Medicine › Neurology

Alcoholism and Thiamine Deficiency

Works Count: 38950

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This cluster of papers focuses on the diagnosis and management of Wernicke-Korsakoff Syndrome, a neurological disorder primarily caused by thiamine deficiency, often associated with alcohol misuse. The papers cover topics such as neuropathology, alcohol withdrawal, diabetic complications, benzodiazepine therapy, neuroimaging, alcoholic neuropathy, and the role of oxidative stress and vitamin B1 in the syndrome.

Keywords

Wernicke-Korsakoff Syndrome; Thiamine Deficiency; Alcohol Withdrawal; Neuropathology; Diabetic Complications; Benzodiazepine Therapy; Neuroimaging; Alcoholic Neuropathy; Oxidative Stress; Vitamin B1

The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition

1990-01-01

Maurice Victor , Raymond D. Adams , George H. Collins

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EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy

2010-07-20

R. Galvin , Geir Bråthen , Andrei Ivashynka +3 more

Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life.To create practical guidelines for diagnosis, management and prevention of the disease.We searched MEDLINE, … Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life.To create practical guidelines for diagnosis, management and prevention of the disease.We searched MEDLINE, EMBASE, LILACS, Cochrane Library.1 The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non alcoholics (Recommendation Level C); although prevalence is higher in alcoholics, WE should be suspected in all clinical conditions which could lead to thiamine deficiency (good practice point - GPP). 2 The clinical diagnosis of WE in alcoholics requires two of the following four signs; (i) dietary deficiencies (ii) eye signs, (iii) cerebellar dysfunction, and (iv) either an altered mental state or mild memory impairment (Level B). 3 Total thiamine in blood sample should be measured immediately before its administration (GPP). 4 MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B). 5 Thiamine is indicated for the treatment of suspected or manifest WE. It should be given, before any carbohydrate, 200 mg thrice daily, preferably intravenously (Level C). 6 The overall safety of thiamine is very good (Level B). 7 After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP). 8 Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (GPP). 9 Patients dying from symptoms suggesting WE should have an autopsy (GPP).

Food and Drug Administration

2011-12-19

S. L. Nightingale

Acamprosate for alcohol dependence

2010-09-02

Susanne Rösner , Andrea Hackl-Herrwerth , Stefan Leucht +3 more

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Lipid Oxidation and Peroxidation in CNS Health and Disease: From Molecular Mechanisms to Therapeutic Opportunities

2009-07-22

Rao Muralikrishna Adibhatla , James F. Hatcher

Reactive oxygen species (ROS) are produced at low levels in mammalian cells by various metabolic processes, such as oxidative phosphorylation by the mitochondrial respiratory chain, NAD(P)H oxidases, and arachidonic acid … Reactive oxygen species (ROS) are produced at low levels in mammalian cells by various metabolic processes, such as oxidative phosphorylation by the mitochondrial respiratory chain, NAD(P)H oxidases, and arachidonic acid oxidative metabolism. To maintain physiological redox balance, cells have endogenous antioxidant defenses regulated at the transcriptional level by Nrf2/ARE. Oxidative stress results when ROS production exceeds the cell's ability to detoxify ROS. Overproduction of ROS damages cellular components, including lipids, leading to decline in physiological function and cell death. Reaction of ROS with lipids produces oxidized phospholipids, which give rise to 4-hydroxynonenal, 4-oxo-2-nonenal, and acrolein. The brain is susceptible to oxidative damage due to its high lipid content and oxygen consumption. Neurodegenerative diseases (AD, ALS, bipolar disorder, epilepsy, Friedreich's ataxia, HD, MS, NBIA, NPC, PD, peroxisomal disorders, schizophrenia, Wallerian degeneration, Zellweger syndrome) and CNS traumas (stroke, TBI, SCI) are problems of vast clinical importance. Free iron can react with H(2)O(2) via the Fenton reaction, a primary cause of lipid peroxidation, and may be of particular importance for these CNS injuries and disorders. Cholesterol is an important regulator of lipid organization and the precursor for neurosteroid biosynthesis. Atherosclerosis, the major risk factor for ischemic stroke, involves accumulation of oxidized LDL in the arteries, leading to foam cell formation and plaque development. This review will discuss the role of lipid oxidation/peroxidation in various CNS injuries/disorders.

Decoding Alzheimer's disease from perturbed cerebral glucose metabolism: Implications for diagnostic and therapeutic strategies

2013-07-11

Zhichun Chen , Chunjiu Zhong

Alzheimer's disease (AD) is an age-related devastating neurodegenerative disorder, which severely impacts on the global economic development and healthcare system. Though AD has been studied for more than 100 years … Alzheimer's disease (AD) is an age-related devastating neurodegenerative disorder, which severely impacts on the global economic development and healthcare system. Though AD has been studied for more than 100 years since 1906, the exact cause(s) and pathogenic mechanism(s) remain to be clarified. Also, the efficient disease-modifying treatment and ideal diagnostic method for AD are unavailable. Perturbed cerebral glucose metabolism, an invariant pathophysiological feature of AD, may be a critical contributor to the pathogenesis of this disease. In this review, we firstly discussed the features of cerebral glucose metabolism in physiological and pathological conditions. Then, we further reviewed the contribution of glucose transportation abnormality and intracellular glucose catabolism dysfunction in AD pathophysiology, and proposed a hypothesis that multiple pathogenic cascades induced by impaired cerebral glucose metabolism could result in neuronal degeneration and consequently cognitive deficits in AD patients. Among these pathogenic processes, altered functional status of thiamine metabolism and brain insulin resistance are highly emphasized and characterized as major pathogenic mechanisms. Finally, considering the fact that AD patients exhibit cerebral glucose hypometabolism possibly due to impairments of insulin signaling and altered thiamine metabolism, we also discuss some potential possibilities to uncover diagnostic biomarkers for AD from abnormal glucose metabolism and to develop drugs targeting at repairing insulin signaling impairment and correcting thiamine metabolism abnormality. We conclude that glucose metabolism abnormality plays a critical role in AD pathophysiological alterations through the induction of multiple pathogenic factors such as oxidative stress, mitochondrial dysfunction, and so forth. To clarify the causes, pathogeneses and consequences of cerebral hypometabolism in AD will help break the bottleneck of current AD study in finding ideal diagnostic biomarker and disease-modifying therapy.

THE WERNICKE-KORSAKOFF SYNDROME

1972-04-01

R. W. R. Russell

This latest addition to the series on contemporary neurology is a classic of its kind and can already be recognized as the definitive work on the Wernicke- Korsakoff syndrome.It is … This latest addition to the series on contemporary neurology is a classic of its kind and can already be recognized as the definitive work on the Wernicke- Korsakoff syndrome.It is an example of what can still be learned by the traditional methods of clinico- pathological correlation.The authors, who are distinguished both as clinicians and pathologists, have studied over 20 years 250 cases of this rare but important syndrome and not only bring together previous work but add much original material on pathology and on prognosis.A number of older observations are subjected to careful analysis and found to be correct.It is confirmed that the disease occurs almost exclusively in alcoholics with dietary deficiency and can be recognized confidently on a clinical basis by a combination of ocular palsy, nystagmus, ataxia, and mental change.The ocular palsies respond well to thiamine, while mental

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The cerebral cortex is damaged in chronic alcoholics

1997-06-01

Jillian J. Kril , Glenda M. Halliday , Mojmír Svoboda +1 more

Elevated Monoamine Oxidase A Levels in the Brain

2006-11-01

Jeffrey H. Meyer , Nathalie Ginovart , Anahita Boovariwala +7 more

Context:The monoamine theory of depression proposes that monoamine levels are lowered, but there is no explanation for how monoamine loss occurs.Monoamine oxidase A (MAO-A) is an enzyme that metabolizes monoamines, … Context:The monoamine theory of depression proposes that monoamine levels are lowered, but there is no explanation for how monoamine loss occurs.Monoamine oxidase A (MAO-A) is an enzyme that metabolizes monoamines, such as serotonin, norepinephrine, and dopamine.Objective: To determine whether MAO-A levels in the brain are elevated during untreated depression.Setting: Tertiary care psychiatric hospital.Patients: Seventeen healthy and 17 depressed individuals with major depressive disorder that met entry criteria were recruited from the care of general practitioners and psychiatrists.All study participants were otherwise healthy and nonsmoking.Depressed individuals had been medication free for at least 5 months.Main Outcome Measure: Harmine labeled with carbon 11, a radioligand selective for MAO-A and positron emission tomography, was used to measure MAO-A DV S (specific distribution volume), an index of MAO-A density, in different brain regions (prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex, caudate, putamen, thalamus, anterior temporal cortex, midbrain, hippocampus, and parahippocampus).Results: The MAO-A DV S was highly significantly elevated in every brain region assessed (t test; P=.001 to 3ϫ10 -7 ).The MAO-A DV S was elevated on average by 34% (2 SDs) throughout the brain during major depression. Conclusions:The sizable magnitude of this finding and the absence of other compelling explanations for monoamine loss during major depressive episodes led to the conclusion that elevated MAO-A density is the primary monoamine-lowering process during major depression.

Chronic ethanol consumption:from neuroadaptation to neurodegeneration

1998-11-01

Fabio Fadda , Zvani L. Rossetti

HEREDITARY PELLAGRA-LIKE SKIN RASH WITH TEMPORARY CEREBELLAR ATAXIA, CONSTANT RENAL AMINO-ACIDURIA, AND OTHER BIZARRE BIOCHEMICAL FEATURES

1956-09-01

D N Baron , C. E. Dent , Heather A. Harris +2 more

A Note on a Simple Apparatus for Detecting Neurological Deficit in Rats and Mice**College of Pharmacy, University of Nebraska, Lincoln 8.

1957-03-01

N.W. Dunham , T.S. Miya

Pattern of Motor and Cognitive Deficits in Detoxified Alcoholic Men

2000-05-01

Edith V. Sullivan , Margaret J. Rosenbloom , Adolf Pfefferbaum

Chronic excessive consumption of alcohol produces marked deficits in cognitive and motor abilities, although not all functions are affected to the same extent. Furthermore, although the occurrence of neuropsychological deficits … Chronic excessive consumption of alcohol produces marked deficits in cognitive and motor abilities, although not all functions are affected to the same extent. Furthermore, although the occurrence of neuropsychological deficits in recently detoxified alcoholics is firmly established, the relative severity of these deficits, the specific neural systems that underlie the deficits, and their relationship to age and alcohol consumption variables either are less established or have proven elusive altogether.We administered an extensive battery of neuropsychological tests, chosen for their known sensitivity to brain lesions in specific locations, to 71 recently (1 month) detoxified alcoholic men and 74 healthy controls who spanned the adult age range. Test scores were standardized to the controls for age and grouped a priori into composites that reflected performance in six functional domains: executive functions, short-term memory, upper limb motor ability, declarative memory, visuospatial abilities, and gait and balance. Analogous verbal and nonverbal materials and left- and right-hand upper limb motor tasks were used to test whether alcohol-related deficits were greater for left or right hemisphere.Compared with controls, the alcoholics were impaired on executive functions, visuospatial abilities, and gait and balance even after we accounted for group differences in estimated premorbid IQ and education. Within the alcoholic group, the most salient deficits were in gait and balance and visuospatial abilities. No consistent lateralized deficit was observed across the four domains tested. Unlike the cognitive composites, the upper limb motor ability and gait and balance composites both showed increasing vulnerability to age, with an independent contribution to the gait and balance dysfunction from the amount of alcohol consumed over a lifetime.The pattern of functional deficits implicates at least two principal neural systems: the cerebellar-frontal system and the corticocortical system between the prefrontal and parietal cortices. In addition, age and amount of alcohol consumption were better predictors of motor than cognitive impairments.

The Clinical Opiate Withdrawal Scale (COWS)

2003-06-01

Donald R. Wesson , Walter Ling

The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can … The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids. With increasing use of opioids for treatment of pain and the availability of sublingual buprenorphine in the United States for treatment of opioid dependence, clinical assessment of opiate withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high level of opioid dependence who are not experiencing opioid withdrawal. Since development of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal scales have been used in clinical and research settings. This article reviews the history of opiate withdrawal scales and the context of their initial use. A template version of the COWS that can be copied and used clinically is appended. PDF formatted versions of the COWS are also available from the websites of the American Society of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated Substance Abuse Programs, and AlcoholMD.com.

Abnormality of a Thiamine-Requiring Enzyme in Patients with Wernicke-Korsakoff Syndrome

1977-12-22

John P. Blass , Gary E. Gibson

We studied a thiamine-requiring enzyme in cultured cells from four patients with the Wernicke-Korsakoff syndrome to determine whether these patients have a genetic predilection to thiamine deficiency. Transketolase in fibroblasts … We studied a thiamine-requiring enzyme in cultured cells from four patients with the Wernicke-Korsakoff syndrome to determine whether these patients have a genetic predilection to thiamine deficiency. Transketolase in fibroblasts from the patients with the syndrome bound thiamine pyrophosphate less avidly than control lines. The apparent Km for thiamine pyrophosphate was 195 +/- 31 micron for transketolase in extracts of the patients' cells as compared to 16 +/- 2 micron in six control lines (means +/- S.E.M.: P less than 0.001). The ranges were 146 to 281 micron for the patients and 12 to 20 micron for the controls. The abnormality in transketolase persisted through serial passages in tissue culture in cells grown in medium containing excess thiamine and no ethanol, indicating that the aberrations were genetic rather than dietary. The abnormality of transketolase in this syndrome would presumably be clinically unimportant if the diet was adequate. These patients appear to have deleterious inborn enzymatic abnormalities of a type originally postulated by Garrod.

Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal

1997-07-09

Michael F. Mayo‐Smith

To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal.English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal--ethyl alcohol" and review of … To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal.English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal--ethyl alcohol" and review of references from identified articles.Articles with original data on human subjects.Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were abstracted by 2 independent reviewers and underwent meta-analysis.Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7; P=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5; P=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (P<.001). beta-Blockers, clonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (P=.002) or seizures (P<.001).Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

Brain Lesions in Alcoholics

1993-02-01

Michael E. Charness

Brain lesions in alcoholics are multifactorial in origin. Ethanol neurotoxicity, Wernicke's encephalopathy, hepatocerebral degeneration, head trauma, central pontine myelinolysis, Marchiafava‐Bignami syndrome, pellagra, and premorbid pathological conditions, such as fetal alcohol … Brain lesions in alcoholics are multifactorial in origin. Ethanol neurotoxicity, Wernicke's encephalopathy, hepatocerebral degeneration, head trauma, central pontine myelinolysis, Marchiafava‐Bignami syndrome, pellagra, and premorbid pathological conditions, such as fetal alcohol syndrome, may all contribute to cognitive dysfunction in alcoholics. With the exception of ethanol neurotoxicity, all of these conditions are associated with specific neuropathological lesions. Wernicke's encephalopathy, the neurological syndrome of thiamine deficiency, is frequently overlooked during life and may cause global dementia as well as the more familiar Korsakoff's amnestic syndrome. Distinguishing ethanol neurotoxicity from nutritional deficiency can be facilitated by magnetic resonance imaging, which can visualize some of the specific macroscopic lesions of Wernicke's encephalopathy, central pontine myelinolysis, cerebellar degeneration, and Marchiafava‐Bignami syndrome. Computerized morphometric studies of alcoholic brains have revealed ventricular enlargement, selective loss of subcortical white matter, and alterations in neuronal size, number, architecture, and synaptic complexity. These lesions tend to be more severe when there is coexisting nutritional deficiency or liver disease, suggesting that ethanol neurotoxicity may not be the sole cause. A search for similar lesions in nonalcoholic Wernicke's encephalopathy and nonalcoholic liver disease will help determine the specificity of these lesions.

Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy.

1997-01-01

Diana Caine , Glenda M. Halliday , Jillian J. Kril +1 more

To establish better operational criteria for the diagnosis of Wernicke's encephalopathy. Current criteria for diagnosing Wernicke's encephalopathy require the presence of three clinical signs (oculomotor abnormalities, cerebellar dysfunction, and an … To establish better operational criteria for the diagnosis of Wernicke's encephalopathy. Current criteria for diagnosing Wernicke's encephalopathy require the presence of three clinical signs (oculomotor abnormalities, cerebellar dysfunction, and an altered mental state), although it has often been reported that most patients do not fulfil all these criteria.The clinical histories of 28 alcoholics with neurological and neuropsychological assessments and definitive neuropathological diagnoses were examined to determine clinical signs for use in a screening schedule. Operational criteria were then proposed for differentiating patients with Wernicke's encephalopathy alone or in combination with Korsakoff's psychosis or hepatic encephalopathy. The new criteria for Wernicke's encephalopathy require two of the following four signs; (1) dietary deficiencies, (2) oculomotor abnormalities, (3) cerebellar dysfunction, and (4) either an altered mental state or mild memory impairment. Reproducibility and validity testing of these criteria were performed on 106 alcoholics screened from a large necropsy sample.Despite rater variability with regard to specific symptoms, within and between rater reliability for diagnostic classification using the criteria retrospectively on patient records was 100% for three independent raters. Validity testing showed that Wernicke's encephalopathy was underrecognized only when occurring with hepatic encephalopathy (50% sensitivity).By contrast with current criteria, the proposed operational criteria show that the antemortem identification of Wernicke's encephalopathy can be achieved with a high degree of specificity.

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Relapse Prevention by Acamprosate

1996-08-01

Henning Saß , Michael Soyka , Karl Mann +1 more

<h3>Background</h3> The effectiveness acamprosate (calcium bisacetylhomotaurinate) as a treatment to maintain abstinence in alcohol-dependent patients was assessed for 1 year. <h3>Methods:</h3> After short-term detoxification, 272 patients participated in a randomized, … <h3>Background</h3> The effectiveness acamprosate (calcium bisacetylhomotaurinate) as a treatment to maintain abstinence in alcohol-dependent patients was assessed for 1 year. <h3>Methods:</h3> After short-term detoxification, 272 patients participated in a randomized, double-blind, placebo-controlled study. Patients received routine counseling and either the study medication or placebo for 48 weeks; they were followed up for another 48 weeks without medication. Statistical analysis was performed according to the intention-to-treat principle. <h3>Results:</h3> Patients who were receiving acamprosate showed a significantly higher continuous abstinence rate within the first 60 days of treatment compared with patients who were assigned to placebo treatment (67% vs 50%) until completion of the treatment period (43% vs 21%, log rank<i>P</i>=.005), and they had a significantly longer mean abstinence duration of 224 vs 163 days, or 62% vs 45% days abstinent (<i>P</i><.001); however, there was no difference in psychiatric symptoms. Of the patients who were receiving acamprosate, 41% had dropped out, whereas 60% of the placebo-treated patients dropped out of the study. Few side effects (mainly diarrhea and headache) were recorded. At the end of a further 48 weeks without receiving study medication, 39% and 17% of the acamprosate- and placebo-treated patients, respectively, had remained abstinent (P=.003). <h3>Conclusion:</h3> Acamprosate proved to be a safe and effective aid in treating alcohol-dependent patients and in maintaining the abstinence of patients during 2 years.

Mitochondrial function and toxicity: Role of the B vitamin family on mitochondrial energy metabolism

2006-05-02

Flore Dépeint , W. Robert Bruce , Nandita Shangari +2 more

Pharmacological Management of Alcohol Withdrawal

1997-07-09

Michael F. Mayo‐Smith

<h3>Objective.</h3> —To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal. <h3>Data Soureces.</h3> —English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal—ethyl … <h3>Objective.</h3> —To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal. <h3>Data Soureces.</h3> —English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal—ethyl alcohol" and review of references from identified articles. <h3>Study Selection.</h3> —Articles with original data on human subjects. <h3>Data Abstraction.</h3> —Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the<i>Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition</i>, were abstracted by 2 independent reviewers and underwent meta-analysis. <h3>Data Synthesis.</h3> —Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7;<i>P</i>=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5;<i>P</i>=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (<i>P</i><.001). β-Blockers, clonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (<i>P</i>=.002) or seizures (<i>P</i><.001). <h3>Conclusions.</h3> —Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. β-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy

2003-02-18

Hans-Peter Hammes , Xueliang Du , Diane Edelstein +7 more

A Dose-Ranging Study of the Effects of Ethyl-Eicosapentaenoate in Patients With Ongoing Depression Despite Apparently Adequate Treatment With Standard Drugs

2002-10-01

Malcolm Peet , David F. Horrobin

<h3>Background</h3> In depressed patients, low blood levels of eicosapentaenoic acid are seen. We tested the antidepressive effect of ethyl-eicosapentaenoate in these patients. <h3>Methods</h3> We included 70 patients with persistant depression … <h3>Background</h3> In depressed patients, low blood levels of eicosapentaenoic acid are seen. We tested the antidepressive effect of ethyl-eicosapentaenoate in these patients. <h3>Methods</h3> We included 70 patients with persistant depression despite ongoing treatment with an adequate dose of a standard antidepressant. Patients were randomized on a double-blind basis to placebo or ethyl-eicosapentaenoate at dosages of 1, 2, or 4 g/d for 12 weeks in addition to unchanged background medication. Patients underwent assessment using the 17-item Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale, and the Beck Depression Inventory. <h3>Results</h3> Forty-six (88%) of 52 patients receiving ethyl-eicosapentaenoate and 14 (78%) of 18 patients receiving placebo completed the 12-week study with no serious adverse events. The 1-g/d group showed a significantly better outcome than the placebo group on all 3 rating scales. In the intention-to-treat group, 5 (29%) of 17 patients receiving placebo and 9 (53%) of 17 patients receiving 1 g/d of ethyl-eicosapentaenoate achieved a 50% reduction on the Hamilton Depression Rating Scale score. In the per-protocol group, the corresponding figures were 3 (25%) of 12 patients for placebo and 9 (69%) of 13 patients for the 1-g/d group. The 2-g/d group showed little evidence of efficacy, whereas the 4-g/d group showed nonsignificant trends toward improvement. All of the individual items on all 3 rating scales improved with the 1-g/d dosage of ethyl-eicosapentaenoate vs placebo, with strong beneficial effects on items rating depression, anxiety, sleep, lassitude, libido, and suicidality. <h3>Conclusion</h3> Treatment with ethyl-eicosapentaenoate at a dosage of 1 g/d was effective in treating depression in patients who remained depressed despite adequate standard therapy.

TREATMENT OF ALCOHOLISM WITH A SENSITISING DRUG

1948-12-01

O. Martensen‐Larsen

Reduced Activities of Thiamine-Dependent Enzymes in the Brains and Peripheral Tissues of Patients With Alzheimer's Disease

1988-08-01

Gary E. Gibson , K.‐F. R. Sheu , John P. Blass +4 more

A report of cell loss in the nucleus basalis of Meynert in patients with Wernicke-Korsakoff disease prompted the examination of thiamine pyrophosphate (TPP)-dependent enzymes in the brain and peripheral tissues … A report of cell loss in the nucleus basalis of Meynert in patients with Wernicke-Korsakoff disease prompted the examination of thiamine pyrophosphate (TPP)-dependent enzymes in the brain and peripheral tissues of patients with Alzheimer's disease. In these brains, the activities of the 2-ketoglutarate dehydrogenase complex were reduced more than 75% and those of transketolase more than 45%. Decreases occurred in histologically damaged and in relatively undamaged areas. Small but statistically significant abnormalities of transketolase, but not of 2-ketoglutarate dehydrogenase complex, were identified in red blood cells and cultured fibroblasts. Previous studies have shown deficiencies in the brain and variable effects in peripheral tissues on another TPP-dependent enzyme--the pyruvate dehydrogenase complex. Activities of TPP-dependent enzymes appear to be deficient in the brain and perhaps in some peripheral tissues in patients with Alzheimer's disease.

The Neuropathology of Alcohol-specific Brain Damage, or Does Alcohol Damage the Brain?

1998-02-01

Clive Harper

The aim of this review is to identify neuropathological changes that are directly related to the long-term use of excessive amounts of alcohol (ethanol). There is still debate as to … The aim of this review is to identify neuropathological changes that are directly related to the long-term use of excessive amounts of alcohol (ethanol). There is still debate as to whether alcohol per se causes brain damage. The main problem has been to identify those lesions caused by alcohol itself and those caused by other common alcohol-related factors, principally thiamin deficiency. Careful selection and classification of alcoholic cases into those with and without these complications, together with detailed quantitative neuropathological analyses, has provided us with useful data. There is brain shrinkage in uncomplicated alcoholics which can largely be accounted for by loss of white matter. Some of this damage appears to be reversible. However, alcohol-related neuronal loss has been documented in specific regions of the cerebral cortex (superior frontal association cortex), hypothalamus (supraoptic and paraventricular nuclei), and cerebellum. The data is conflicting for several regions: the hippocampus, amygdala and locus ceruleus. No change is found in the basal ganglia, nucleus basalis, or serotonergic raphe nuclei. Many of the regions that are normal in uncomplicated alcoholics are damaged in those with the Wernicke-Korsakoff syndrome. Dendritic and synaptic changes have been documented in uncomplicated alcoholics and these, together with receptor and transmitter changes, may explain functional changes and cognitive deficits that precede the more severe structural neuronal changes. The pattern of damage appears to be somewhat different and species-specific in animal models of alcohol toxicity. Pathological changes that have been found to correlate with alcohol intake include white matter loss and neuronal loss in the hypothalamus and cerebellum.

Enhanced Negative Emotion and Alcohol Craving, and Altered Physiological Responses Following Stress and Cue Exposure in Alcohol Dependent Individuals

2008-06-18

Rajita Sinha , Helen Fox , Kwangik Hong +3 more

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Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy.

1986-04-01

C Harper , Mathew Giles , Robert Finlay‐Jones

A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed … A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed that only 16% had the classical clinical triad and 19% had no documented clinical signs. The incidence of clinical signs in this and other retrospective pathological studies is very different from that of prospective clinical studies. This discrepancy may relate to "missed" clinical signs but the magnitude of the difference suggests that at least some cases of the Wernicke-Korsakoff syndrome may be the end result of repeated subclinical episodes of vitamin B1 deficiency. In order to make the diagnosis, clinicians must maintain a high index of suspicion in the "at risk" group of patients, particularly alcoholics. Investigations of thiamine status may be helpful and if the diagnosis is suspected, parenteral thiamine should be given.

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Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment

2005-04-14

Ronald Petersen , Ronald G. Thomas , Michael Grundman +7 more

Mild cognitive impairment is a transitional state between the cognitive changes of normal aging and early Alzheimer's disease. Mild cognitive impairment is a transitional state between the cognitive changes of normal aging and early Alzheimer's disease.

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Management of Alcohol Withdrawal Delirium<subtitle>An Evidence-Based Practice Guideline</subtitle>

2004-07-12

Michael F. Mayo‐Smith

Background: Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal.Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.Methods: Articles with original data on management of … Background: Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal.Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.Methods: Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis.Results: Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6.Statistically

Assessment of Alcohol Withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA‐Ar)

1989-11-01

John T. Sullivan , Kathy Sykora , Joyce Schneiderman +2 more

A shortened 10-item scale for clinical quantitation of the severity of the alcohol withdrawal syndrome has been developed. This scale offers an increase in efficiency while at the same time … A shortened 10-item scale for clinical quantitation of the severity of the alcohol withdrawal syndrome has been developed. This scale offers an increase in efficiency while at the same time retaining clinical usefulness, validity and reliability. It can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal.

Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management

2007-04-17

GianPietro Sechi , Alessandro Serra

FRONTAL LOBE CHANGES IN ALCOHOLISM: A REVIEW OF THE LITERATURE

2001-09-01

Hamdy F. Moselhy

— Alcohol can induce a wide spectrum of effects on the central nervous system. These effects can be recognized at the neurophysiological, morphological and neuropsychological levels. Several studies of the … — Alcohol can induce a wide spectrum of effects on the central nervous system. These effects can be recognized at the neurophysiological, morphological and neuropsychological levels. Several studies of the effect of alcohol on the frontal lobes were identified for review from MedLine, PsychLIT databases and by manual searching. In this review article, the different changes are examined in detail. Computed tomography studies have reported changes of frontal lobe in alcoholism, while magnetic resonance imaging studies supported these findings. Neurophysiological studies with positron emission tomography and single photon emission computed tomography have reported a decreased frontal lobe glucose utilization and reduced cerebral blood flow. There is also evidence from neuropsychological studies that there are specific deficits in alcoholism that suggest frontal lobe dysfunction. Considered together, these studies lend a strong credence to the concept of frontal lobe pathology in alcoholism. However, frontal lobe is not an isolated part of the brain and should be considered with its heavy connections to different cortical and subcortical areas of the brain.

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Degeneration of anterior thalamic nuclei differentiates alcoholics with amnesia

2000-01-01

A. Harding

The specific neural substrate underlying the amnesia in alcoholic Korsakoff's psychosis is poorly defined because of the considerable brain damage found in many non-amnesic alcoholics, particularly those with Wernicke's encephalopathy. … The specific neural substrate underlying the amnesia in alcoholic Korsakoff's psychosis is poorly defined because of the considerable brain damage found in many non-amnesic alcoholics, particularly those with Wernicke's encephalopathy. Using operational criteria to identify alcoholics with and without Korsakoff's psychosis, we have shown that many of the cortical and subcortical regions involved in the encoding and retrieval of episodic memory are either unaffected (hippocampus) or damaged to the same extent (prefrontal cortex and the cholinergic basal forebrain) in both amnesic and non-amnesic alcoholics. In the present study we analysed the diencephalic regions involved in episodic memory to determine the neural substrate for the amnesia observed in alcoholic Korsakoff's psychosis. The number of neurons in spaced serial sections containing the hypothalamic mamillary nuclei and the anterior and mediodorsal thalamic nuclei was estimated using unbiased stereological techniques. Neurodegeneration of the hypothalamic mamillary nuclei and the mediodorsal thalamic nuclei was substantial in both non-amnesic and amnesic alcoholics with Wernicke's encephalopathy. However, neuronal loss in the anterior thalamic nuclei was found consistently only in alcoholic Korsakoff's psychosis. This is the first demonstration of a differentiating lesion in alcoholic Korsakoff's psychosis and supports previous evidence that degeneration of thalamic relays are important in this memory disorder.

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Management of Drug and Alcohol Withdrawal

2003-04-30

Thomas R. Kosten , Patrick G. O'Connor

This review summarizes the current approaches to the management of withdrawal in patients addicted to sedatives such as alcohol or benzodiazepines, opioids, or stimulants such as amphetamines or cocaine. Included … This review summarizes the current approaches to the management of withdrawal in patients addicted to sedatives such as alcohol or benzodiazepines, opioids, or stimulants such as amphetamines or cocaine. Included are details of detoxification regimens and guidelines for recognizing and managing the most common complications.

The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment

2009-01-16

Michael D. Kopelman , Allan D. Thomson , Irene Guerrini +1 more

The Korsakoff syndrome is a preventable memory disorder that usually emerges (although not always) in the aftermath of an episode of Wernicke's encephalopathy. The present paper reviews the clinical and … The Korsakoff syndrome is a preventable memory disorder that usually emerges (although not always) in the aftermath of an episode of Wernicke's encephalopathy. The present paper reviews the clinical and scientific literature on this disorder.A systematic review of the clinical and scientific literature on Wernicke's encephalopathy and the alcoholic Korsakoff syndrome.The Korsakoff syndrome is most commonly associated with chronic alcohol misuse, and some heavy drinkers may have a genetic predisposition to developing the syndrome. The characteristic neuropathology includes neuronal loss, micro-haemorrhages and gliosis in the paraventricular and peri-aqueductal grey matter. Lesions in the mammillary bodies, the mammillo-thalamic tract and the anterior thalamus may be more important to memory dysfunction than lesions in the medial dorsal nucleus of the thalamus. Episodic memory is severely affected in the Korsakoff syndrome, and the learning of new semantic memories is variably affected. 'Implicit' aspects of memory are preserved. These patients are often first encountered in general hospital settings where they can occupy acute medical beds for lengthy periods. Abstinence is the cornerstone of any rehabilitation programme. Korsakoff patients are capable of new learning, particularly if they live in a calm and well-structured environment and if new information is cued. There are few long-term follow-up studies, but these patients are reported to have a normal life expectancy if they remain abstinent from alcohol.Although we now have substantial knowledge about the nature of this disorder, scientific questions (e.g. regarding the underlying genetics) remain. More particularly, there is a dearth of appropriate long-term care facilities for these patients, given that empirical research has shown that good practice has beneficial effects.

The Neuropathology of Alcohol-Related Brain Damage

2009-01-16

C Harper

Excessive alcohol use can cause structural and functional abnormalities of the brain and this has significant health, social and economic implications for most countries in the world. Even heavy social … Excessive alcohol use can cause structural and functional abnormalities of the brain and this has significant health, social and economic implications for most countries in the world. Even heavy social drinkers who have no specific neurological or hepatic problems show signs of regional brain damage and cognitive dysfunction. Changes are more severe and other brain regions are damaged in patients who have additional vitamin B1 (thiamine) deficiency (Wernicke–Korsakoff syndrome). Quantitative studies and improvements in neuroimaging have contributed significantly to the documentation of these changes but mechanisms underlying the damage are not understood. A human brain bank targeting alcohol cases has been established in Sydney, Australia, and tissues can be used for structural and molecular studies and to test hypotheses developed from animal models and in vivo studies. The recognition of potentially reversible changes and preventative medical approaches are important public health issues.

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Decision-Making Deficits of Korsakoff Patients in a New Gambling Task With Explicit Rules: Associations With Executive Functions.

2005-05-01

Matthias Brand , Esther Fujiwara , Sabine Borsutzky +3 more

Decision-making deficits reflected by risky decisions in gambling tasks have been associated with frontal lobe dysfunctions in various neurologic and psychiatric populations. The question remains whether decision-making impairments are related … Decision-making deficits reflected by risky decisions in gambling tasks have been associated with frontal lobe dysfunctions in various neurologic and psychiatric populations. The question remains whether decision-making impairments are related to executive functions. The authors developed a new gambling task, the Game of Dice Task, with explicit and stable rules for reinforcement and punishment, to investigate relations between executive functions and risk-taking behavior in an explicit decision-making situation. A sample of 35 alcoholic Korsakoff patients and 35 healthy controls was examined with the Game of Dice Task and a neuropsychological test battery. Results show that Korsakoff patients are strongly impaired in this explicit decision-making task and that these disturbances are correlated with specific executive functions.

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Addition of Omega-3 Fatty Acid to Maintenance Medication Treatment for Recurrent Unipolar Depressive Disorder

2002-03-01

Boris Nemets , Ziva Stahl , Robert H. Belmaker

OBJECTIVE: Studies have reported that countries with high rates of fish oil consumption have low rates of depressive disorder. The authors studied a specific omega-3 fatty acid, the ethyl ester … OBJECTIVE: Studies have reported that countries with high rates of fish oil consumption have low rates of depressive disorder. The authors studied a specific omega-3 fatty acid, the ethyl ester of eicosapentaenoic acid (E-EPA), as an adjunct to treatment for depressive episodes occurring in patients with recurrent unipolar depressive disorder who were receiving maintenance antidepressant therapy. METHOD: Twenty patients with a current diagnosis of major depressive disorder participated in a 4-week, parallel-group, double-blind addition of either placebo or E-EPA to ongoing antidepressant therapy. Seventeen of the patients were women, and three were men. RESULTS: Highly significant benefits of the addition of the omega-3 fatty acid compared with placebo were found by week 3 of treatment. CONCLUSIONS: It is not possible to distinguish whether E-EPA augments antidepressant action in the manner of lithium or has independent antidepressant properties of its own.

Delirium, a syndrome of cerebral insufficiency

1959-02-01

George L. Engel , John Romano

A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients

1996-02-01

William Breitbart , Rosa Marotta , Meredith M. Platt +7 more

The purpose of this study was to examine the efficacy and side effects of haloperidol, chlorpromazine, and lorazepam for the treatment of the symptoms of delirium in adult AIDS patients … The purpose of this study was to examine the efficacy and side effects of haloperidol, chlorpromazine, and lorazepam for the treatment of the symptoms of delirium in adult AIDS patients in a randomized, double-blind, comparison trial.Nondelirious, medically hospitalized AIDS patients (N = 244) consented to participate in the study and were monitored prospectively for the development of delirium. Patients entered the treatment phase of the study if they met DSM-III-R criteria for delirium and scored 13 or greater on the Delirium Rating Scale. Thirty patients were randomly assigned to treatment with haloperidol (N = 11), chlorpromazine (N = 13), or lorazepam (N = 6). Efficacy and side effects associated with the treatment were measured with repeated assessments using the Delirium Rating Scale, the Mini-Mental State, and the Extrapyramidal Symptom Rating Scale.Treatment with either haloperidol or chlorpromazine in relatively low doses resulted in significant improvement in the symptoms of delirium as measured by the Delirium Rating Scale. No improvement in the symptoms of delirium was found in the lorazepam group. Cognitive function, as measured by the Mini-Mental State, improved significantly from baseline to day 2 for patients receiving chlorpromazine. Treatment with haloperidol or chlorpromazine was associated with an extremely low prevalence of extrapyramidal side effects. All patients receiving lorazepam, however, developed treatment-limiting adverse effects. Although only a small number of patients had been treated with lorazepam, the authors became sufficiently concerned with the adverse effects to terminate that arm of the protocol early.Symptoms of delirium in medically hospitalized AIDS patients may be treated efficaciously with few side effects by using low-dose neuroleptics (haloperidol or chlorpromazine). Lorazepam alone appears to be ineffective and associated with treatment-limiting adverse effects.

Wernicke's Encephalopathy

1985-04-18

James B. Reuler , Donald E. Girard , Thomas G. Cooney

Despite its description over a century ago, Wernicke's encephalopathy continues to be underrecognized in both alcoholic and nonalcoholic populations. Recent studies suggest that Wernicke's encephalopathy is the most common neuropathological … Despite its description over a century ago, Wernicke's encephalopathy continues to be underrecognized in both alcoholic and nonalcoholic populations. Recent studies suggest that Wernicke's encephalopathy is the most common neuropathological finding underlying chronic cognitive impairment in alcoholics and that its prevalence at autopsy, in both alcoholic and nonalcoholic populations, far exceeds its rate of recognition during life. Since Wernicke's encephalopathy is both treatable and preventable, and untold health care expenditures result from the disorder, familiarity with its epidemiologic and clinical features is important. In this article, the pathophysiologic, clinical, and neuropathological features of Wernicke's encephalopathy are reviewed, and principles of . . .

[Drug addiction and drug abuse].

1969-12-12

W. Feuerlein

Wernicke-Korsakoff Syndrome

2013-01-01

Gerald F. Gebhart , Robert F. Schmidt

Delirium Tremens: Assessment and Management

2018-05-05

Sandeep Grover , Abhishek Ghosh

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Alcohol dependence syndrome: Measurement and validation.

1982-06-01

Harvey A. Skinner , Barbara Ann Allen

Dementia

2018-02-07

Seth A. Gale , Diler Acar , Kirk R. Daffner

Oxidative stress and nitration in neurodegeneration: Cause, effect, or association?

2003-01-15

Harry Ischiropoulos , Joseph S. Beckman

Nonstandard abbreviations used: amyotrophic lateral sclerosis (ALS); manganese superoxide dismutase (Mn-SOD); Cu/Zn superoxide dismutase (Cu/Zn-SOD); hypochlorous acid (HOCl); nitric oxide synthase (NOS); 1-methyl-4-phenyl-1,2,3,6tetrahydropyridine (MPTP); copper chaperone for Cu/Zn superoxide dismutase … Nonstandard abbreviations used: amyotrophic lateral sclerosis (ALS); manganese superoxide dismutase (Mn-SOD); Cu/Zn superoxide dismutase (Cu/Zn-SOD); hypochlorous acid (HOCl); nitric oxide synthase (NOS); 1-methyl-4-phenyl-1,2,3,6tetrahydropyridine (MPTP); copper chaperone for Cu/Zn superoxide dismutase (CCS).

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The disease concept of alcoholism.

1960-01-01

E. M. Jellinek

Alcohol tolerance and dependence

1980-01-01

Henk Rigter , John C. Crabbe

Wernicke’s encephalopathy following radical gastrectomy and prolonged parenteral nutrition: a case report of pyloric obstruction and undisclosed psychiatric comorbidity

2025-06-23

Hu Ma , Zheng Zhao , Wenjie Zhang +7 more | Frontiers in Oncology

Wernicke’s encephalopathy (WE), a neuropsychiatric emergency caused by thiamine deficiency, is increasingly recognized in nonalcoholic populations. We present a 64-year-old male with pyloric obstruction from gastric cancer (stage IIIA) who … Wernicke’s encephalopathy (WE), a neuropsychiatric emergency caused by thiamine deficiency, is increasingly recognized in nonalcoholic populations. We present a 64-year-old male with pyloric obstruction from gastric cancer (stage IIIA) who developed WE 20 days after gastrectomy. Prolonged thiamine-free total parenteral nutrition (TPN), delayed enteral intake, and cancer-related hypermetabolism jointly precipitated a thiamine deficiency. Undisclosed psychiatric comorbidity exacerbated diagnostic challenges and potential risk. Despite initial diagnostic challenges, timely neurological assessment and urgent brain MRI confirmed the diagnosis on the day of readmission. Immediate thiamine supplementation led to full neurological recovery. At six-month follow-up, the patient remained neurologically intact with structured dietary and psychological counseling, ensuring sustained psychiatric stability during adjuvant chemotherapy. This novel case of WE following radical gastrectomy, prolonged TPN, and in the context of gastric cancer with pyloric obstruction and undisclosed psychiatric comorbidity, underscores the necessity of multidisciplinary collaboration to optimize perioperative nutritional and psychosocial management in high-risk oncological surgical populations.

Italian pellagra and pellagrous insanity

2025-06-23

Douglas J. Lanska | Journal of the History of the Neurosciences

Thiamin deficiency in children with chronic kidney disease on peritoneal dialysis and its association with dialysis duration and transport peritoneal membrane status

2025-06-23

Wipawee Suwanboriboon , Thanaporn Chaiyapuk , Intraparch Tinnabut +7 more | Pediatric Nephrology

Patients with chronic kidney disease (CKD) stage 5D receiving peritoneal dialysis (PD) are at risk for thiamin deficiency (TD). This study compared the proportion of TD in pediatric CKD patients … Patients with chronic kidney disease (CKD) stage 5D receiving peritoneal dialysis (PD) are at risk for thiamin deficiency (TD). This study compared the proportion of TD in pediatric CKD patients undergoing PD with that in healthy controls and evaluated the associations of various factors with TD in CKD patients. Thirty-two patients with CKD stage 5D and 34 healthy children were recruited. The participants reported their consumption of foods containing antithiamin factors and completed a 3-day food record to assess their intake of thiamin, energy, and macronutrients. The medical records of the CKD group were reviewed. Thiamin status was assessed via an erythrocyte transketolase activity assay, where the thiamin pyrophosphate effect was determined. Thirteen percent of participants in the CKD group had TD, whereas 29% of the healthy controls did (p = 0.093). The CKD group had significantly greater total thiamin intake per 1,000 kcal of energy due to thiamin supplementation (2.14 [1.83, 2.99] vs. 0.87 [0.59, 1.14] mg/1,000 kcal; p < 0.001), despite inadequate dietary thiamin intake. A longer PD duration (in months) and a high-transport peritoneal membrane status were significantly associated with poorer thiamin status (β = + 0.59, p < 0.001, and β = + 0.38, p = 0.013, respectively). In contrast, greater total thiamin intake was correlated with improved thiamin status (β = -0.35, p = 0.022). Thiamin deficiency was observed in 13% of pediatric CKD patients on PD and 29% of healthy controls. In CKD patients, TD was associated with longer PD duration (in months), high-transport peritoneal membrane status, and low total thiamin intake.

Wernicke’s Encephalopathy in the Context of Hyperemesis Gravidarum: A Case Report and Literature Review

2025-06-20

Choubane Nabila | Deleted Journal

Introduction Wernicke’s encephalopathy (WE) is a rare but potentially fatal neurological emergency caused by thiamine deficiency. It can occur during pregnancy, especially in cases of prolonged hyperemesis gravidarum. Case Report … Introduction Wernicke’s encephalopathy (WE) is a rare but potentially fatal neurological emergency caused by thiamine deficiency. It can occur during pregnancy, especially in cases of prolonged hyperemesis gravidarum. Case Report We report the case of a 28-year-old primigravida admitted at 16 weeks of gestation with muscle weakness and suspected polyradiculoneuropathy. Electromyography revealed a sensory-motor axonal polyneuropathy. Secondary worsening with confusion and nystagmus led to the diagnosis of Wernicke’s encephalopathy confirmed by brain MRI. The patient improved following thiamine supplementation. Discussion This case illustrates an atypical form of WE with predominant peripheral involvement, which delayed diagnosis. Early treatment with intravenous thiamine enabled partial neurological recovery and prevented severe sequelae. Conclusion Any unexplained neurological symptoms in a pregnant woman with prolonged vomiting should raise suspicion for WE. Empirical thiamine supplementation is justified in the presence of clinical doubt.

Animal Models of Substance Use and Neurodegeneration

2025-06-20

Amine Larnaout , Youssef Ernez , R. Lansari +1 more | CRC Press eBooks

Addiction and Neurodegenerative Disorders

2025-06-20

Samer El Hayek | CRC Press eBooks

Tobacco and Neurodegenerative Disorders

2025-06-20

Celal Yesilkaya , Serkan Turan | CRC Press eBooks

Alcohol and Neurogenerative Disorders

2025-06-20

Victor Olufolahan Lasebikan , Victor Makanjuola , Tiwatayo Olufolahan Lasebikan +3 more | CRC Press eBooks

Sedative, Hypnotic, and Anxiolytic Use and Neurodegenerative Disorders

2025-06-20

Kirtika Aggarwal , Awanish Mishra , Ramdas Ransing +1 more | CRC Press eBooks

Amprolium-induced thiamine deficiency in female mice: Role of oxidative stress and inflammation

2025-06-20

Mirian Pereira da Silva , Francisco Wanderson Bizerra Lima , Adha Gabriela Santos Moura +3 more | Research Society and Development

Experimental models of thiamine deficiency (TD) have primarily focused on male rodents, meaning that the effects of TD in females and the pathogenesis associated with neurological disorders remain unknown. This … Experimental models of thiamine deficiency (TD) have primarily focused on male rodents, meaning that the effects of TD in females and the pathogenesis associated with neurological disorders remain unknown. This article aimed to present an investigation on the effects of TD with amprolium in female mice, evaluating metabolic and behavioral effects, as well as the modulation of ERK1/2 phosphorylation in the cerebral cortex and thalamus. Furthermore, we used the antioxidant Trolox and anti-inflammatory agent dimethyl sulfoxide to investigate the role of oxidative stress and neuroinflammation in this process. The animals were exposed to a thiamine-deficient diet with the additional administration of amprolium (60 mg/kg) for 20 days. After treatment, we observed a reduction in food consumption and animal body weight, with a decrease in motor coordination and exploratory activity, and, in parallel, an increase in the phosphorylation of ERK1/2, both in the cerebral cortex and thalamus in deficient animals. Deficient animals that received Trolox or dimethyl sulfoxide presented with attenuation of these effects, with the maintenance of motor coordination and total blockage of ERK1/2 activation. The results showed that female mice could be used as a valid TD model, compatible with other methods, showing important neurological changes. This study showed that in females, TD also involves mechanisms of oxidative stress and inflammation, responds positively, and can be used as a model animal.

TNFR1 and TNFR2 levels in patients with severe alcohol use disorder undergoing withdrawal and their relationship with delirium tremens

2025-06-18

Shu-Hao Hsu , Ming‐Chyi Huang , Tung‐Hsia Liu +3 more | Brain Behavior and Immunity

A Rare Presentation of Wernicke’s Encephalopathy With Internuclear Ophthalmoplegia

2025-06-18

Montasir Elmobark , Osama Ahmed , Wasif Mohammad Ali | Cureus

Distinguishing Wernicke Encephalopathy from Artery of Percheron Infarction in a 43-Year-Old Man: A Case Report

2025-06-17

Syed Raza , Salma Mohamed , Nazia Naz S. Khan | American Journal of Case Reports

Case Report: Favorable outcome in a patient with simultaneous dengue meningoencephalitis and Wernicke’s thiamine deficiency

2025-06-17

Saket Toshniwal , Jiwan Kinkar , Sourya Acharya +1 more | Frontiers in Medicine

This case report describes the case of a 35-year-old man with a history of chronic binge drinking who presented with fever, associated confused state of mind, and symptoms indicative of … This case report describes the case of a 35-year-old man with a history of chronic binge drinking who presented with fever, associated confused state of mind, and symptoms indicative of acute alcohol withdrawal, including tremors and agitation. Routine investigations revealed pancytopenia and a positive dengue NS1 antigen test, confirming a diagnosis of dengue fever. Neurological examination revealed abnormalities, such as nystagmus, ophthalmoplegia, and altered mental status, which raised the initial suspicion of an alternative diagnosis of Wernicke’s encephalopathy (WE). Magnetic resonance imaging (MRI) revealed bilateral thalamic hyperintensities and meningeal enhancement, while the positive dengue status revealed a rare manifestation of dengue meningoencephalitis. However, owing to the patient’s history of chronic alcoholism, WE could not be completely ruled out. The diagnostic challenge in distinguishing between WE and dengue-associated neurological complications is highlighted by the overlapping symptoms in this case. Furthermore, early administration of thiamine played a crucial role in managing the patient’s condition, highlighting the importance of timely intervention in such complex cases marked by diagnostic uncertainties.

Multi-omics analyses reveal altered gut microbial thiamine production in obesity

2025-06-17

Yu Xia , Longya Lu , Lulu Wang +3 more | Frontiers in Microbiology

Objective Accumulating evidence highlights the important role of B vitamins in maintaining the balance of gut microbial ecology and metabolism, however, few studies have focused on changes in B vitamins … Objective Accumulating evidence highlights the important role of B vitamins in maintaining the balance of gut microbial ecology and metabolism, however, few studies have focused on changes in B vitamins homeostasis in the gut and their associations with disease. This study aims to investigate the potential interplay between B vitamins, gut microbiota, and obesity. Methods We conducted an integrated analysis of fecal shotgun metagenomics, fecal metabolome concerning B vitamins and short chain fatty acids (SCFAs), and obese phenotypes in a cohort of 63 participants, including 31 healthy controls and 32 individuals with obesity. Results Metabolomic analysis identified significantly lower levels of fecal thiamine in individuals with obesity ( P Wilcoxon &lt; 0.001). Fecal thiamine levels exhibited a positive correlation with HDL-C and a negative correlation with BMI, DBP, fasting serum insulin, HOMA-IR, triglycerides, and propionic acid. Binary logistics regression suggested that fecal thiamine deficiency may be a potential contributor to the onset of obesity (Odds ratio: 0.295). Metagenomic analysis indicated that the microbial composition in individuals with obesity was characterized by a predominance of potential opportunistic pathogens, a loss of complexity, and a decrease in thiamine-producing bacteria. Integrated analysis indicated that thiamine deficiency was positively associated with the depletion of thiamine auxotrophic bacteria in the obese microbiome. Functional analysis revealed that KOs content for enzymes involved in the microbial production of thiamine were significantly lower in obesity, including tRNA uracil 4-sulfurtransferase (ThiI, P Wilcoxon = 0.001) and nucleoside-triphosphatase (NTPCR, P Wilcoxon = 0.006), both of which were positively associated with fecal thiamine. Conclusion Our study highlights the impairment of microbial thiamine production and its broad associations with gut microbiota dysbiosis and obesity-related phenotypes. Our findings provide a rationale for developing treatments that utilize thiamine to prevent obesity by modulating gut microbiota.

Hydrocodone-Induced Delirium in an Otherwise Healthy 20-Year-Old Male

2025-06-16

Abigail B. Ginsberg , Ravi Chauhan | Ochsner Journal

The Relationship Between Alcohol Tolerance Level and Severity of Alcohol Withdrawal Syndrome

2025-06-14

R. S. Achuvakov , Vyacheslav Е. Alehin , Л Р Бакиров +6 more | Neurology Bulletin

BACKGROUND: Alcohol withdrawal syndrome (AWS) is a condition that develops as a result of an abrupt reduction or cessation of ethanol intake. The severity of AWS depends on numerous factors, … BACKGROUND: Alcohol withdrawal syndrome (AWS) is a condition that develops as a result of an abrupt reduction or cessation of ethanol intake. The severity of AWS depends on numerous factors, one of which is the extent of ethanol consumption and alcohol tolerance. Alcohol tolerance, especially when it is increased, is one of the key diagnostic criteria of alcohol dependence. AIM: The work aimed to analyze the relationship between severity of AWS and maximum daily alcohol tolerance. METHODS: A continuous screening of patients with alcohol dependence syndrome who were undergoing inpatient treatment at a specialized addiction facility was conducted on days 7–14 of their hospital stay (post-withdrawal period). Inclusion, non-inclusion, and exclusion criteria were established for the selection of participants. All patients were diagnosed with middle stage alcohol dependence syndrome. At the time of inclusion in the study, none of the participants had AWS. To assess the severity of AWS, the CIWA-Ar scale was used. RESULTS: The study included 399 participants diagnosed with F10.2 (alcohol dependence), of whom 83 (21%) were females and 316 (79%) were males. The mean age of the patients was 41.52 ± 8.42 years. During hospital stay, 108 (27%) patients had an AWS-associated convulsive seizure, while 291 (73%) had no convulsive seizures. Statistical analysis revealed a significant relationship between daily alcohol tolerance and the severity of individual alcohol withdrawal symptoms. It was also found that patients with convulsive seizures after alcohol withdrawal had higher daily alcohol tolerance. A threshold value of daily alcohol tolerance of 3.59 g/kg of body weight predictive of the development of AWS-associated convulsive seizures was calculated. CONCLUSION: The study found that the severity of AWS was positively correlated with the maximum daily alcohol tolerance. When daily alcohol tolerance is more than 3.5 g/kg of body weight, patients should be considered at risk for developing AWS-associated convulsive seizures.

Phosphatidylethanol levels and their association with withdrawal severity among individuals with severe alcohol use disorder seeking inpatient withdrawal management

2025-06-13

Jeong Hoo Lee , Veronica Szpak , Lisa Vercollone +4 more | Frontiers in Psychiatry

Introduction This study aimed to determine if phosphatidylethanol (PEth) levels are associated with alcohol withdrawal severity among individuals seeking inpatient withdrawal management. Methods A prospective study enrolled individuals undergoing alcohol … Introduction This study aimed to determine if phosphatidylethanol (PEth) levels are associated with alcohol withdrawal severity among individuals seeking inpatient withdrawal management. Methods A prospective study enrolled individuals undergoing alcohol withdrawal treatment at a ASAM level 4 inpatient unit. Primary outcome was the association between serum PEth levels with alcohol withdrawal medication requirements in diazepam equivalent (mg). Secondary objectives examined associations between PEth levels, Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scores, drinking history, Alcohol Use Disorders Identification Test (AUDIT), and Prediction of Alcohol Withdrawal Severity Scale (PAWSS) scores. Results Thirty participants (mean age 48.7 years, SD 11.7; 67.7% white) reported average daily alcohol consumption of 14.2 drinks (SD 11.4, range 1.2-47.6) and percent heavy drinking days of 72% (SD 31.9, range 13.3-100). Nine (29%) reported history of withdrawal seizures and seven (22.6%) reported history of delirium tremens. Admission PEth (PO, ng/mL) levels (mean 934.9, SD 546.6; range 42 - 2000-) did not significantly associate with total medication requirements (r=0.05, p=0.78) or CIWA scores (r=0.09 to -0.14, p&gt;0.05). PEth levels showed no significant correlations with AUDIT (r=0.17, p=0.35) or PAWSS scores (r=0.13, p=0.50). However, significant correlations were found between PEth levels and average drinks per day (r=0.54, p=0.002), as well as with the percentage of heavy drinking days (r=0.54, p=0.002). Discussion and conclusions Consistent with prior reports, PEth levels appear to correlate with patients’ alcohol consumption including heavy drinking, but our results did not find that PEth levels predict alcohol withdrawal severity among heavy drinkers seeking inpatient withdrawal management. Further research is warranted to better understand the utility of PEth testing.

PELLAGRA-LIKE DERMATITIS - A CASE REPORT

2025-06-12

Kujtime Rushiti Mehmeti , Ivana Dimoska , Nevenka Adjievska +3 more | Academic Medical Journal

Pellagra-like dermatitis refers to a skin condition resembling the dermatologic manifestations of pellagra, which is a systemic disease resulting from niacin (vitamin B3) deficiency. Vitamin B3 is needed for several … Pellagra-like dermatitis refers to a skin condition resembling the dermatologic manifestations of pellagra, which is a systemic disease resulting from niacin (vitamin B3) deficiency. Vitamin B3 is needed for several metabolic processes, cell signaling and DNA repair. This condition is characterized by a photosensitive rash that typically affects sun-exposed areas. The classic skin changes include symptoms known as the 4Ds: dermatitis, diarrhea, dementia and death. The main causes of pellagra are: nutritional deficiency of niacin, restrictive diets, chronic alcoholism, gastrointestinal malabsorption, metabolic disorders and certain medications. We present the case of a 55-year-old farmer, with megaloblastic anemia and a seven-month history of skin changes, including erythematous lesions on sun-exposed areas such as the face, neck, bilaterally on forearms, dorsum of the hands and feet, along with itching and desquamation. Gastrointestinal symptoms included intermittent diarrhea, weight loss, neurological symptoms, and anxiety. Laboratory tests revealed anemia, hypoproteinemia, low levels of folic acid and serum iron. Skin biopsy results were consistent with pellagra, but did not exclude contact dermatitis. Treatment with niacin, folic acid, vitamin B12 and iron led to significant clinical improvement. Regular follow-up visits with hematology, gastroenterology, neurology specialists, and nutritional therapy were recommended. While pellagra is rare in modern clinical practice due to better nutrition, it still occurs sporadically. Diagnosis relies on the classic 4D features, laboratory findings and histopathological features. Despite its rarity, pellagra-like dermatitis should be considered in differential diagnoses for dermatological and gastrointestinal symptoms. Early diagnosis and treatment can result in significant improvement.

Not ‘Inactive’ After All: Cardiotoxic Mechanisms of Catecholamine Metabolism by Monoamine Oxidase

2025-06-10

Rachel M Crawford , Ethan J. Anderson | Cardiovascular Toxicology

Post-Traumatic Wernicke’s Aphasia: The Role of Magnetic Resonance Imaging in Diagnosis

2025-06-03

M. El Khalifa , M. Mekouar , Y. Bouktib +4 more | SAS Journal of Medicine

Wernicke’s aphasia is a fluent type of aphasia characterized by unintelligible speech and impaired auditory comprehension, typically resulting from damage to the posterior portion of the superior temporal gyrus in … Wernicke’s aphasia is a fluent type of aphasia characterized by unintelligible speech and impaired auditory comprehension, typically resulting from damage to the posterior portion of the superior temporal gyrus in the dominant hemisphere. We report the rare case of Wernicke’s aphasia following a traumatic brain injury, emphasizing the crucial role of magnetic resonance imaging (MRI) in establishing the topographic diagnosis.

Wernicke Encephalopathy in a Child With Acute Lymphoblastic Leukemia: A Case Report

2025-06-01

Ghazaleh Shakibamaram , Mohammadreza Dolikhani , Farideh Moussavi +3 more | Cancer Reports

Wernicke encephalopathy (WE) is a life-threatening neurological disorder caused by thiamine deficiency, commonly associated with alcoholism but also observed in malnourished pediatric cancer patients undergoing intensive chemotherapy. WE remains underdiagnosed … Wernicke encephalopathy (WE) is a life-threatening neurological disorder caused by thiamine deficiency, commonly associated with alcoholism but also observed in malnourished pediatric cancer patients undergoing intensive chemotherapy. WE remains underdiagnosed in children, with many cases only confirmed postmortem. We report a 6-year-old girl with acute lymphoblastic leukemia (ALL) who developed WE secondary to treatment-resistant nausea and vomiting. The patient presented with acute gait disturbance, ophthalmoparesis, and paraparesis following persistent vomiting and significant weight loss. Initial diagnostic evaluations, including cerebrospinal fluid analysis and neuroimaging, suggested alternative diagnoses such as cerebellitis and Guillain-Barré Syndrome. However, progressive neurological deterioration, the emergence of encephalopathy, and follow-up magnetic resonance imaging (MRI) findings of hyperintense lesions in the periventricular, periaqueductal, and cerebellar regions supported the diagnosis of WE. The overlapping features with other neurological conditions contributed to a delay in recognizing WE and initiating thiamine therapy. Despite initiating high-dose intravenous thiamine, symptom resolution was significant but partial. Unfortunately, the patient later developed lymphomatous meningitis and sepsis and ultimately succumbed to complications. This case highlights the importance of early clinical recognition of WE in pediatric leukemia patients with prolonged vomiting, as delayed diagnosis can lead to irreversible neurological damage or death. Given the limitations of early neuroimaging findings, clinical suspicion should prompt immediate thiamine supplementation. The report points out the need for heightened awareness of thiamine deficiency in pediatric oncology, emphasizing the role of prophylactic supplementation in high-risk patients.

Impact of Change of Length of Admission During COVID-19 for Inpatient Alcohol Detoxification on Relapse to Daily Alcohol Use With 1 Year: A Service Evaluation

2025-06-01

Aled Davies | BJPsych Open

Aims: We reviewed the impact of reducing length of admission during COVID-19 for planned inpatient medically assisted alcohol withdrawal (MAAW) on relapse to daily alcohol use within one year. We … Aims: We reviewed the impact of reducing length of admission during COVID-19 for planned inpatient medically assisted alcohol withdrawal (MAAW) on relapse to daily alcohol use within one year. We aimed to describe the demographic, social and medical characteristics of patients admitted for a planned MAAW, rate of relapse to alcohol use over time, and identify good aspects of care that improved outcomes. Methods: A retrospective cohort methodology was used using electronic health records. Patients included were identified as alcohol dependent, admitted for a planned inpatient MAAW to a specialist unit within Swansea Bay University Health Board between January 2019 and June 2023. Patients admitted from March 2020 to April 2022 were identified as the exposed group, and those admitted between January 2019 and February 2020 and May 2022 and June 2023 as the control group. Results: 311 admissions for MAAW were identified (125 in the exposed and 186 in the control group). Demographic and medical characteristics were evenly matched. Mean length of admission in the exposed and control group was 6 and 10 days respectively. 57.2% of admissions had relapsed to daily alcohol use by 52 weeks, comparable with existing research. Time-to-event analysis identified the median time to relapse as 22 weeks and 26 weeks in exposed and control groups respectively. Hazard ratio of 1.20 (95% confidence interval 0.89–1.61, p-value 0.22) was found in the risk of relapse in the exposed group compared with the control group, suggesting a 20% higher risk of relapse in the exposed group compared with the control by 52 weeks. However, this was not statistically significant. The hazard ratio for relapsing if discharged on relapse prevention medication (RPM) was 0.50 (95% CI 0.31–0.78, P-value 0.002), suggesting a 50% benefit to remaining abstinent at 52 weeks if discharged on RPM. Similarly, prescribing disulfiram after MAAW, had a hazard ratio of 0.39 (95% CI 0.26–0.58, P-value 0.000004), reducing the risk of relapse by 61%. Conclusion: We were able to characterise the demographic and medical background of patients receiving planned inpatient MAAW, which will help in future design and delivery of specialist MAAW units. No evidence was found to support a reduction in the length of admission for an inpatient MAAW. RPM significantly reduced the risk of relapse, especially the use of disulfiram. Several combinations of RPMs were prescribed, highlighting the need to standardise prescribing of RPMs post MAAW.

Prescribing for Substance Misuse: Alcohol Detoxification in Adult Mental Health Inpatient Services. The National Prescribing Observatory for Mental Health (POMH-UK) Quality Improvement Programme: 14c

2025-06-01

Fareeba Anwar , Haroon Siddiq , Roisin Nuttall | BJPsych Open

Aims: To help specialist mental health Trusts/healthcare organisations improve their prescribing practice. To assess the Trusts’ alcohol detoxification practices, benchmark against the national average performance and to compare results to … Aims: To help specialist mental health Trusts/healthcare organisations improve their prescribing practice. To assess the Trusts’ alcohol detoxification practices, benchmark against the national average performance and to compare results to the previous audit of 2016. This was the second re-audit in the cycle. Methods: The audit included any person (Male and Female) admitted to an acute adult or psychiatric intensive care ward, or a specialist inpatient drug or alcohol unit, who underwent alcohol detoxification (assisted alcohol withdrawal) whilst an inpatient. Patients identified via RiO, EPMA, Pharmacy Databases and Ward/Team caseloads. The final sample consisted of 80 patients, 20 patients from each of the 4 boroughs (Warrington, Halton, Kn owsley, Wigan). Data was collected in May 2021 via clinical audit days over Microsoft Teams, checked for quality twice by the audit leads and inputted by the Medicines Management Team in June 2021. Data was analysed by the national POMH team followed by the production of a national and trust level report. The findings of the audit were then presented at various forums. Results: Five POMH-UK Standards were chosen for the audit that were divided in 12 criteria to assess results against. In addition, three “targets” for assessing alcohol intake at admission and follow up following detoxification process were also selected for the audit. Four of twelve standard criteria (assessment of.iver function test and glucose tests, prescription for acute alcohol withdrawal and prescribing parenteral thiamine) and all the three targets (measurement of alcohol breath test at initial assessment, relapse prevention treatment and referral to specialist alcohol services for follow up) indicated less than 60% compliance with standards and a lower compliance than the national sample. For all targets, practices across the trust were variable. Conclusion: There is a need for developing guidance, detailing professional responsibilities and aligning procedures and documents across Mersey Care Foundation Trust to create a single standard method for alcohol detoxification. This includes developing a standard junior doctor admission checklist for both assessment and monitoring and raising the importance of assessment for alcohol detox at Junior doctor induction programme. It highlighted the need to consider alcohol breath test as part of the initial assessment at admission and including the required blood tests in routine admission blood investigations. The financial implications of this were also considered. The process emphasised the need for dissemination of results to all staff, focussing mainly on inpatient staff.

A Case of Prolonged Wernicke's Encephalopathy Successfully Treated With Long-Term High-Dose Thiamine

2025-06-01

Ryo Mizui , Ryohei Takada , Koki Ikuno +2 more | Cureus

Alcohol use disorder exacerbates clinical and vascular risks differentially in Psychiatric disorders

2025-06-01

Eva Christina Meyer , Younes Adam Tabi | Alcohol

Alcohol Use Disorder (AUD) is a major public health concern with detrimental effects on cognitive and neurological function, yet its impact on psychiatric populations remains incompletely defined. In this global … Alcohol Use Disorder (AUD) is a major public health concern with detrimental effects on cognitive and neurological function, yet its impact on psychiatric populations remains incompletely defined. In this global propensity score-matched cohort study, we examined the clinical and vascular consequences of comorbid alcohol abuse across diverse psychiatric disorders. Data from the TriNetX network, encompassing electronic medical records from 143 healthcare organizations, were analyzed. For each disorder-anxiety, depression, bipolar disorder, schizophrenia, reaction to severe stress, eating disorders, personality disorders, psychoactive substance dependence, developmental disorders, and obsessive-compulsive disorder-patients with alcohol abuse were matched 1:1 to those without, controlling for demographic and clinical factors. Over a 1,095-day follow-up, outcomes evaluated included emergency department visits, pain prevalence, mortality, and cerebrovascular events (transient ischemic attacks and strokes). Alcohol abuse was consistently associated with significantly higher emergency care utilization, increased somatic pain, and elevated mortality across all groups. For instance, anxiety and depression cohorts exhibited 8.1% and 7.3% higher emergency visits and increased mortality by 2.7% and 2.4%, respectively, while schizophrenia showed a twofold increase in stroke risk and markedly higher pain (risk ratio 2.21). These results underscore that AUD exacerbates clinical and vascular risks in psychiatric patients, highlighting the urgent need for targeted interventions.

ABS0953 THE RELATIONSHIP BETWEEN METABOLIC SYNDROME AND PAIN CATASTROPHIZING IN PATIENTS WITH PSORIATIC ARTHRITIS

2025-06-01

E. Corberi , Damiano Currado , Francesca Saracino +7 more | Annals of the Rheumatic Diseases

Alemtuzumab/Cyanocobalamin/lidocaine/pyridoxine/thiamine

2025-05-30

| Reactions Weekly

Valbenazine Improves Tardive Dyskinesia in Older Adults Over Long Term

2025-05-29

Linda M. Richmond | Psychiatric News

Clinical progress note: Phenobarbital in the treatment of alcohol withdrawal syndrome

2025-05-29

Thad E. Abrams , Matthew V. Ronan | Journal of Hospital Medicine

Abstract Alcohol withdrawal syndrome (AWS) is a common condition experienced by hospitalized patients. Practice patterns have evolved over time to include the use of phenobarbital, a barbiturate, as an adjunct … Abstract Alcohol withdrawal syndrome (AWS) is a common condition experienced by hospitalized patients. Practice patterns have evolved over time to include the use of phenobarbital, a barbiturate, as an adjunct to benzodiazepines or as an alternative monotherapy. The American Society of Addiction Medicine (ASAM) has recommended the use of phenobarbital in the management of AWS in certain clinical contexts. The current evidence base for the use of phenobarbital in AWS remains limited, though sufficient to demonstrate safety and efficacy as an alternative to benzodiazepines.

Evaluation of Symptom-Triggered Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in Trauma-Surgical Intensive Care Patients

2025-05-28

Taylor M. Law , Spencer Roper , Amanda McKinney +7 more | Annals of Pharmacotherapy

Background: The standard of care for alcohol withdrawal syndrome (AWS) is symptom-triggered benzodiazepines. There is an interest in utilizing phenobarbital first line for AWS in trauma-surgical patients. Objective: The objective … Background: The standard of care for alcohol withdrawal syndrome (AWS) is symptom-triggered benzodiazepines. There is an interest in utilizing phenobarbital first line for AWS in trauma-surgical patients. Objective: The objective of this study was to compare a preemptive phenobarbital monotherapy protocol to symptom-triggered benzodiazepines for the prevention or treatment of AWS in the trauma-surgical patients. Methods: This was a single-center, retrospective study to evaluate the AWS standard of care for the Trauma Surgical Critical Care Service. Patients were divided into groups based on AWS protocol. The primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes included: hospital mortality, hospital LOS, use of adjunctive agents for sedation, and incidence of mechanical ventilation rates. Results: A total of 514 patients were screened for eligibility, and 200 patients met inclusion criteria, with 100 patients being in each group. Patients who received the symptom-triggered benzodiazepine protocol had similar ICU LOS (median [IQR], 2.6 days [1.4-5.6 days] vs 2.9 days [1.8-4.7 days]; P = 0.4) and hospital LOS (8.1 days [3.9-16.9 days] vs 7.1 days [3.9-11.2 days]; P = 0.05) compared with the phenobarbital protocol. Hospital mortality was significantly lower in those who received phenobarbital (4% vs 14%; P = 0.02), as was use of adjunctive sedative agents (22% vs 46%; P < 0.001), and mechanical ventilation rates (9% vs 31%; P < 0.001) when compared with symptom-triggered benzodiazepines. Conclusion and Relevance: Trauma-surgical patients receiving phenobarbital for prevention or treatment of AWS had similar ICU and hospital LOS compared with symptom-triggered benzodiazepines. The use of a phenobarbital protocol was associated with lower mortality, mechanical ventilation, and adjunctive sedative medication use.