Poisoning the Mind Flashcards
What types of psychological harm can result from regular heavy drinking?
Insomnia, depression, anxiety, attempted suicide, changes in personality, amnestic syndrome, dementia, delirium tremens, alcohol hallucinosis
Long-term heavy alcohol use can result in problems with memory, visuospatial skills and language. T/F?
False - this causes problems with visuospatial skills, memory, learning and planning but not with IQ and language
What conditions are included in the umbrella term ‘alcohol related brain damage’?
Neuropathies
Cerebellar degeneration
Dementia
Wernicke-Korsakoff syndrome
What neurotoxic factors affect predisposition to alcohol induced brain damage?
Genetic predisposition Quantity and frequency of alcohol use Severity of alcohol dependence Frequent episodes of acute intoxication Withdrawal syndromes Other drug use Concurrent liver damage
Deficiencies of which vitamins are significant in the development of alcohol induced brain damage?
Vitamin B1
Thiamine
How much thiamine is required in the diet each day?
1-2 mg
There are only small body stores of thiamine. In which organ is a large proportion of thiamine stored?
Liver
In Wernicke-Korsakoff syndrome there is particular shrinkage of which brain structure related to memory function?
Mamillary bodies
Korsakoff’s amnesic syndrome is always preceded by Wernicke’s encephalopathy. T/F?
False
What are the symptoms of Wernicke-Korsakoff syndrome?
Confusion
Eye symptoms (gaze paralysis, nystagmus)
Gait ataxia
What is agnosia?
Inability to process sensory information often resulting in inability to recognise objects/people
What is apraxia?
Inability to plan motor functions despite understanding what is being asked and having the physical ability to do so
Encephalopathy indicates liver failure and should prompt consideration of…?
Liver transplantation
What are the differential diagnoses of hepatic encephalopathy?
Metabolic encephalopathies Drugs Intracranial structure disorders Infection Seizures Wernicke's encephalopathy Head injury
What factors can precipitate hepatic encephalopathy?
Increased protein load Decreased excretion of ammonia Electrolyte disturbances Dehydration Infection Paracentesis Superimposed liver injury
How is hepatic encephalopathy treated?
Lactulose and dietary measures to decreased nitrogen load
Removal of precipitants
General supportive measures
Reduction or closure of shunts
How does age affect alcohol metabolism?
Decreased liver oxidation of alcohol
increased sensitivity to alcohol by the brain
decreased lean body mass and total body water causing an increase in blood alcohol concentration
What factors affect the prognosis of alcohol related brain damage?
Poorer in sudden onset than insidious onset cases
Better with more global cognitive impairment than in purer amnestic syndrome
Improvement if abstinence from alcohol maintained
Thiamine is important in glucose metabolism, which is particularly important for the brain as it is dependent on glucose. What are the other functions of thiamine with regards to. the. brain?
Helps to metabolise lipids and carbohydrates
Maintains normal levels of amino acids and neurotrasmitters
How does alcohol decrease thiamine levels?
Interferes. with conversion to active form
Prevents absorption of thiamine from the small intestine
Steatosis prevents storage of thiamine in the liver
What are the characteristic symptoms of Wernicke’s encephalopathy?
Weakness/paralysis of the eye muscles (opthalmoplegia) ataxia confusion apathy difficulty concentrating
What are the characteristic symptoms of Korsakoff’s syndrome?
Anterograde amnesia
Retrograde amnesia
confabulation
