Neuropsychiatric alcoholism

Thiamine deficiency results in early decreases in activity of the mitochondrial enzyme a-ketoglutarate dehydrogenase in brain. Wernicke s encephalopathy, also known as the Wernicke-Korsakoff syndrome is a neuropsychiatric disorder characterized by ophthalmoplegia, ataxia and memory loss. Wernicke s encephalopathy is encountered in chronic alcoholism, in patients with HIV-AIDS and in other disorders associated with grossly impaired nutritional status. The condition results from thiamine deficiency. 

In addition, the alcohol addicts are liable to other neuropsychiatric syndrome (Korsakoff s psychosis) which is associated with hallucination, suicidal tendencies and encephalopathy. They may also suffer from hyperlipidemia, hyperuricemia, pancreatitis and hepatitis. 

To paraphrase William Osier, If you know alcoholism, you know all of medicine. This observation is particularly pertinent given alcohol s myriad neuropsychiatric manifestations, co-morbid mental disturbances, and complicating medical conditions. The interaction between alcohol and its related physical disturbances requires the careful use of various psychotropics to safely detoxify patients and to help prevent more serious medical or emotional complications. The use of BZDs should only... 

Grebb JA, Greengard P. 1990. An analysis of synapsin II, a neuronal phosphoprotein, in postmortem brain tissue from alcoholic and neuropsychiatrically ill adults and medically ill children and young adults. Arch Gen Psychol 47 1149-1156. 

Wilkemeyer (4) determined that 3-pentanol, 2-pentanol, cyclopentanol, 4-methyl -1-pentanol, 2-methyl-2-pentanol, and 2,6-diisopropylphenol were effective in mitigating alcohol-induced cell adhesion disorders associated with alcohol addiction in adults, fetal alcohol syndrome, and neuropsychiatric behavioral disorders. 

Prolonged toxic delirium related to disulfiram and alcohol intake has been reported (237). The predominant presenting feature was neuropsychiatric rather than autonomic symptoms. 

Reversible neuropsychiatric symptoms, readily resembling alcoholic intoxication, have occurred after a single dose of 5 ml. Sleep apnea causing neuropsychiatric abnormalities has been attributed to exposure to high concentrations of tetrachloroethylene and A-butanol vapors however, the patient was obese and the association with the solvents was not clear (611). 

BUPROPION ALCOHOL Rare reports of adverse neuropsychiatric events and 1 alcohol tolerance Uncertain Warn patients to avoid or minimize alcohol intake during bupropion treatment... 

Similarly, in various liver diseases, thought should be given to the presence of HE if neuropsychiatric disturbances occur. This is true for acute liver diseases (severe acute viral hepatitis, acute liver failure) and for severe (particularly alcohol-related) fatty liver, Wilson s disease, severe chronic hepatitis, severe infectious or parasitic liver diseases such as schistosomiasis, metastatic liver, nodular regenerative hyperplasia, and liver cirrhosis. (1,16,17, 22, 24,28,29, 67,76,78,95,104) The diagnosis of HE can prove difficult if the liver disease is (still) unknown. 

All reports have suggested that the neuropsychiatric reactions to mefloquine are transient. They may be precipitated by alcohol (18). 

One case history has suggested that the use of alcohol with mefloquine can precipitate a neuropsychiatric reaction (18). 

To examine the relation between adverse effects profiles, study retention, and treatment outcomes in alcohol-dependent individuals receiving naltrexone for relapse prevention, 92 subjects had their adverse effects monitored weekly and categorized as either neuropsychiatric or gastrointestinal (3). The neuropsychiatric adverse effects had little effect on medication compliance but reduced the length of study retention. In contrast, the gastrointestinal adverse effects significantly affected medication compliance but not study retention. 

Reversible neuropsychiatric symptoms, readily resembling alcoholic intoxication, have occurred after a single dose of 5 ml. Sleep apnea causing neuropsychiatric... 

Primary effects of Xyrem are dose related and include CNS depression, amnesia, and hypotonia (lOmgkg ). Exposures in the range of 20-30 mg kg cause somnolence, drowsiness, dizziness, and euphoria. At levels of 50-70mgkg common symptoms are bradycardia, nausea, and vomiting. Higher exposures can lead to coma. Xyrem may cause neuropsychiatric side effects even at recommended doses. Oral doses as low as 5 g have caused CNS depression. Concurrent alcohol use can delay the onset of symptoms. 

Philibert RA, Sandhu H, Hollenbeck N, et al. The relationship of 5HTT (SLC6A4) methylation and genotype on mRNA expression and liability to major depression and alcohol dependence in subjects from the Iowa adoption studies. Am J Med Genet B Neuropsychiatr Genet 2007 [Epub ahead of print]. 

Neuropsychiatric, neuromuscular, autonomic dysfunction, and intense abdominal pain characterize AIP. In the liver, this enzyme deficiency results in the increased inducibility of abnormal heme intermediates by certain drugs. Drugs and agents known to induce hepatic cytochrome P450 enzymes or to increase hepatic heme mrnover are theoretically capable of precipitating porphyria. Barbiturates, estrogens, alcohol, and heavy metals such as lead have been documented to induce porphyria in genetically susceptible people. ... 

Accumulating electrophysiological and neuroanatomical analyses indicate that some of the CB, CNR receptor is targeted to the presynaptic terminals of neurons where it acts to inhibit release of classical neurotransmitters as reviewed by Elphick and Egertova, (2001). It is therefore tempting to speculate that the endocannabinoid system may be a major player in the reward pathway, particularly as it is one of the most abundant neurochemical systems in the CNS. Other studies report that THC, the major psychoactive constituent in marijuana, inhibits the synaptosomal uptake of dopamine, serotonin, norepinephrine, acetylcholine, and GABA. This, therefore, warrants pre-clinical evaluations to determine the role(s) of the endocannabinoid system in dmg and alcohol dependence and other neuropsychiatric conditions. 

Tabershaw and Cooper64 evaluated 87 patients who had been exposed to an organophosphate insecticide more than 3 years previously and who had had persistent complaints for over a 6-month period. The symptoms involved the visual, gastrointestinal, cardiorespiratory, and neuropsychiatric systems. In each instance, the complaint could be attributed to other problems for example, several cases of visual blurring were due to presbyopia, a case of chronic abdominal pain was due to a peptic ulcer, and in one case, nervousness and tremors were due to chronic alcoholism. 

The manufacturers report rare adverse neuropsychiatric events or reduced alcohol tolerance in patients drinking alcohol during bupropion treatment. They recommend that the consumption of alcohol should be minimised or avoided. For comment on the increased risk of seizures with alcohol see (d), below. 

Wernicke s encephalopathy. This is most frequent clinical manifestation of thiamine deficiency in developed countries. It is frequently associated with alcoholism and other conditions impairing nutrition. This neuropsychiatric disorder is characterized by eye muscle paralysis, abnormal posture and gait, and impaired cognitive functions. Progressive deterioration of WE patients ends with KorsakofFs psychosis with manifestation of amnesia, stupor and loss of conceptual functions. 

Cook, C.C., Hailwood, P.M., and Thomson, A.D., 1998. B Vitamin deflciency and neuropsychiatric syndromes in alcohol misuse. Alcohol and Alcoholism. 33 317-336. 

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