Stage II usually starts 48 hours after the last drink. Hallucinations are the hallmark of Stage II , but patients usually understands them to be benign. Rarely, patients progress to Stage III , or delirium tremens, which is an acute, reversible organic psychosis that begins about 72 hours after the last drink. Stage III is a serious medical condition and has significant morbidity and mortality. They can happen in any of the three stages mentioned above.
Seizures generally consist of single grand mal seizures, but occasionally are multiple.
Patients experiencing their first seizure while in withdrawal should be worked up to rule out other causes, such as intracranial bleeding or a metabolic disturbance. The time between discontinuation of the drug and the onset of symptoms depends on the half-life of the drug. Short acting drugs cause a withdrawal syndrome with a quick onset and relatively short duration. For instance, patients dependent on short acting benzodiazepines may develop signs of withdrawal in 6 hours and the syndrome may last only 5 days. With long acting benzodiazepines, onset may be delayed for a week or more and last for several weeks.