Korsakoffs psychosis

Perceptual Visual hallucinations, disordered thinking, psychosis, Korsakoff s psychosis, paranoia... 

Beri-beri or clinically manifest thiamin deficiency exists in several subforms infantile beri-beri and adult beri-beri. Infantile beri-beri occurs in exclusively breastfed infants of thiamin-deficient mothers. Adults can develop different forms of the disease, depending on their constitution, environmental conditions, the relative contribution of other nutrients to the diet as well as the duration and severity of deficiency. First of all, there is a so called dry or atrophic (paralytic or nervous) form, including peripheral degenerative polyneuropathy, muscle weakness and paralysis. Second, a wet or exudative (cardiac) form exists. In this form, typical symptoms are lung and peripheral oedema as well as ascites. Finally, there is a cerebral form, that can occur as Wernicke encephalopathy or Korsakoff psychosis. Tli is latter form mostly affects chronic alcoholics with severe thiamin deficiency. 

Thiamin has a very low toxicity (oral LD5o of thiaminchloride hydrochloride in mice 3-15 g/kg body weight). The vitamin is used therapeutically to cure polyneuropathy, beri-beii (clinically manifest thiamin deficiency), and Wernicke-Korsakoff Syndrome ( Wernicke encephalopathy and Korsakoff psychosis). In mild polyneuropathy, 10-20 mg/d water-soluble or 5-10 mg/d lipid-soluble thiamin are given orally. In more severe cases, 20-50 mg/d water-soluble or 10-20 mg/d lipid-soluble thiamin are administered orally. Patients suffering from beri-beri or from early stages of Wernicke-Korsakoff Syndrome receive 50-100 mg of thiamin two times a day for several days subcutaneously or intravenously until symptoms are alleviated. Afterwards, the vitamin is administered orally for several weeks. 

Wernicke s syndrome is a serious consequence of alcoholism and thiamine (vitamin Bx) deficiency. Certain characteristic signs of this disease, notably ophtalmoplegia, nystagmus, and ataxia, respond rapidly to the administration of thiamine but to no other-vitamin. Wernicke s syndrome may be accompanied by an acute global confusional state that may also respond to thiamine. Left untreated, Wernicke s syndrome frequently leads to a chronic disorder in which learning and memory are strongly impaired. This so-called Korsakoff s psychosis is characterized by confabulation, and is less likely to be reversible once established. 

True. Excessive alcohol use can lead to serious damage to mental health. Depression, anxiety, delusions and negative changes in personality can occur. Korsakoff s psychosis occurs in some excessive users of alcohol. This form of dementia results in disorientation, loss of memory and lowered intellectual abilities. It is reversible in some sufferers through the administration of thiamine (vitamin Bj. 

However, when used in excess it can lead to a wide range of physical and mental problems, e.g. heart and liver disease, cancers, increased risk of stroke, mood and personality changes and dementia (Korsakoff s psychosis). 

Transketolase HMP shunt Korsakoff (confebulation, psychosis) High-output cardiac failure (wet beri-beri)... 

Thiamine deficiency is commonly seen in alcoholics, who may develop a complex of symptoms associated with Wernicke peripheral neuropathy and Korsakoff psychosis. Alcohol interferes with thiamine absorption from the intestine. Symptoms include ... 

A variety of pathological problems involving the CNS have been described in chronic alcoholics, the main ones being Wernicke s encephalopathy and Korsakoff s psychosis Brain damage from chronic ethanol consumption can be especially severe in the elderly and may accelerate aging. 

The spectrum of cognitive deficits associated with chronic alcohol use extends to the extreme of Wernicke s encephalopathy and Korsakoff s psychosis. Wernicke s encephalopathy is an acute neurologic syndrome caused by thiamine deficiency. Symptoms include mental confusion, ophthalmoplegia, and ataxia. Many of these symptoms reverse with administration of thiamine however about 50% of patients are left with some degree of ataxia. Left untreated, Wernicke s encephalopathy can progress to stupor, coma, and death. Approximately 80% to 90% of alcoholics treated for Wernicke s encephalopathy are left with Korsakoff s psychosis, a syndrome of impaired learning and recent memory produced by lesions of the medial dorsal nuclei of the thalamus. 

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. 

Yudofsky SC, Stevens L, Siiver J, et ai. Propranoioi in the treatment of rage and vioient behavior associated with Korsakoffs psychosis. Am J Psychiatry 1984 141 114-115. 

The Wernicke-Korsakofi syndrome consists of both an acute (i.e., Wernicke s encephalopathy) and a chronic phase (i.e., Korsakoff s psychosis). The acute encephalopathy may be precipitated or worsened by carbohydrates (including intravenous glucose) unless thiamine is also replenished before or during administration. Wernicke s encephalopathy may first be manifested by the following ... 

Ocular findings, including nystagmus (horizontal or vertical), weakness or paralysis of the lateral recti muscles, and weakness or paralysis of conjugate gaze Korsakoff s psychosis is most characterized by the following ... 

Wernicke-Korsakoff syndrome is a relatively uncommon but important entity characterized by paralysis of the external eye muscles, ataxia, and a confused state that can progress to coma and death. It is associated with thiamin deficiency but is rarely seen in the absence of alcoholism. Because of the importance of thiamine in this pathologic condition and the absence of toxicity associated with thiamine administration, all patients suspected of having Wernicke-Korsakoff syndrome (including virtually all patients who present to the emergency department with altered consciousness, seizures, or both) should receive thiamine therapy. Often, the ocular signs, ataxia, and confusion improve promptly upon administration of thiamine. However, most patients are left with a chronic disabling memory disorder known as Korsakoff s psychosis. 

Korsakoff s psychosis An organic brain syndrome associated with prolonged, heavy ingestion of alcohol. It is characterized by amnesia for recent events and an inability to memorize new information. 

Casadevall CT, Pascual MLF, Fernandez IT, Escalza Cl, Navas VI, Fanlo MC, Morales AF. Pharmacological treatment of Korsakoff psychosis a review of the literature and experience in two cases. Rev Neurol 2002 35 341-5. 

Thiamin deficiency can result in three distinct syndromes a chronic peripheral neuritis, beriberi, which may or may not be associated with heart failure and edema acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, with little evidence of peripheral neuritis and Wernicke s encephalopathy with Korsakoff s psychosis, a thiamin-responsive condition associated especially with alcoholism and narcotic abuse. 

Initially, there is a confused state, Korsakoff s psychosis, that is characterized by confabulation and loss of recent memory, although memory for past events may be unimpaired. Later, clear neurological signs develop - Wernicke s encephalopathy. This is characterized by nystagmus and extraocular palsy. Postmortem examination shows hemorrhagic lesions in the thalamus, pontine tegmentum, and mammillary body, with severe damage to astrocytes, neuronal dendrites, and myelin sheaths. 

Korsakoff s psychosis is considered by some to represent a progression of WE. It is characterized by a striking loss of working memory with relatively little loss of reference memory. Prompt treatment of Wernicke s syndrome with thiamine is believed to prevent the development of Korsakoffs syndrome, but the latter responds little if at all to treatment with thiamine. 

Thiamin deficiency in alcoholics may be caused by decreased intake, reduced absorption, and impaired ability to use ihe absorbed vitamin. The ataxia and ocular symptoms associated with the deficiency in alcoholics are known as Wernicke s disease. Vitamin therapy can provide relief from nystagmus within a few hours of treatment and from ataxia within several weeks. The treatment of alcoholics also involves the supply of other nutrients lacking in the diet, such as folate, vitamin B12, and protein. Left imtreated, patients suffering from Wernicke s disease continue to develop Korsakoff s psychosis, which involves amnesia and confusion. Only about 25% of patients with Korsakoff s psychosis can be completely cured by thiamin treatment, which must be continued for a few weeks or months. The two conditions just described constitute the Wemicke-Korsakoff syndrome. The S5mdrome was named after two researchers. Karl Wernicke, a German, noted impaired or paralyzed eye movements and imstable walking and disorientation in his patients, most of whom were alcoholics. Polyneuropathy, a weakness of the hands, calves, and feet, was also noted. Sergei Korsakoff, a Russian, observed amnesia and confusion and an inability to learn new names or tasks in alcoholic patients. 

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