Delirium tremens - Definition and Overview

Delirium tremens (colloquially, the DTs) is a condition almost invariably associated with complete alcohol withdrawal in an individual with a reported history of long-term alcohol consumption.

Symptoms

The symptoms include tremors and intense visual hallucinations (for example, drawings on wallpaper that the patient would perceive as giant spiders ready to attack her or him). Delirium tremens typically manifests about 18 to 24 hours after initial withdrawal. Since schizophrenic hallucinations are traditionally auditory and often of religious or police contents, the presence of intense visual hallucinations can indicate a diagnosis of delirium tremens.

The condition is caused by the effect of alcohol on the benzodiazepine-GABAa-chloride receptor complex for the inhibitory neurotransmitter GABA. Constant consumption of alcoholic beverages down regulates these receptors; when alcohol is no longer consumed, there are not as many receptors for GABA to bind to.

As GABA normally inhibits an action potential formation, fewer receptors mean that sympathetic activation is unopposed.

Treatment

Treatment is with benzodiazepines, such as diazepam, which enhance binding of GABA to the receptors.