DTs Pharmacological Management — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryDTs Pharmacological ManagementMRCPsych Paper B

A 70-year-old man on a medical ward develops delirium tremens. He is severely agitated and experiencing visual hallucinations, but he can swallow safely and accepts oral medication. According to NICE CG100, which pharmacological treatment should be offered first-line?

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Correct answer: B — Oral lorazepam

NICE CG100 specifically recommends oral lorazepam as first-line treatment for delirium tremens. If symptoms persist or oral medication is declined, parenteral lorazepam or haloperidol may be offered. Haloperidol is therefore an alternative rather than first-line treatment and requires caution because of adverse effects including QT prolongation and a reduced seizure threshold. Carbamazepine may be considered for acute alcohol withdrawal generally, but it is not the recommended first-line treatment for established delirium tremens. Phenobarbital and propofol are not NICE first-line treatments; their use would be confined to specialist management of severe or refractory cases. The original option was overly broad because neither chlordiazepoxide nor intravenous lorazepam is the specific first-line recommendation in CG100.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications (CG100), section 1.1.4, recommendation 1.1.4.1. 2010, amended 2017. https://www.nice.org.uk/guidance/CG100/chapter/recommendations