In DSM-5, delirium due to alcohol withdrawal is distinguished from other causes of delirium by which feature?

• A Onset exclusively during intoxication, not abstinence
• B Requires serum ethanol level > 400 mg/dL for diagnosis
• C Typical onset 24–72 hours after cessation of alcohol with prominent autonomic hyperactivity, making it 'Substance Withdrawal Delirium' ✓
• D Delirium tremens is classified under Neurocognitive Disorders, not Substance-Related Disorders in DSM-5

Explanation

Delirium tremens (DTs) is the most severe form of alcohol withdrawal, classified in DSM-5 as 'Substance Withdrawal Delirium — Alcohol.' It typically begins 24–72 hours after the last drink (occasionally up to 96–120 hours), presenting with severe autonomic hyperactivity (diaphoresis, tachycardia, hypertension, fever), tremors, agitation, and global confusion. It is not an intoxication phenomenon. The distinction from other deliria is its temporal relationship to cessation/reduction of heavy alcohol use and its specific pathophysiology (GABA/NMDA imbalance). Untreated DTs carry mortality up to 20%; treated mortality is ~1–5%.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.