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Post-acute-withdrawal syndrome
Post-acute withdrawal syndrome (PAWS) is the prolonged psychological symptoms following a physical acute withdrawal from many drugs including alcohol, opioids, benzodiazepines, and barbiturates. It is caused by the brain adjusting from being addicted to a certain substance and can last all the way from a few months up to a few years. Infants born to mothers who used these substances during pregnancy may also experience PAWS.
The brain can have a hard time adjusting to changes following the physical detoxification from a substance, thus causing many psychological symptoms to occur including prolonged psychosis, anxiety or depression. PAWS can occur with symptoms persisting from months to years after cessation of substance use. In almost all cases drug-induced psychiatric disorders fade away with prolonged abstinence, although permanent damage to the brain and nervous system may be caused by continued substance use.
Symptoms can sometimes come and go with wave-like re-occurrences or fluctuations in severity of symptoms. Common symptoms include impaired cognition, irritability, depressed mood, and anxiety, and can lead to relapse.
PAWS as a result of benzodiazepines, opioids, and alcohol in particular can produce symptoms identical to generalized anxiety disorder as well as panic disorder. Due to the sometimes prolonged nature and severity these withdrawals, abrupt sobriety from these substances is not advised.
Some symptoms of PAWS include:
Symptoms occur intermittently, but are not always present. They are made worse by stress or other triggers and may arise at unexpected times and for no apparent reason. They may last for a short while or longer. Any of the following may trigger a temporary return or worsening of the symptoms of PAWS:[citation needed]
Disturbances in mental function can persist for several months or years after withdrawal from benzodiazepines. Psychotic depression persisting for more than a year following benzodiazepine withdrawal has been documented in the medical literature. The patient had no prior psychiatric history. The symptoms reported in the patient included, major depressive disorder with psychotic features, including persistent depressed mood, poor concentration, decreased appetite, insomnia, anhedonia, anergia and psychomotor retardation. The patient also experienced paranoid ideation (believing she was being poisoned and persecuted by co-employees), accompanied by sensory hallucinations. Symptoms developed after abrupt withdrawal of chlordiazepoxide and persisted for 14 months. Various psychiatric medications were trialed which were unsuccessful in alleviating the symptomatology. Symptoms were completely relieved by recommending chlordiazepoxide for irritable bowel syndrome 14 months later. Another case report noted a similar phenomenon in a female patient who abruptly reduced her diazepam dosage from 30 mg to 5 mg per day. She developed electric shock sensations, depersonalization, anxiety, dizziness, left temporal lobe EEG spiking activity, hallucinations, visual perceptual and sensory distortions which persisted for years.
A clinical trial of patients taking the benzodiazepine alprazolam (Xanax) for eight weeks triggered protracted symptoms of memory deficits which were still present after up to eight weeks post cessation of alprazolam.
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Post-acute-withdrawal syndrome
Post-acute withdrawal syndrome (PAWS) is the prolonged psychological symptoms following a physical acute withdrawal from many drugs including alcohol, opioids, benzodiazepines, and barbiturates. It is caused by the brain adjusting from being addicted to a certain substance and can last all the way from a few months up to a few years. Infants born to mothers who used these substances during pregnancy may also experience PAWS.
The brain can have a hard time adjusting to changes following the physical detoxification from a substance, thus causing many psychological symptoms to occur including prolonged psychosis, anxiety or depression. PAWS can occur with symptoms persisting from months to years after cessation of substance use. In almost all cases drug-induced psychiatric disorders fade away with prolonged abstinence, although permanent damage to the brain and nervous system may be caused by continued substance use.
Symptoms can sometimes come and go with wave-like re-occurrences or fluctuations in severity of symptoms. Common symptoms include impaired cognition, irritability, depressed mood, and anxiety, and can lead to relapse.
PAWS as a result of benzodiazepines, opioids, and alcohol in particular can produce symptoms identical to generalized anxiety disorder as well as panic disorder. Due to the sometimes prolonged nature and severity these withdrawals, abrupt sobriety from these substances is not advised.
Some symptoms of PAWS include:
Symptoms occur intermittently, but are not always present. They are made worse by stress or other triggers and may arise at unexpected times and for no apparent reason. They may last for a short while or longer. Any of the following may trigger a temporary return or worsening of the symptoms of PAWS:[citation needed]
Disturbances in mental function can persist for several months or years after withdrawal from benzodiazepines. Psychotic depression persisting for more than a year following benzodiazepine withdrawal has been documented in the medical literature. The patient had no prior psychiatric history. The symptoms reported in the patient included, major depressive disorder with psychotic features, including persistent depressed mood, poor concentration, decreased appetite, insomnia, anhedonia, anergia and psychomotor retardation. The patient also experienced paranoid ideation (believing she was being poisoned and persecuted by co-employees), accompanied by sensory hallucinations. Symptoms developed after abrupt withdrawal of chlordiazepoxide and persisted for 14 months. Various psychiatric medications were trialed which were unsuccessful in alleviating the symptomatology. Symptoms were completely relieved by recommending chlordiazepoxide for irritable bowel syndrome 14 months later. Another case report noted a similar phenomenon in a female patient who abruptly reduced her diazepam dosage from 30 mg to 5 mg per day. She developed electric shock sensations, depersonalization, anxiety, dizziness, left temporal lobe EEG spiking activity, hallucinations, visual perceptual and sensory distortions which persisted for years.
A clinical trial of patients taking the benzodiazepine alprazolam (Xanax) for eight weeks triggered protracted symptoms of memory deficits which were still present after up to eight weeks post cessation of alprazolam.