Alcohol withdrawal syndrome

Heavy drinkers will experience withdrawal symptoms following abstinence. Alcohol withdrawal syndrome includes seizures (20-30% chronic users); hallucinations (15-30% hospitalized chronic users) and 5-10% delirium tremens (fatal complication of alcohol withdrawal). After alcohol withdrawal, relapse should be prevented. Mechanism of this withdrawal syndrome isn’t understood however, metabolic changes in body may be the cause. Risk factors for developing delirium tremens include prior history of delirium tremens and seizures. Lack of access to alcohol with lack of identification of alcohol abuse is predisposing factors of withdrawal syndromes. Failure in recognition of intoxication and withdrawal syndromes can lead to mortality and morbidity. Poor outcome is associated with intercurrent illnesses, fluid and electrolyte imbalances.

Tramadol

Tramadol is weak synthetic opioid analgesic than morphine which acts selectively upon mu receptors.It has low dependence liability and does not produce significant respiratory depression. Toxic doses can produce convulsions and even cause excitement. Analgesic effect if aspirin is enhanced when tramadol is combined with it.Oral absorption of tramadol is higher with bioavailability being 50%. Addiction to tramadol is much less than codeine hence it is mostly used now-a-days. Dizziness, nausea and sedation are few adverse effects of the drug.

Phobias

Phobias are anxiety disorders which fall under DSM IV and ICD 10 classification. Unexplained persistent and irrational morbid fears of animate or inanimate objects are phobias. Mainly children and adolescents are involved. Disorder is commonly seen in anxious persons. Fearful anticipations and anxious cognitions appears earlier, giving rise to chronic state of anxiety in later stage. Average age of onset of simple phobia is in childhood and late teenagers and people in early twenties develop social phobias (Marks and Gelder (1966). Agoraphobias have late onset and occurs in mid- twenties. Panic attacks are more frequent in agoraphobias. Situations predisposing to agoraphobias include distance from home, crowding and confinement. Course and onset of agoraphobias differ from other two types of phobic disorders. Isolated phobias of late onset, illness of shorter duration and well adjusted personalities, carry better prognosis. Behavioral therapy in recent years and semi narcotic therapy has been attempted with success.