**Question:** Delirium tremens is seen in -

A. Alcohol withdrawal
B. Antipsychotic withdrawal
C. Benzodiazepine withdrawal
D. Antidepressant withdrawal

**Correct Answer:** A. Alcohol withdrawal

**Core Concept:** Delirium tremens (DTs) is a severe form of alcohol withdrawal syndrome characterized by both cognitive and somatic symptoms. It occurs in patients who abruptly stop or reduce their intake of alcohol after prolonged الاعتماد على الكحول or alcoholism.

**Why the Correct Answer is Right:** DTs are a consequence of abrupt cessation of alcohol consumption in individuals with a history of chronic alcohol abuse. The withdrawal process leads to increased levels of neurotransmitters, particularly glutamate, which activates the central nervous system and results in the manifestation of DTs. The most common cause of DTs is alcohol withdrawal, as patients with a history of chronic alcohol abuse are more susceptible to severe withdrawal symptoms when stopping alcohol intake abruptly.

**Why Each Wrong Option is Incorrect:**

A. Antipsychotic withdrawal (B and D): DTs are specific to alcohol withdrawal and not observed in patients with withdrawal from antipsychotic medications, benzodiazepines, or antidepressants.

B. Antipsychotic withdrawal (B): DTs are not associated with abrupt cessation of antipsychotic medications, which are used to treat psychotic disorders and are not directly related to alcohol consumption.

C. Benzodiazepine withdrawal (D): Although benzodiazepine withdrawal can lead to withdrawal symptoms, DTs are not specific to benzodiazepine withdrawal. DTs occur primarily due to alcohol withdrawal, not benzodiazepine withdrawal.

D. Antidepressant withdrawal (D): Similar to benzodiazepine withdrawal, DTs are not specific to antidepressant withdrawal. DTs are mainly associated with alcohol withdrawal.

**Clinical Pearl:** Understanding the correct answer and the distinction between the wrong options is essential for healthcare professionals to diagnose and appropriately manage patients presenting with delirium tremens. Early recognition and management of DTs can prevent severe complications, including mortality.

**Correct Answer Explanation:** Delirium tremens occurs in patients with a history of chronic alcohol abuse due to the complex interaction between alcohol and neurotransmitter systems, particularly glutamate. Alcohol withdrawal triggers a cascade of events, including increased glutamate levels, leading to excessive stimulation of glutamate receptors, and potential secondary complications like seizures, cardiovascular instability, and altered mental status, which manifest as delirium tremens.