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Stages of alcohol withdrawal are characterized by the following symptoms:

1)Earliest or Mild Withdrawal: sensation of uneasiness, consciousness of visceral function, nausea, churning, tightness, anxiety, and insomnia.

2)Minimal: fidgeting, agitation, chain smoking, drinking many cups of coffee.

3)Moderate: severe agitation, difficult to keep patient in bed, attention lapses, involuntary tremors, diaphoresis, tachycardia, elevated blood pressure, nausea, vomiting, malaise.

4)Severe: auditory/visual hallucinations, delirium tremens (DT’s), irrational fears, sensitive to noise, extreme agitation, difficult cooperating, muscular hyperactivity, severe diaphoresis.

5)Extreme: all of stage 4 symptoms, totally irrational, extreme diaphoresis and tachycardia, convulsions

Criteria: Medications (prescription & over-the-counter)

Effects of Medications: Certain medications can alter client’s perception, medical condition, and actions. Because medications have different and sometimes unexpected effects on individuals, they may cause clients to become aggressive or violent towards workers. Medications such as the benzodiazepines, can have a disinhibiting effect that can result in uncharacteristically violent behaviour.

Changes in Medications: Changes in or combinations of, medications require constant assessment of client behaviour and condition. The distress of substituting one medication for another and the required time intervals between medications can frustrate clients and cause them to act out.

Irreversible: dementia related to long standing alcohol use, Alzheimer's disease

When assessing elderly clients with difficult behavior, the fundamental question to ask of the behavior is “why?” Psychiatric and physical illness will produce physical and behavioral symptoms. Learning to ask “why?” may give the care-giver answers to questions about the elderly client’s aggressive behavior leading to treatment of the conditions triggering the difficult behavior.

Criteria: Presence of acute organic brain syndrome

Behavior:

•sudden rise or fall in level of consciousness

•disorientation as to time, place, person

•impairment of recent memory

•auditory hallucinations within the psychic horizon (i.e. within earshot)

•visual hallucinations

Comment:

Sense of time is lost first. Hallucinations indicate functional mental disorder.