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Mayo-Smith et al¹ have provided an important guideline for the management of alcohol withdrawal delirium in hospitalized patients with alcohol dependence. Based on thorough examination of the literature, they recommend benzodiazepines as the first line of treatment because "these drugs reduce mortality, reduce the duration of symptoms, and are associated with fewer complications compared with neuroleptic agents."¹

As a working group appointed by the Dutch Association of Psychiatry, we developed an evidence-based practice guideline for delirium including alcohol withdrawal delirium.² Contrary to Mayo-Smith et al,¹ we concluded that, in medically ill patients admitted to a general hospital, haloperidol is the first line of treatment for suspected alcohol withdrawal delirium. After all, it is impossible to decide whether delirium was actually caused by alcohol withdrawal and/or by medical illness. Moreover, as Mayo-Smith et al¹ rightly mention, only 5% of patients withdrawing from alcohol develop delirium, raising the risk of overstating the . . . [Full Text of this Article]

AUTHOR INFORMATION
Ine A. M. Klijn, MD; Rose C. van der Mast, MD, PhD

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Management of Alcohol Withdrawal Delirium: An Evidence-Based Practice Guideline
Michael F. Mayo-Smith, Lee H. Beecher, Timothy L. Fischer, David A. Gorelick, Jeanette L. Guillaume, Arnold Hill, Gail Jara, Chris Kasser, John Melbourne, and for the Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine
Arch Intern Med. 2004;164(13):1405-1412.
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