Poisoning the Mind

Question 1

What types of psychological harm can result from regular heavy drinking?

Answer 1

Insomnia, depression, anxiety, attempted suicide, changes in personality, amnestic syndrome, dementia, delirium tremens, alcohol hallucinosis

Question 2

Long-term heavy alcohol use can result in problems with memory, visuospatial skills and language. T/F?

Answer 2

False - this causes problems with visuospatial skills, memory, learning and planning but not with IQ and language

Question 3

What conditions are included in the umbrella term ‘alcohol related brain damage’?

Answer 3

Neuropathies
Cerebellar degeneration
Dementia
Wernicke-Korsakoff syndrome

Question 4

What neurotoxic factors affect predisposition to alcohol induced brain damage?

Answer 4

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

Question 5

Deficiencies of which vitamins are significant in the development of alcohol induced brain damage?

Answer 5

Vitamin B1

Thiamine

Question 6

How much thiamine is required in the diet each day?

Answer 6

1-2 mg

Question 7

There are only small body stores of thiamine. In which organ is a large proportion of thiamine stored?

Answer 7

Liver

Question 8

In Wernicke-Korsakoff syndrome there is particular shrinkage of which brain structure related to memory function?

Answer 8

Mamillary bodies

Question 9

Korsakoff’s amnesic syndrome is always preceded by Wernicke’s encephalopathy. T/F?

Answer 9

False

Question 10

What are the symptoms of Wernicke-Korsakoff syndrome?

Answer 10

Confusion
Eye symptoms (gaze paralysis, nystagmus)
Gait ataxia

Question 11

What is agnosia?

Answer 11

Inability to process sensory information often resulting in inability to recognise objects/people

Question 12

What is apraxia?

Answer 12

Inability to plan motor functions despite understanding what is being asked and having the physical ability to do so

Question 13

Encephalopathy indicates liver failure and should prompt consideration of…?

Answer 13

Liver transplantation

Question 14

What are the differential diagnoses of hepatic encephalopathy?

Answer 14

Metabolic encephalopathies
Drugs
Intracranial structure disorders
Infection
Seizures
Wernicke's encephalopathy
Head injury

Question 15

What factors can precipitate hepatic encephalopathy?

Answer 15

Increased protein load
Decreased excretion of ammonia
Electrolyte disturbances
Dehydration
Infection
Paracentesis
Superimposed liver injury

Question 16

How is hepatic encephalopathy treated?

Answer 16

Lactulose and dietary measures to decreased nitrogen load
Removal of precipitants
General supportive measures
Reduction or closure of shunts

Question 17

How does age affect alcohol metabolism?

Answer 17

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

Question 18

What factors affect the prognosis of alcohol related brain damage?

Answer 18

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

Question 19

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?

Answer 19

Helps to metabolise lipids and carbohydrates

Maintains normal levels of amino acids and neurotrasmitters

Question 20

How does alcohol decrease thiamine levels?

Answer 20

Interferes. with conversion to active form
Prevents absorption of thiamine from the small intestine
Steatosis prevents storage of thiamine in the liver

Question 21

What are the characteristic symptoms of Wernicke’s encephalopathy?

Answer 21

Weakness/paralysis of the eye muscles (opthalmoplegia)
ataxia
confusion
apathy
difficulty concentrating

Question 22

What are the characteristic symptoms of Korsakoff’s syndrome?

Answer 22

Anterograde amnesia
Retrograde amnesia
confabulation