Delirium Tremens Delirium Tremens is an emergent situation, that we may regard as the most severe form of alcohol withdrawal syndrome. In most cases, it occurs after long-term heavy use. It may also occur in patients who stop benzodiazepines. In most cases, it occurs after long-term heavy use of alcohol. Presentation Psychological and behavioural manifestations Rapidly changing picture Clouding of Consciousness Disorientation Disorganised mental activity Short term memory disturbance Perceptual abnormalities Hallucinations Visual misinterpretations Illusions Cocaine bugs (formication) Behavioural manifestations Agitation Shouting Restlessness Fear Sleeplessness Physical Manifestations General Physical Dehydration Electrolyte disturbances Autonomic Manifestations Autonomic manifestations of delirium tremens differentiate it from delirium (acute confusional state) that occurs because of organic causes other than substance use and alcohol withdrawal. Sweating Fever tachycardia Raised