Heavy drinkers often eat poorly, and the metabolism of alcohol depletes the body’s stores of ‘B’ vitamins. This can lead to a severe deficiency of vitamin B1 (thiamine), causing Wernicke-Korsakoff Syndrome. In the Wernicke’s phase of this syndrome, patients become drowsy and unresponsive, and their walking and eye movements become uncoordinated. Wernicke’s is a medical emergency, requiring prompt administration of intravenous thiamine. If not treated in time, patients develop Korsakoff’s, exhibiting marked impairment of short term memory. Patients with Korsakoff’s may not remember an event that occurred ten minutes earlier; to mask their confusion and make sense of their lives, they sometimes fabricate events (‘confabulation’). Patients with Korsakoff’s rarely recover, and frequently require long term care.

Organic psychiatric syndromes with specific psychological dysfunctions.

Korsakoff syndrome - Psychological impairment is partial rather than general; that is, a limited number of specific functions are effected, such as memory, thinking, perception, or mood. Affective syndromes occur, depressive disorders being more common than mania. Schizophrenia-like syndrome can arise in association with brain disease. Personality disorder is another highly important complication.

In some conditions, but not all, focal lesions in the brain are demonstrable.

Course and Prognosis

Victor et al. (1971) studied 245 patients who had developed an acute Wernicke-Korsakoff syndrome, most of whom had histories of many years of alcohol abuse. There was a 17 per cent death rate in the acute stage. All except 4 per cent of cases presented with Wernicke's encephalopathy. Eighty four per cent of those who were followed up developed a typical amnestic syndrome. Once established there was no improvement in a half complete recovery in a quarter, and partial recovery in the rest. The best predictors of a better prognosis are a short history before diagnosis, and little delay between diagnosis and the start of a replacement treatment in cases due to thiamine deficiency.

Rarely an improvement occurs in cases due to causes other than alcoholism; for example, carbon monoxide poisoning or thiamine deficiency due to simple malnutrition. Sometimes the amnesia is progressive, as in cases with slowly expanding brain tumours.