ALCOHOL & WERNICKE-KORSAKOFF SYNDROME | BRAIN DISORDER caused by Thiamine (Vitamin B1) Deficiency |

DR SANIL REGE, CONSULTANT PSYCHIATRIST explains Wernicke-Korsakoff syndrome (WKS).
#alcohol #wernickekorsakoff #alcoholdementia #thiamine
Wernicke-Korsakoff syndrome (WKS) is a type of brain disorder caused by a lack of vitamin B-1, or thiamine.
The syndrome is actually two separate conditions that can occur at the same time, Wernicke’s disease (WD) and Korsakoff syndrome.
Usually, people get the symptoms of WD first and WD is also known as Wernicke’s encephalopathy.
The most common cause of WKS is alcoholism.
Other causes are:
Malnutrition
Renal dialysis
Chemotherapy
Prominent symptoms of WD are:
1. Double vision
2. Drooping upper eyelid, also known as ptosis
3. Up-and-down or side-to-side eye movements (nystagmus)
4. Loss of muscle coordination, or ataxia, which may interfere with walking
a confused mental state
With Korsakoff's dementia/ psychosis the following symptoms can occur
1. Amnesia for events that happen after the onset of the disorder
2. Difficulty understanding the meaning of information
3. Difficulty putting words into context
4. Hallucinations
5. Exaggerated storytelling, or confabulation
The treatment for WKS may include:
1. Vitamin B-1 given through an intravenous line (IV) in the arm or hand
2. Vitamin B-1 given by mouth
3. A balanced diet to keep vitamin B-1 levels up
4. Treating excess alcohol use
You can prevent WKS by avoiding alcohol and eating a balanced diet rich in vitamin B-1.
Foods rich in vitamin B-1 include:
lean pork
rice
peas
whole wheat bread
spinach
oranges
milk
Credits :
Dr House House M.D. - Histories (NBC Universal, NBCUniversal_International)
UCD medicine Neurology - Topic 31 - Nystagmus - • Neurology - Topic 31 -...

[@jamesharmer9293]

Interesting to see this pop up on youtube. I had Wernicke encephalopathy many years ago due to alcoholism. I went all cross eyed and then started hallucinating. Very luckily it was spotted as I was wheeled into rehab. I was unconscious for two weeks. Haven't had a drink since.

[@PsychiatrySimplified]

Wow. Thanks for sharing.

[@britneysharp2889]

Did you or anyone notice anything unusual beforehand? Such as paranoia or mild hallucinations? How impaired was your memory and speech? My dad is in the hospital with it right now and it’s going on 3 weeks. They said wernickes but then changed it to Korsakoff 2 weeks later. Took that back 3 days later because he was talking (but confused) all of a sudden and bc “thiamine was elevated” and then came back 5 days after that saying korsakoff psychosis. Not sure how it’s not Korsakoff and then all of a sudden it is again. Very concerned over here. They had him in restraints for 19 days before we got in town and threw a fit

[@jamesharmer9293]

@@britneysharp2889 There were no symptoms that I noticed beforehand. Afterwards, my short term memory was shot and took several years to get back to normal for my age. Physically, I made a full recovery in about a year. This was all eighteen years ago. I was very lucky to make a full recovery. These days I can pass for normal.

[@cincin4515]

I've been taking a thiamine supplement after quitting long term alcohol abuse. My digestion isn't great as I'm in my 60's with lifelong digestive disorders so thanks for the heads up on dosage. You certainly convinced me to stay off the grog and get back to the healthier eating. Thanks.

[@BoredT-Rex]

Another note...alcoholics often have poor diets, and alcohol impairs intestinal absorption of nutrients thus leading to wks

[@PsychiatrySimplified]

Yes correct !

[@saraheweaver1825]

I know this isn't therapy class but seeing this has helped more than I can describe. I have had acute pancreatitis twice and after a year I became an occasional drinker then it got bad again. So I had to detox AGAIN. I had the full everything, horribly scary audible and visual hallucinations, the shakes, non stop puking 6 days only alcohol staying down before I knew I needed to tell my family I needed help. I do research to keep me sober and came across this. Why after all I've been through it's still hard not to go back I don't know, but I know it's a dead end and this added a whole new level of HELL NO. Thank you for posting!!! Addiction has absolutely destroyed everything I worked so hard for but each day I feel my brain coming back to life. It's only been a few months but I was worried it wouldn't ever start to function again.

[@PsychiatrySimplified]

Thank you for your feedback and sharing your experience. Wish you well

[@matthewgrimm5383]

The ugly truth is alcoholics and drug users dont get the the same care as others. They look at it like hey you did this to yourself

[@mrdave777]

It’s similar with transplants. And you know what? I agree with caregivers and this attitude. And I’m recovering!!!

[@benmoxham628]

True but alkies and addicts don't tend to take care of themselves either

[@kyliebeechall3984]

I wish I knew then what I know now :( . I’ve just lost my mum to this illness. Unfortunately she didn’t have the triad of symptoms and when I mentioned she was a drinker because her liver was tested and was in great nick it got overlooked as an eating disorder. My mum walked into hospital in may and came out July 3 months later completely bed bound, couldn’t use her hands or legs, couldn’t eat or drink so needed a PEG fitted. She also had the hallucinations and confabulation… only then was she diagnosed.. it was too late! She just passed on the 10th December and am still reeling. What I really wish though was that there would have been information to say how it progressed at the end… nothing could have prepared me for what I had to go through in the end

[@PsychiatrySimplified]

I’m so sorry to hear. Thank you for sharing your experience . Hoping it can help others pick up this condition earlier . Wish you well. Take care

[@tendresexton4957]

My sister has been diagnosed with schizophrenia. I don't know why doctors didn't think of treating her for this she drinks heavy. I'm just realizing after 8 years this could be what she is dealing with. It's horrible. What should I do at this point? She tells stories that are not true piecing them together. She thinks 7 years ago was yesterday. She's only 39.

[@PsychiatrySimplified]

@@tendresexton4957 So sorry to hear. Not advice - in general . Consider a neuropsychiatric assessment as a detailed cognitive assessment may be needed . the treating team would be able to advise. Wish your sister well.

[@darkblue1423]

absolutely appreciated the way you approached the topic and implemented parts of Dr. House in this video! PERFECT 💎

[@PsychiatrySimplified]

Thank you for the feedback 🙏🏼

[@skumbananish]

This is very interesting, thank you! I’ve always believed myself to be a bit of a hypochondriac growing up- and of course, this came to mind whenever I had a drink (or two..), especially since I didn’t seem to remember some things afterwards.. This year, my sister and I, got asked by random physicians (for different issues) if we didn’t have ADHD. Ironically- this is how we found your channel! I’m a 25 year old psychology student, she is 32 and working as a therapist, and we both love your content :) (so, there’s not only medical students here watching 😄) Warm regards from Sweden/Poland!

[@PsychiatrySimplified]

Ha ha! 😁 Thank you so much for your feedback! Really appreciate it. Interestingly in my early days I was planning to go to Sweden 🇸🇪 after med school. Went to England instead. Tack så mycket / Dziękuję

[@ingeturns]

Thank you so much for such thorough explanation . I so enjoy and appreciate your very pleasant manner. Thank you.

[@PsychiatrySimplified]

Thanks for your feedback. 🙏🏼

[@muktarahimad2805]

Amazing lession

[@PsychiatrySimplified]

Thank you for your feedback. 🙏🏼

[@chamikaishara3778]

Was super useful...❤ from Sri Lanka

[@PsychiatrySimplified]

Thanks for your feedback 🙏🏼

[@michaelduffy7633]

Hi tx for the content your videos are very informative. Just wondering why you never mentioned Pabrinex treatment?

[@PsychiatrySimplified]

Yes pabrinex is an option ( contains Pabrinex Intravenous High Potency contains vitamins B1, B2, B6, nicotinamide, vitamin C and glucose.). In this video wanted to highlight the specific dose of thiamine. pabrinex comes as two ampoules - first one contains Thiamine. But you are correct Pabrinex can be administered : 2 to 3 pairs of 5 ml ampoules (1 pair = ampoule 1 + ampoule 2) diluted with 50 ml to 100 ml infusion solution (physiological saline or glucose 5%) and administered over 30 minutes every 8 hours, or at the discretion of the physician.

[@rebekkad.2092]

My husband had heart valve surgery and was never quite the same afterwards. Then it started getting worse. He had some seizures (2) and they put him on meds that actually things much worse. I figured out that it was this but not until quite a bit of time passed. No doctor would have ever figured this out because all they want to do is give you medications to treat symptoms and most of the time they aren't very good at figuring out the root cause. Anyway - he's on benfotiamine as well as over the counter b1 (water soluble) and it is making a difference. Thanks for this.

[@mfranck1]

Well did he tell the doctors that he is a severe alcoholic?

[@DOGOID]

Nutritional yeast is a good source of B1. How bioavailable are the common B1 supps like thiamine hydrochloride and mononitrate? the other analolgues like Subultiamine are expensive.

[@jane178]

Treating a B1- Thiamine Deficiency due to Alcohol Misuse Syndrome and malnutrition with a handful of pharmaceuticals, including medicine for lowering blood pressure is like treating Scurvy, a Vitamin C Deficiency with Antibiotics. In addition to that, giving an alcoholic low blood pressure medicine can be a lethal combination.

[@kfstreich4787]

If house is right I now understand my parents

[@sidka84]

Dr also benzodiazepines and z-drugs vs barbiturates (+ghb,meprobamate,methaqualone, glutethimide) in general would be interesting👍🙂just like your video mph vs amp

[@PsychiatrySimplified]

Great suggestion!

[@sidka84]

@@PsychiatrySimplified Maybe somewhat stupid in some way talking about drugs like those,but You r able to explain it good Dr Rege, I forgot to mention carisoprodol (Soma was brand name) ,it belongs there also ,i like your video mph vs amph-there was even a person in comments section,probably from U.S,,who said he used to take Desoxyn for adult add in high dose,maybe would be interesting comparing d-amphetamine vs methamphetamine aswell.. Even comapring hypnotics would be interisting,zolpidem/zopiclone vs benzo types flunitrazepam,triazolam,nitrazepam,temazepam etc vs secobarbital vs methaqualone.

[@PsychiatrySimplified]

@@sidka84 Really good suggestions. Now to find the time (:

[@vonaldautterback8831]

Just confirming - I understand that just giving Thiamine(or eating food) orally will not suffice/will not be well absorbed, since absorption is part of the issue here. And if someone has AUD plus very low Thiamine levels, IV therapy with Thiamine should be given vs. depending on an oral supplement. Correct?

[@PsychiatrySimplified]

Yes that's correct in case of severe AUD and thiamine deficiency.

[@vonaldautterback8831]

@@PsychiatrySimplified Thank you for confirming. My son's doctor simply said to go supplement with thiamine and Folic acid and I'm guessing this may be a typical recommendation without even checking levels or any indication that absorption is an issue for someone with AUD! Also thiamine levels from a typical blood draw are notoriously inaccurate. To get accurate levels, you need transketolase testing. It may not be easy to find a lab to do this whole blood (the blood is frozen and sent in for testing) test, but if you want accuracy, it's what is needed. I'm checking to see if LabCorp offers this test and we will get it done on our own since his insurance will not cover it. If you could also address these issues in another video, that could be very helpful!

[@brasshound4442]

I went 15 years with a Thiamine Deficiency I just recently discovered after many doctors had no answers. My symptoms got so severe I was wishing to not wake up each night. I couldn't remember anything long term and my short term memory was starting to get bad, the pain throughout my body was severe, and I felt like my heart was having issues. I'm now taking Allithiamine in high doses and I get instant relief each dose but my symptoms return if I miss doses. My doctor's are of no help I really would like to have someone guide me through this process, right now I've acted on my own heavy research.

[@PsychiatrySimplified]

Sorry to hear. Was this linked to alcohol or any other risk factors ?

[@brasshound4442]

@@PsychiatrySimplified I don't drink so I am unsure. Is it possible to be hereditary?

[@PsychiatrySimplified]

@@brasshound4442 there are genetic metabolism conditions - but other aspects of absorption, surgery etc which covered in video . Currently, four genetic defects have been described causing impairment of thiamine transport and metabolism: SLC19A2 dysfunction leads to diabetes mellitus, megaloblastic anemia and sensory-neural hearing loss, whereas SLC19A3, SLC25A19, and TPK1-related disorders result in recurrent encephalopathy.

[@brasshound4442]

@@PsychiatrySimplified Thank you for the responses. I have been scheduled for CT scan due to my symptoms also being in line with pancreatic cancer. I get relief with B1 so I'm not sure what to think now, do the symptoms mimic each other? Either way I appreciate your content and responses have a blessed day.

[@PsychiatrySimplified]

@@brasshound4442 wish you well. A thorough medical evaluation is a good thing.

[@rubyred621]

How soon should you recheck a thiamine level? Is there evidence or need for a maintenance dose? Would it help someone outpatient who won’t stop drinking alcohol in excess? How do you manage symptoms with Korsakoffs in terms of vitamin repletion, or would that even help and you’d be managing dementia instead? Thanks!

[@PsychiatrySimplified]

Recheck after what do you mean? If alcohol use is significant then supplementation is recommended. I've covered high dose thiamine administration required in early stages of Korsakoff’s but if late it may not be reversible and yes it is like managing dementia.

[@rubyred621]

Wow thanks for the quick response. I’m referring to rechecking the level after how many days of repletion, or is it that it takes the 2-3 days of IV Thiamine for mental status to return to baseline and safe to say adequately treated? I work in nursing homes and when I was working as a RN (USA) I had a patient with advanced wernickes, dysphagia, very bad dementia. He was only about 60 when he passed. I also had a friend in his 30s (bipolar diagnosis) who recently took his own life was a heavy drinker and was questionably delusional at times saying his dad beat him which wasn’t true according to everyone…and for our own curiosity and closure wondering if he could have had some advancement of Korsakoffs. Is there a particular antipsychotic or mood stabilizer that works well with managing irreversible damage from Korsakoffs? Thanks so much.

[@randallhesse5011]

When I was young, I used to wonder, what is this beri beri I hear about , from cartoons ( commander McBrag) Bullwinkle, etc) I never knew until recently. But, I can't quite remember, Does dry beri-beri precede wet beri-beri?

[@PsychiatrySimplified]

Wow that takes me down memory lane. Both can coexist and one can occur before the other from my understanding as dry - neurological / wet - CVS. Possibly wet after as may take more for CVS to be involved.

[@DrGearHeadSS]

How long does someone have to be deficient in their diet before these signs start to show? If they begin to supplement with 100mg daily, would that keep them safe or should they ask their Doctor for a blood test?

[@PsychiatrySimplified]

Good question. It takes 18 days for thiamine stores to be depleted and 3 weeks for thiamine levels to start falling. Supplementation of thiamine should be discussed with the doctor as it is required if risk factors are present. Thiamine is obtained from a good diet. But if risk factors are present as discussed in the video then supplementation may be necessary. Pa not medical advice

[@andyg9203]

My friend has just been diagnosed with this , drinking everyday from waking to sleep and only eating a few times a week , took 2 years , onset of seizures , had to be shocked resuscitated 4 times , then placed on life support, five months has passed now and she is still in hospital, the damage to her brain has affected her short term memory & speech , she can read at a basic level but is unable to write. Also in intensive care tests discovered her liver was failing and the placed a Do not resuscitate order on her , meaning if she went into cardiac arrest they wouldn't of brought her back , thankfully her liver although damaged is now stable , removing the DNR She is only 45 , was drinking half a large bottle of spirits a day Writing this on the bus on they way home from seeing her on a hospital visit, Sure puts life into perspective 👍

[@acts837kjv4]

Interesting as the actor doctor tells the acting nurse to give her thiamine, and then he says give her cake and ice cream which will deplete the thiamine he just prescribed as carbohydrates deplete thiamine. I wonder if this was done on purpose or if it was just bad advice.

[@StarHarvestOfficial]

Can Benfotiamine do a better job? I can't get access to injections where I am and I have to buy orally.

[@okidoki3201]

TTFD (Allithiamine) is the best absorption, Benfotiamine usually best for peripherial nerves.

[@Destroyer28911]

Do fortified cereals help at all?

[@PsychiatrySimplified]

It really depends. Fortification is for population level primary prevention. For individuals at risk or with actual deficiency this is unlikely to suffice as treatment is needed .

[@bartbarrett4867]

my friend is in the hospital with it now. will she ever be the same?

[@PsychiatrySimplified]

So sorry to hear. We hope things go well.

[@mr.sessle8444]

yea the doctors gave me gabapatin that killed me during covid while my gallbladder was exploding . I also have an eating disorder everyone laughs at and refusing to listen to me about. so yea thats cool I dont do much for humans any who

[@lispendens]

Not to be a jerk or anything but can't this simply be prevented by taking a multi-B-vitamin capsule everyday? Even as a drinker?

[@PsychiatrySimplified]

Yea it can but also depends on severity. In severe cases oral thiamine won’t be absorbed due to gastritis or gastric mucosa changes

[@lispendens]

@@PsychiatrySimplified Thanks for the response, much respect and love, always like your videos!'

[@Ireland1981]

My brother had this condition about 7 years ago. He could not walk and did not recognize anyone, was seeing people in the room that were not there and had to be kept in an adult highchair which he thought was a car. He was given intervious Thiamine and slowly recovered but his short term memory is not great. He quit drinking for a short period after leaving the hosital but he is back drinking daily for the pass 6 and a half years. Is it likely that he will develop encephalopathy again?

[@PsychiatrySimplified]

Alcohol related brain involvement can be due to a range of reasons. Thiamine is one element that can be supplemented. However it can also result in Vit b12 deficiency ; liver related encephalopathy , nutritional deficiencies and vascular brain involvement. Hope he gets the treatment.

[@PalebloodOrphan]

This disease took my mom a month ago.

[@PsychiatrySimplified]

So sorry to hear . Sorry for your loss. Take care .

[@kimberlysimpson8766]

Iam so sorry to hear this & my heart goes to you ❤️❤️ I got placed on hospice due to Korsaoff brain disease non alcoholic at 42 years old so I feel your pain 💔💔 may I ask what caused your mother's?

[@PalebloodOrphan]

@@kimberlysimpson8766 She got really depressed and just drank herself into a spiral. We didn't notice until it was too late. She was 53

[@kcrehkopf]

I am so sorry to hear that. You are not alone.

[@danielsan3681]

Will B1 TTFD be the best form of thiamine for this?

[@PsychiatrySimplified]

B1 yes - best to discuss this with the pharmacist if using as a supplement. For acute treatment - it needs to be given IV / IM. But as prevention or supplementation - the pharmacist will able to advise the different options

[@danielsan3681]

@@PsychiatrySimplified Thank you. 🙏

[@Smitty19966]

In other words if you eat shit vitamin deficient food and a lot of alcohol. This could happen. So drink less eat healthier.