From the Guidelines
Management of Pervasive Arousal Withdrawal Syndrome (PAWS) should prioritize a gradual weaning strategy to prevent withdrawal symptoms, with careful monitoring using tools like the WAT-1 or SOS 1. When managing PAWS, it is essential to consider the potential for iatrogenic withdrawal syndrome (IWS) due to opioid and/or benzodiazepine use.
- A weaning strategy for gradual decreasing of opioid and/or benzodiazepine dosages is crucial to prevent IWS, as recommended by the ESPNIC position statement 1.
- The effect of a drug should be re-evaluated depending on the drug's half-life, taking into account the grade of recommendation 1.
- Environmental modifications, such as reduced sensory input, consistent caregivers, and predictable routines, can help create a safe and predictable environment for the patient.
- Medications like low-dose propranolol or benzodiazepines may be considered in severe cases, but their use should be carefully monitored and titrated to minimize the risk of adverse effects.
- Therapy approaches, including gentle engagement techniques and trauma-informed care principles, should be tailored to the individual patient's needs and tolerance.
- Parent/caregiver education and support, as well as coordination between medical, psychological, and educational professionals, are vital components of a comprehensive treatment plan.
- Recovery from PAWS is typically gradual, with progress measured in small improvements in engagement and reduced withdrawal behaviors, and treatment aims to restore the child's sense of safety and gradually rebuild their capacity for social engagement and emotional regulation 1.
From the Research
Pervasive Arousal Withdrawal Syndrome Management
- Pervasive arousal withdrawal syndrome (PAWS) is a condition that can affect individuals, particularly children and young people, and is characterized by a range of symptoms including refusal to perform daily activities and reliance on others for physical and emotional support 2.
- The management of PAWS is crucial, and children's nurses should be aware of the disorder and its symptoms to provide appropriate support and care.
- Staff working with individuals with PAWS should be able to validate the individual's experiences and provide a supportive environment to help them cope with their symptoms 2.
Benzodiazepine Withdrawal Syndrome
- Benzodiazepine withdrawal syndrome is a condition that can occur when an individual stops taking benzodiazepines, and is characterized by a range of symptoms including anxiety, insomnia, and seizures 3, 4.
- The risk of developing benzodiazepine withdrawal syndrome is greater with higher doses and longer treatment duration, but can also occur with recommended doses and short-term therapy 3, 4.
- The management of benzodiazepine withdrawal syndrome typically involves slow tapering of the medication, and may also include psychotherapy and pharmacological aids such as antidepressants and benzodiazepine antagonists 5, 6.
Treatment and Management
- The treatment of PAWS and benzodiazepine withdrawal syndrome requires a comprehensive approach that includes medical, psychological, and social support.
- Tapering of benzodiazepines is a common approach to managing withdrawal symptoms, but the optimal withdrawal schedule is not well established 5.
- Further research is needed to explore alternative methods of treating benzodiazepine withdrawal and PAWS, and to develop effective management strategies for these conditions 5, 6.