Alcoholic Korsakov psychosis: causes and consequences

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• History of Korsakov's psychosis
• Differences between the disease and others
• Causes of psychosis
• Signs and symptoms of Korsakov's psychosis
• Diagnosis of mental disorder
• Treatment of Korsakoff psychosis in alcoholism
• Prevention of Korsakov's psychosis

Alcoholism has become a rather serious problem of our time. Statistics show that the majority of people whose death occurred from external factors were under the influence of alcohol. In addition to the fact that it has a detrimental effect on physical health, excessive consumption can also lead to mental disorders. One of these is Korsakov psychosis.

Picture the picture. An intoxicated man, about 60 years old, is admitted to the hospital and is easily communicative, but what he states sounds quite strange. He is confused, does not understand how he got here and what they want from him, he cannot stay straight on his feet. He doesn’t refuse medical help, but he can’t explain much. Soon after hospitalization , it became clear that the old man did not remember the faces and names of the doctors or the location of his room at all. But he could talk with admiration and in detail about how yesterday he took part in the battle, and thanks to him the army won.

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The disease that the article will be about is important for many medical fields - neurology, neuropathology, psychology, etc.

History of Korsakov's psychosis

Korsakov's psychosis is a disease of chronic alcoholics, which is associated with damage and manifests itself as a mental disorder that occurs mainly in the third stage of alcoholism.

The disorder got its name from the name of the Russian psychiatrist who described it in 1877. Sergei Korsakov proved that alcoholism is a disease that needs to be fought. He found that this psychological condition is preceded by alcoholic encephalopathy. Initially, the doctor called it “polyneuretic psychosis,” since polyneuritis is the destruction of the peripheral nervous system.

Why does it appear

It is clear that the main cause of alcoholic psychosis is the consumption of strong alcoholic drinks for many years. This usually results from acute psychosis. It is often provoked by exacerbations of pathologies of the digestive system, such as the liver. The syndrome develops against the background of a lack of nicotinic acid in the body, as well as thiamine. Due to excess alcohol and poor nutrition, digestive problems occur, which results in problems with the brain, as mass death of its cells begins.

Causes of psychosis

The cause of Korsakov's alcoholic polyneuritic psychosis is not a prolonged binge, but its consequences, a gross deficiency of B vitamins, in particular thiamine (B1). Since alcohol destroys the intestinal mucosa, food cannot be properly digested and absorbed. This leads to a lack of essential vitamins. Acute Wernicke encephalopathy begins to develop. It is characterized by such obvious symptoms as delirium tremens and gait disturbance. If a chronic alcoholic does not receive timely and complete treatment for encephalopathy, then in 80% it will develop into Korsakov's psychosis.

There are other “non-alcoholic” causes of mental disorder:

• head injuries;
• previous brain surgery;
• infectious diseases;
• acute poisoning and intestinal dysfunction;
• failure to maintain proper nutrition;
• liver diseases, gastritis;
• stroke;
• tumors and hemorrhage in the brain;

Risks and forecasts

It is almost impossible to completely get rid of a disease such as Korsakoff syndrome, since brain damage is often irreversible. But with timely treatment, it is possible to stop the development of the disease, as well as significantly improve the patient’s condition.

Recently, the number of patients with Korsakoff's syndrome has decreased markedly, since thiamine is used in the treatment of alcoholism at all its stages. As a result, it is possible to prevent the development of vitamin B1 deficiency, which is the main cause of amnestic syndrome.

In addition to people leading an antisocial lifestyle and abusing alcohol, people who may be exposed to the following factors are also at risk:

• treatment of cancer using chemotherapy;
• dialysis;
• radical dietary restrictions caused by the desire to lose weight or religious beliefs;
• advanced age;
• genetic predisposition.

Since the disease is based on a certain pattern of behavior, for example, alcoholism or poor nutrition, Korsakoff's syndrome is highly preventable. First of all, it is necessary to limit the consumption of alcoholic beverages, as well as introduce foods containing B vitamins into the diet. The latter is important for all people, since thiamine is necessary for vital processes, but it is not synthesized in the body.

Signs and symptoms of Korsakov's psychosis

The first symptoms may appear several years before the clinical picture develops. The disease begins with aches and heaviness in the legs, unsteadiness is noticeable when walking, which is especially noticeable on the second day after drinking alcohol. At the beginning of the development of psychosis, it can be confused with delirium tremens, since the patient may behave inappropriately, not understand where he is and how he got here, behave aggressively, and may be haunted by hallucinations.

The main signs of Korsakoff psychosis are:

• amnesia. The patient has absolutely no memory of the events that happened to him during and before the attack. It is difficult for him to remember what he did and where he was. Memory can reproduce events that happened before the onset of the disease (childhood stories, for example), but then everything is in a fog. Amnesia can manifest itself so acutely that the patient becomes unteachable , forgets new faces, and even moving to a new place can be a huge trauma. Rearranging the furniture in his home can provoke confusion and panic.

1. amnestic disorientation. The person does not understand where he is and what he needs to do. The time frame is completely erased. There is no orientation in space.
2. memory impairments and disorders. May manifest themselves in different ways:

A person fills in the gaps in memory with the help of made-up stories and memories. The worst thing is that he himself completely believes in what he is talking about and does not pay attention to arguments to the contrary.

1. Invents a fantastic reality that surrounds him.
2. The patient confuses what is real and what was read or seen once. He may perceive an episode from a film as part of his life, confusing what he was going to do with what he had already done a long time ago.
3. Temporary confusion of events that happened to the patient. The past is presented as the present. They rearrange events in time without realizing it.

At the same time, patients can remain quite smart and understand the connection between different objects. They can captivate with their humor and be a pleasant conversationalist. However, upon closer acquaintance, another side of psychosis appears.

Signs of Korsakov's psychosis such as clouding of reason may appear, such as weakening of the intellect, selective memory, helplessness in everyday life, an obsessive feeling of fear, lethargy, or vice versa, a depressive state, loss of strength and others. These symptoms can occur simultaneously or alternate. Frequent mood swings are also characteristic, from complete apathy to joy and euphoria.

If all these signs are present, urgent hospitalization and treatment is necessary.

How to determine

Mostly, pathology is determined from the patient’s words. They are then supported by specialist examinations and research. The patient requires consultation with a psychiatrist who differentiates amnesia from other similar conditions, and a neurologist who will work on the situation with muscle atrophy. Diagnostic methods include MRI to determine the degree and presence of brain atrophy, EEG, CT and blood tests for biochemistry. A thorough diagnosis will make it possible to separate Korsakoff psychosis from similar pathologies, for example dementia.

Diagnosis of mental disorder

Diagnosing Korsakoff psychosis is quite simple, judging by the symptoms. It is better to examine such patients and discuss treatment tactics in the presence of relatives. When making a diagnosis, it is very important to exclude other causes of the disease. If the disease did not occur through alcohol addiction, then the treatment will be different.

To make a diagnosis, first of all, the patient must be completely examined, blood taken, and in addition to general tests, the thiamine level must be examined. It is also necessary to check the functioning of the liver (do an enzyme test), possible disturbances in coordination during movement, and the correct functioning of the brain. Specialists are required to conduct tests that can help determine memory disorders and the ability to process information, as well as determine the level of memorization of new information. Tests are carried out on the oldest area of ​​the brain - the limbic system. It is responsible for converting short-term memory into long-term memory. If during the tests damage to at least one part of the system was detected, then a diagnosis can be made.

Often, patients do not realize their disorder and, accordingly, do not seek help themselves. Therefore, it is very important to do all the necessary examinations and study the clinical picture in detail in order to prescribe the most effective treatment.

Diagnostic methods

A diagnosis such as Korsakoff syndrome can be made after detecting signs of vitamin B1 deficiency. A blood test and testing of basic liver functions can indicate a thiamine deficiency. In addition, a general examination of the patient is carried out. However, to make a clinical diagnosis, it is necessary to have a stable symptom - impaired memory function due to prolonged use of alcoholic beverages. Psychological tests for memorizing phrases or individual words help identify memory problems.

For treatment to be successful, it is important at the diagnostic stage to differentiate Korsakov's syndrome from other pathological processes in the nervous system, which can also be caused by alcoholism. It is also important to rule out other disorders that may cause memory problems that are not related to alcohol use. These include: dementia, organic brain damage, depressive disorders, etc.

Treatment of Korsakoff psychosis in alcoholism

No matter how sad it may sound, all mental disorders (including Korsakov’s) are difficult to treat, but significant improvement is possible.

Treatment of Korsakoff psychosis is aimed primarily at eliminating the causes of the disease. For this, the skills of doctors such as a psychiatrist, neurologist and narcologist are used.

First of all, in order to get a good therapeutic effect, you need to completely give up alcohol, and then carry out complete detoxification of the body. For this, salt solutions or glucose are often used.

The full treatment course consists of the following stages:

• giving up alcohol;
• removal of toxic substances from the body and introduction of the necessary vitamin complex, which necessarily contains thiamine. Vitamins help eliminate the symptoms of polyneuritis;
• the use of antipsychotics to suppress the development of a mental disorder;
• administration of antidepressants to reduce anxiety;
• administration of drugs that stimulate brain function;
• prescribing a special protein diet;
• mandatory psychological sessions aimed at returning to normal life;
• engage in physical activity, massage to restore muscle tone and eliminate paralysis.

Various techniques are used to improve and restore memory. For better memorization, patients often use notepads. There they record everything that happens to them. It is very important to eliminate the apathetic state that a person learns to take care of his appearance and perform hygiene procedures.

The success of treatment depends on the complexity of the situation and the wishes of the patient and can last for decades. Often all efforts are wasted because the patient returns to drinking strong drinks. In such cases, a person’s dementia and even death are quite possible.

Young patients who are ready to completely give up alcohol consumption for the sake of recovery have a greater chance of full recovery.

Fortunately, in our time, polyneuritic psychosis is and can be eliminated even in the initial stages with the help of B vitamins.

Treatment and prevention

Treating Korsakoff syndrome is quite difficult. The success of therapy will depend on many factors, including:

• degree of social adaptation of the patient;
• his age;
• health status;
• duration of alcohol consumption;
• degree of brain damage.

The main problem is that a person who begins to develop Korsakoff's syndrome does not realize it. Memory lapses can also remain invisible to others, since the patient masks them with long statements and florid thoughts. Even after diagnosis, patients often refuse treatment, considering themselves completely healthy people.

Treatment carried out after diagnosis is aimed at eliminating the cause that caused it. If memory defects are the result of alcoholism, then the basis of therapy is drugs containing thiamine and other trace elements that can minimize brain damage.

Nootropic drugs can significantly improve memory, increase the patient’s attentiveness and learning ability. If anxiety and increased excitability are present, the patient may be prescribed antipsychotic drugs in small doses.

Prevention of Korsakov's psychosis

It is much easier to prevent any disease than to cure it. The most important thing is to lead a healthy lifestyle that excludes the use, and most importantly, the abuse of alcohol.

essential into your diet . It doesn’t hurt to undergo regular medical examinations in order to promptly identify and prevent the development of various diseases.

It is very important to seek medical help in a timely manner, and even better not to abuse alcohol.

Symptoms of the syndrome

The main symptoms of Korsakoff's syndrome:

1. Fixation amnesia is the inability to remember current events. Patients forget who they saw a few minutes ago, what they said, read or heard. They can say hello to the same people several times, repeat questions over and over again, or read one page from a book for several days. Verbal memory deteriorates the most, figurative memory deteriorates less, and emotional memory suffers virtually no damage. For example, when finding yourself in a situation in which an unpleasant incident occurred, a person becomes angry, but cannot explain what this is connected with. Along with fixation amnesia, memory for events that happened in the past is preserved.
2. disorientation in time and space. Patients cannot name today's date, and in some cases they cannot identify the time of year. In addition, many patients are disoriented in their surroundings: they do not remember the location of the rooms in their apartment.
3. false memories (paramnesia). Manifests itself in such forms as:

• pseudo-reminiscences – replacement of present events with past ones;
• confabulation - adding fictitious elements to real memories;
• cryptomnesia (rarely observed) - the perception of information read, heard or seen as experienced.

Other signs of psychosis:

• intellectual impairments, which are expressed in stereotyping and monotony of actions, as well as the inability to adequately evaluate one’s judgments;
• decrease in the level of volitional activity.

The symptoms of the disease have some features depending on the age of the patient:

• Children rarely have attacks of paramnesia;
• middle-aged people often arrive in a state of euphoria;
• elderly patients become apathetic and lose track of time.

Forecast

The prognosis of Korsakoff syndrome is considered favorable and quickly curable if the disease began to develop as a result of trauma to the brain, skull, or subarachnoid hemorrhage. The worst thing for the patient is if the disease begins its active development after a heart attack or during a lack of thiamine in the body. In this case, the victims require hospital treatment.

Attention! Even with proper adherence to the treatment regimen, only 20% of patients are completely cured of Korsakoff syndrome. The treatment will have a positive effect on the health of patients after 12-24 months, during which the treatment should proceed in full. First, the therapy will take place in a hospital, after which the person will need to take medications at home, as well as visit sanatoriums every six months.