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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.

Signs and symptoms
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: • Psychosocial dysfunction • AnhedoniaDepression • Impaired interpersonal skillsObsessive-compulsive behaviour • Feelings of guilt • Autonomic disturbances • Pessimistic thoughts • Impaired attentional control • Lack of initiative • Craving • Inability to think clearly • Memory problems • Emotional overreactions or numbness • Sleep disturbances • Extreme fatigue • Physical coordination problems • Stress sensitivity • Increased sensitivity to pain • Panic disorder 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. Dopamine agonist protracted withdrawal After long-term use of dopamine agonists, a withdrawal syndrome may occur during dose reduction or discontinuation with the following possible side effects: anxiety, panic attacks, dysphoria, depression, agitation, irritability, suicidal ideation, fatigue, orthostatic hypotension, nausea, vomiting, diaphoresis, generalized pain, and drug cravings. For some individuals, these withdrawal symptoms are short-lived and make a full recovery, for others a protracted withdrawal syndrome may occur with withdrawal symptoms persisting for months or years. ==Cause==
Cause
The syndrome is caused in part due to persisting physiological adaptations in the central nervous system manifested in the form of continuing but slowly reversible tolerance, disturbances in neurotransmitters and resultant hyperexcitability of neuronal pathways. However, data supports "neuronal and overwhelming cognitive normalization" in regards to chronic methamphetamine use and PAWS. Stressful situations that arise in early recovery may result in the symptoms of post-acute withdrawal syndrome to worsen and should be avoided when necessary. The severity, frequency, and duration of symptoms associated with the condition vary depending on the drug of use. ==Treatment==
Treatment
The condition gradually improves over a period of time which can range from six months to several years in more severe cases. Flumazenil was found to be effective in reduce feelings of hostility and aggression in patients who had been free of benzodiazepines for 4 to 266 weeks. Carbamazepine or trazodone may also be effective in the treatment of post acute withdrawal syndrome in regards to alcohol use. Cognitive behavioral therapy can also help the post acute withdrawal syndrome especially when cravings are a prominent feature. ==See also==
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