.e., non-physical) factors also play a role, especially those of
infectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s,
malnutritionMalnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, or other underlying medical disorders, often related to
alcoholismAlcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
.
Treatment
Delirium tremens due to alcohol withdrawal can be treated with benzodiazepines. High doses may be necessary to prevent mortality. Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with
benzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s, such as
diazepamDiazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium),
lorazepamLorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...
(Ativan),
chlordiazepoxideChlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine. It is marketed under the trade names Angirex, Klopoxid, Librax , Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen and Tropium.Chlordiazepoxide was the first benzodiazepine to be synthesised and...
(Librium), or
oxazepamOxazepam , is a drug which is a short to intermediate acting 3-hydroxy benzodiazepine derivative...
(Serax) and in extreme cases low-levels of antipsychotics, such as
haloperidolHaloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
or even stronger
benzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s like
temazepamTemazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
(Restoril) or
midazolamMidazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
(Versed) until symptoms subside. Older drugs such as
paraldehydeParaldehyde is the cyclic trimer of acetaldehyde molecules. Formally, it is a derivative of 1,3,5-trioxane. The corresponding tetramer is metaldehyde. A colourless liquid, it is sparingly soluble in water and highly soluble in alcohol. Paraldehyde slowly oxidizes in air, turning brown and producing...
and
clomethiazoleClomethiazole is a sedative and hypnotic originally developed by Hoffmann-Le Roche in the 1930s. The drug is used in treating and preventing symptoms of acute alcohol withdrawal....
were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances.
AcamprosateAcamprosate, also known as N-acetyl homotaurine and by the brand name Campral, is a drug used for treating alcohol dependence.Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic...
is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If
status epilepticusStatus epilepticus is a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures...
is present,
seizureAn epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...
s are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the visual hallucinations mentioned above.
In the media
- Writer Jack Kerouac
Jean-Louis "Jack" Lebris de Kerouac was an American novelist and poet. He is considered a literary iconoclast and, alongside William S. Burroughs and Allen Ginsberg, a pioneer of the Beat Generation. Kerouac is recognized for his spontaneous method of writing, covering topics such as Catholic...
details his experiences with delirium tremens in his book Big SurBig Sur is a 1962 novel by Jack Kerouac. It recounts the events surrounding Kerouac's three brief sojourns to a cabin in Bixby Canyon, Big Sur, owned by Kerouac's friend and Beat poet Lawrence Ferlinghetti...
.
- In the 1945 film The Lost Weekend, an alcoholic writer, played by Ray Milland
Ray Milland was a Welsh actor and director. His screen career ran from 1929 to 1985, and he is best remembered for his Academy Award–winning portrayal of an alcoholic writer in The Lost Weekend , a sophisticated leading man opposite a corrupt John Wayne in Reap the Wild Wind , the murder-plotting...
, is admitted to a hospital's alcoholic ward in the throes of delirium tremens.
- In the 1962 film Days of Wine and Roses
Days of Wine and Roses is a film directed by Blake Edwards with a screenplay by JP Miller adapted from his own 1958 Playhouse 90 teleplay of the same name....
, public relations man Joe Clay (played by Jack LemmonJohn Uhler "Jack" Lemmon III was an American actor and musician. He starred in more than 60 films including Some Like It Hot, The Apartment, Mister Roberts , Days of Wine and Roses, The Great Race, Irma la Douce, The Odd Couple, Save the Tiger John Uhler "Jack" Lemmon III (February 8, 1925June...
) is committed to a sanitorium twice. In the first instance, he is held in a straitjacket and in a padded room while experiencing delirium tremens. In the second instance, Joe is committed after breaking into a liquor store and afterwards wakes in the sanitorium, strapped down to a table and sweating profusely, whereupon his Alcoholics AnonymousAlcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...
sponsor Jim Hungerford (played by Jack KlugmanJacob Joachim "Jack" Klugman is an American stage, film and television actor known for his roles in sitcoms, movies, and television and on Broadway...
) informs him that "For two days there was a little green man chasing you around with pruning shears."
- In the 2003 film The Last Samurai
The Last Samurai is a 2003 American epic drama film directed and co-produced by Edward Zwick, who also co-wrote the screenplay based on a story by John Logan. The film was inspired by a project developed by writer and director Vincent Ward, who had previously filmed the movie in 1990, starring...
, Nathan Algren, a disenchanted ex-United States Army captain and an alcoholic, who is traumatized by his experience fighting in the Civil War and the Indian Wars, played by Tom CruiseThomas Cruise Mapother IV , better known as Tom Cruise, is an American film actor and producer. He has been nominated for three Academy Awards and he has won three Golden Globe Awards....
, is treated by the Hirotaro family in the throes of delirium tremens after being captured in battle with samurai troops led by Katsumoto.
- In Leaving Las Vegas
Leaving Las Vegas is a 1995 romantic drama film directed and written by Mike Figgis, based on a semi-autobiographical novel of the same name by John O'Brien. Nicolas Cage stars as a suicidal alcoholic who has ended his personal and professional life to drink himself to death in Las Vegas...
, the main character, Ben Sanderson, suffers from the DT's after a huge drinking binge and furiously rushes to his liquor supply to prevent them from continuing.
- In the novel L'Assommoir
L'Assommoir is the seventh novel in Émile Zola's twenty-volume series Les Rougon-Macquart. Usually considered one of Zola's masterpieces, the novel—a harsh and uncompromising study of alcoholism and poverty in the working-class districts of Paris—was a huge commercial success and established...
(1876), by French author Emile ZolaÉmile François Zola was a French writer, the most important exemplar of the literary school of naturalism and an important contributor to the development of theatrical naturalism...
, the husband of the heroine Gervaise, an alcoholic roofer named Coupeau, succumbs to delirium tremens in a Parisian hospital.
- Ethan Thomas, protagonist of Condemned 2, has become an alcoholic since the events of the previous game
Condemned: Criminal Origins is a psychological horror first-person shooter video game, developed by Monolith Productions and published by Sega. It was launched worldwide in 2005 on the Xbox 360, with a Microsoft Windows version released later in 2006...
and must regularly consume whiskey to prevent the violent shaking of his delirium tremens from spoiling his aim.
- The protagonist of Malcolm Lowry
Clarence Malcolm Lowry was an English poet and novelist who was best known for his novel Under the Volcano, which was voted No. 11 in the Modern Library 100 Best Novels list.-Biography:...
's 1947 novel Under the VolcanoUnder the Volcano is a 1947 semi-autobiographical novel by English writer Malcolm Lowry . The novel tells the story of Geoffrey Firmin, an alcoholic British consul in the small Mexican town of Quauhnahuac , on the Day of the Dead.Surrounded by the helpless presences of his ex-wife, his...
suffers from delirium tremens.
See also
- Alcohol dementia
Alcohol dementia, which is sometimes associated with Wernicke-Korsakoff syndrome, is a form of dementia caused by long-term or excessive drinking resulting in neurological damage and memory loss. Other names for the condition are alcoholic dementia, alcohol related dementia and alcohol-induced...
- Alcohol detoxification
Alcohol detoxification, or detox, for individuals with alcohol dependence, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross-tolerant drugs that have similar effects in order to prevent alcohol withdrawal...
- Delusional parasitosis
Delusional parasitosis is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present...
- Excited delirium
Excited delirium is a condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature, and superhuman strength...
External links