Beyond Alcoholism

Abstract

Objective Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. Methods A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. Results Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. Conclusions Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency.

Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

“…This greater sensitivity to alcohol seems to be less in LAGB patients [221–224]. Moreover, vitamin deficiencies after GBP, especially thiamine, can result in the onset of acute Wernicke’s encephalopathy and/or Korsakoff syndrome [225]. Studies on the effects of cognitive behavioral therapy before surgery for obesity to reduce dependence on alcohol showed no significant effect in the long-term follow-up of patients with substance dependence [226].…”

Thiamine Deficiency and Neurodegeneration: the Interplay Among Oxidative Stress, Endoplasmic Reticulum Stress, and Autophagy

“…It has now been established that TD is the primary cause of WKS. Clinically, WKS is usually associated with chronic alcoholism which depletes thiamine in the human body, but it can also be caused by malnourishment [43, 44]. …”

Thirty Days without a Bite: Wernicke?s Encephalopathy in a Patient with Paranoid Schizophrenia

“…Only a few authors have described cases along the WKS continuum in patients with nutrional deficiencies not attributable to alcoholism or anorexia (see [ 4 ], for a review). Our patient was not in psychosis at the time of presentation but we hypothesized that the negative symptoms of schizophrenia might have caused his behavior of isolation, social withdrawal and poor diet leading to nutritional deficiency.…”

“…Although WKS most often affects people with a nutritional deficiency related to alcoholism, the syndrome can result from inadequate supply of thiamine of any cause (e.g., gastric bypass surgery, immunodeficiency syndromes, malignancies, hyperemesis gravidarum, liver disease, hyperthyroidism, or severe anorexia). Generally under-recognized is WKS in patients with psychiatric disorders who do not abuse alcohol or suffer from anorexia [ 4 ]. We report herein the case of a 36-year-old young man with paranoid schizophrenia who was brought to hospital for confusion and difficulties with his vision.…”