Korsakov's syndrome in alcoholism or metamorphosis of the alcoholic's memory

General information about Korsakoff psychosis

Psychosis should not be confused with Korsakoff's syndrome. In the first case, the disease implies an alcoholic etiology (origin), while the development of the syndrome can be caused by other reasons not related to abuse , for example: traumatic brain injury, infection, hypoxia, tumors, various dementias.
Alcoholic Korsakov psychosis, as a mental disorder caused by prolonged exposure to alcohol on the human brain with mnestic disorders, as well as positive and negative symptoms, was first described by the Russian psychiatrist S. S. Korsakov in 1887. The disease occurs in a chronic form, observed in approximately 5% of those suffering from alcoholism.
As a rule, it affects elderly people, less often middle-aged people. In most cases, the disease is accompanied by other pathologies caused by prolonged alcohol consumption (liver cirrhosis, cardiovascular diseases, dysfunction of the digestive system).

Withdrawal syndrome :: Symptoms, causes, treatment and code according to ICD-10

We consider alcohol addiction as a bad habit.

From a medical point of view, it is a mental disorder caused by alcohol abuse. Let us consider in more detail what the symptoms of the condition are, the causes and whether it is possible to cure the person.

Unfortunately, the number of people suffering from addiction to alcohol, drugs, and smoking is growing exponentially. There are many factors that provoke a person to abuse, but the main ones are considered to be:

• heredity;
• stress;
• mental and physical overload;
• low level of comfort;
• social inequality, etc.

How does alcoholism develop?

It's no secret that addiction to bad habits begins with the first puff, drink, or injection. Alcohol can relax a person, push accumulated problems and stress into the background, and alleviate an acute state of depression.

Moreover, many drink in order to dispel tension during communication, to find a common language with colleagues, in a large company.

What is noteworthy is that the majority understands that the habit can be addictive, but everyone is confident that it is possible to cope with addiction without any problems. Unfortunately, only very strong-willed people can be saved, but with strong addiction, a person’s psyche is disturbed, which weakens his abilities.

What is chronic ethicism

There are sites on the Internet that provide questions. By answering them, everyone will be able to accurately determine whether he is addicted to alcoholic beverages or not. According to the international classification of diseases, the disease not only has causes, but also describes the consequences, complications, and what pathologies may appear in the human body.

So, let's start with the material itself - ethyl alcohol, which can destroy the life of not only an addicted person, but also those around him. The word "alcoholism" translated from Arabic means "antimony".

According to research, by 2000, the World Health Organization counted more than 140 million addicted people.

The main component of drinks is ethyl alcohol, which is a powerful neuroparalytic toxin. The poison poisons the entire body, damaging all internal organs. Excessive consumption causes serious consequences for both physical and mental health.

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There are still debates about whether to recognize chronic alcoholism as a disease according to ICD 10 or not, but at the institute that studies the consequences of excessive consumption of alcoholic beverages, the problem is classified as a dangerous type of disease.

Alcohol can ruin a person's life

Alarm calls

When do you need to start thinking about whether a habit is developing into a serious problem? According to doctors, one should be concerned since alcoholism differs in its symptoms from everyday consumption.

In order to catch yourself in time and start taking action, you should study the comparison table in detail.

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Causes of development of Korsakoff psychosis

The development of the disease occurs over a long period of time - 10–20 years. Symptoms of the chronic disorder often appear after an exacerbation of the psychosis that results from alcoholic encephalopathy. Also, the manifestation of characteristic symptoms can provoke complex delirium. Much less often, pathology develops in conditions of relative well-being in mental terms, without preliminary phenomena of a psychotic nature. Many sources cite the presence of somatic pathologies (especially the digestive system and liver) or traumatic injuries as provoking factors.

Symptoms

Korsakov's psychosis, which developed against the background of chronic alcoholism, has characteristic symptoms:

• weakness, headache;
• loss of orientation in time and space;
• fixation amnesia, in which the patient cannot reproduce the information just received;
• confabulation - replacing memories with information heard from third parties or read in books, that is, that has never happened to a person;
• anterograde amnesia – loss of memory for events that occurred after the development of the disease;
• decreased critical thinking towards yourself and the world around you;
• intellectual disability;
• gross personality violations;
• increased aggressiveness;
• decreased learning ability, loss of professional skills;
• depressive states.

Pathogenesis

There is an opinion that Korsakov's psychosis in alcoholism develops due to acute acquired deficiency of nicotinic acid and thiamine. A deficiency of biologically active substances occurs due to poor nutrition and disruption of the digestive system. Ethyl alcohol has a stimulating effect on the functioning of the small intestine, which plays a leading role in the process of digesting food and absorbing substances necessary for the normal functioning of the body. Due to the high speed of chyme movement, the small intestine is not able to properly absorb the required amount of vitamins. Atrophy of the intestinal mucosa, a characteristic result of prolonged exposure to alcohol, also a negative The lack of biologically active components leads to gradual degradation of limbic structures. Histological studies reveal massive death of the nerve tissue of the brain, which is also accompanied by the destruction of the nervous tissue of the spinal cord.

Causes of pathology

The disease was named after the Russian psychiatrist S.S. Korsakov, who described this pathology in 1887. The cause is long-term (sometimes decades) alcohol consumption, leading to third-stage alcoholism. It is characterized by the use of surrogate alcoholic products (cologne, polish, etc.).

Often the disease is provoked by severe alcoholic delirium (delirium tremens), against the background of which a coma develops. Psychosis occurs after leaving this state. Some researchers argue that the disorder occurs with various somatic injuries - liver cirrhosis, exhaustion, intestinal diseases.

The disease is based on a deficiency of thiamine and nicotinic acid, which is characteristic of alcoholism. Vitamin deficiency is caused by eating disorders that accompany alcohol consumption and resulting gastrointestinal diseases. Studies have shown that ethyl alcohol causes the small intestine to work faster than necessary. With accelerated work, absorption of nutrients does not have time to occur, because food passes through the intestines too quickly.

Symptoms of Korsakov's psychosis

The first symptoms of Korsakoff psychosis appear long before the development of signs of a full clinical picture of the disease. Within 1–2 years before the formation of pathology, patients complain of aches, sensory disturbances and nagging pain in the lower extremities. The gait becomes unsteady. Problems become especially obvious a day after drinking alcohol. mental begin to appear - decreased quality of sleep, decreased sphere of interests, anxiety without an objective reason, fears.

At the next stage, as a rule, during the next binge or after the onset of a somatic illness, delirium begins, which results in the formation of a classic clinical picture of Korsakov's psychosis. Deterioration of the psyche without hallucinations and clouding of consciousness is possible, but such a development of the disease is observed quite rarely. Classic signs of pathology:

• severe form of amnesia;
• false memories;
• loss of orientation;
• polyneuritis of the legs.

Patients are most often aware of the presence of mental defects, so they try to hide them. They avoid direct answers when it comes to their well-being and try to steer the conversation in a different direction. Gaps in memory are replaced by fantasies, assumptions , passed off as events that actually happened. Facts get mixed up and lose their objective connection to place and time.

Other signs of Korsakov's psychosis are observed, for example, the manifestation of affective disorders - lethargy, passivity, or, conversely, causeless fussiness. There may also be manifestations of carelessness, bravado, inappropriate complacency or unreasonable anxiety accompanied by confusion. Deviations in the functioning of the nervous system become noticeable.

The disease occurs in one of two forms - regressive or stationary. In the first case, the manifestation of amnesia decreases, the volume of memories increases, including about past events. The stationary form is characterized by persistence of memory dysfunction.

Features of the clinical picture of Korsakoff's syndrome

In the totality of manifestations of Korsakoff's syndrome, a combination of paramnesia and amnestic disorder is observed.

Memory disorders

The patient experiences amnesia:

• retrograde, when very recent events are washed out of the memory, but old memories remain firmly in it;
• fixation – loss of the ability to remember new information, store it and reproduce it. A person is not able to record current events and those that happened recently. The patient seems to have everything in order with consciousness and motivation, but he instantly forgets what happened to him a couple of minutes ago.

The patient categorically does not recognize his illness and does not realize that he has lost his memory. At the same time, he will not say what he did an hour ago, what dishes breakfast or lunch consisted of. He remembers the words of what he read, but soon forgets not only them, but also that he was holding the book.

Paramnesia

Paramnesia refers to a memory disorder. This manifests itself in the fact that the patient develops false memories. The present shifts with the past, real events and invented ones are mixed. It is characteristic that the patient sincerely believes in his significant, decisive role in the incidents that once took place. Experts consider paramnesia to be qualitative memory distortions.

Alcoholism gives rise to several types of them.

Confabulation

This type is interpreted as erroneous, false memories. The patient has gaps in his memory, which he fills with fictitious plots and stories absolutely sincerely. Facts remembered in fragments flashing through the brain are completely distorted in the patient’s stories. He either modifies them, transfers them to another time, or combines them with fictional events.

Most often, patients with Korsakov's syndrome experience confabulations that are substitutes, that is, those that are close to reality. For example, the event that took place - watching a “star”’s concert on TV, is replaced by a personal visit to her dressing room and a joint performance on stage.

When memories become too fantastic, this means that Korsakov's psychosis has begun to develop. The patient can talk about his teleportation to Venus and his meeting with local beauties.

Korsakov psychosis

Pseudo-reminiscences

With this type of paramnesia, the patient's memory shifts the times of events that occurred. They once really existed, and the patient “drags” them from the past to the present.

Pseudo-reminiscences are equal to “memory illusions,” as experts call them. The patient speaks about them repeatedly and consistently. It is useless to argue that what happened was different.

The patient supplements his story with what once took place, but is not related to the main action. Invented elements of an insignificant nature also appear. The subject of most pseudo-reminiscences is absolutely ordinary.

Cryptomnesia

Lost memories in cryptomnesia are replaced by information once read or seen on TV or in the movies. The patient is confused between dreams and reality, a movie plot and episodes from his life.

It may seem to him that he traveled around the world for 80 days with Passepartout. And he recently saw in a movie that his son became a school boxing champion, and that boxer guy is just a fictional character in the film. There is nothing funny or tragic about this. The patient is simply sick, he has Korsakov's syndrome.

Affective disorders

A patient with alcohol dependence exhibits emotional instability. His mood changes instantly. One minute the patient was friendly and complacent, but a second later he developed anxiety and restlessness, easily turning into aggression.

Affective disorders manifest themselves:

• fatigue and lifelessness;
• motor retardation;
• sadness and inability to concentrate on one thing.

Taken together, this is characterized as asthenic depression. All he can do is lie:

Diagnosis of Korsakov's alcoholic psychosis

For specialists, identifying Korsakov's alcoholic polyneuritic psychosis is not difficult. The presence of pathology is obvious. The diagnostic procedure includes:

1. Examination by a psychiatrist. The nature of amnesia, its severity, the degree of loss of orientation, the presence of hallucinations, and delusions are clarified. A significant role is played by the patient’s relatives and friends, who are able to provide truthful information about the patient’s behavior in everyday life, the duration of alcohol consumption, the presence of preliminary symptoms and triggering factors of the disease.
2. Examination by a neurologist. The presence and degree of development of polyneuritis is revealed. The doctor also pays attention to muscle atrophy, paresis of the limbs, function of the eye muscles, identifies the presence of an unsteady gait, and a violation of the coordinated functioning of the muscles.
3. Examination by specialists of various profiles. There is often a need to seek advice from a cardiologist, gastroenterologist and other highly specialized doctors to clarify the presence and degree of development of somatic disorders.
4. Laboratory research. It is necessary to undergo hardware examinations - EEG, MRI of the brain and abdominal cavity, computed tomography (CT) of internal organs. A detailed biochemical blood test is also required.

It is necessary to carry out differential diagnosis. Some symptoms of the disease are also characteristic of: Korsakoff's syndrome, atherosclerosis, progressive paralysis.

Types of encephalopathies due to alcohol consumption

As already mentioned, all these diseases are divided into acute and chronic. It is also customary to distinguish the fulminant form of the disease. Gaye-Wernicke encephalopathy is classified as acute; Korsakoff psychosis and alcoholic pseudoparalysis can be classified as chronic.

It should be noted that the diagnosis of “alcohol toxic encephalopathy” is made only after a full examination of the patient. A person needs to have an electroencephalogram (EEG), CT scan or MRI of the brain. The examination program must necessarily include taking tests and determining the level of toxins in the blood. Treatment can begin only after diagnosis.

Korsakoff syndrome (psychosis)

In percentage terms, Korsakoff psychosis develops much more often in females.
It is extremely rare in men. This psychosis is often called alcoholic paralysis or polyneuric psychosis. Korsakoff syndrome in alcoholism has the following symptoms:

• Marked disorientation in space. A person has difficulty finding his way home or confuses the rooms in the apartment. He may go for a walk, get lost and not return home. Over time, the situation becomes more and more complex, and treatment becomes less and less effective;
• Fixation or retrograde amnesia. Korsakov's psychosis is notable because it causes severe memory loss in a person. An alcoholic may quickly forget current events or have no memory of their past at all. Moreover, the options can be completely different;
• The appearance of false memories (confabulations). A person remembers events that never happened and could not happen. In this way he tries to fill the memory gaps caused by amnesia. Over time, the psychosis progresses more and more;
• Damage to peripheral nerves. A person experiences impaired sensitivity of the skin of the upper and lower extremities, muscle atrophy, decreased physiological and the appearance of pathological tendon reflexes. As a rule, the severity of polyneuropathy does not depend on the severity of mental disorders.

It is curious that Korsakov psychosis does not affect a person’s intelligence. His knowledge remains the same, and he can think relatively sensibly. In older women, the disease leads to a pronounced impairment of facial expressions. She becomes very slow and her face looks lifeless.

Gaye-Wernicke encephalopathy

This disease is the only acute form of alcoholic psychosis. Gaye-Wernicke encephalopathy progresses very quickly and poses a significant threat to human health and life. It can develop over several months or even weeks. The patient develops a large number of somatic, nervous and mental disorders.

Gaye-Wernicke disease manifests itself with the following symptoms:

• the occurrence of severe headaches;
• pain in the extremities;
• burning sensation and numbness in the arms and legs;
• decreased skeletal muscle tone;
• arrhythmias, sharp pain in the heart;
• severe weakness and apathy;
• worsening sleep, nightmares;
• the appearance of fear, anxiety, panic;
• inability to speak and perceive speech;
• falling into stupor, then into a coma.

Gaye-Wernicke encephalopathy is often accompanied by exacerbation or development of diseases of internal organs. In alcoholics, hepatitis or gastritis may worsen, and acute pancreatitis may occur. Often these conditions appear after a binge that lasts several weeks or longer. Gaye-Wernicke encephalopathy is an indication for immediate hospitalization of the patient in a hospital.

Alcoholic pseudoparalysis

The disease is more common in men aged forty to fifty years. A person develops delusional and manic states, and severe memory impairment occurs. Soon neurological disorders are added to the mental ones: lethargy of facial expressions, slight tremor of the limbs and unsteadiness when walking.

Timely treatment helps return a person to a normal state. Gradually all symptoms regress and disappear. This disease has a more favorable prognosis than Gaye-Wernicke Encephalopathy, which is often fatal.

Treatment of Korsakov's psychosis

If Korsakoff psychosis is clearly diagnosed, treatment will be comprehensive, aimed at localizing the damage and restoring various body functions. The acute course of the disease requires keeping the patient in a hospital setting. Treatment is carried out by psychiatrists, narcologists, neurologists and other specialized specialists. List of therapeutic measures:

1. Eliminating the possibility of drinking alcohol. An obligatory and main component of treatment. Already at this stage, restoration of some functions is observed, and the risk of further deterioration of the condition is significantly reduced.
2. Detoxification. It starts from the first days of therapy. Includes infusion of saline solutions, administration of glucose, and the use of other drugs.
3. Vitamin therapy. It consists of saturating the body with B vitamins. This is an effective method of treating polyneuritis, eliminating or significantly reducing the manifestation of neurological disorders.
4. General care and supervision. Necessary for serious problems with orientation, passivity, and severe forms of amnesia. The medical staff monitors the implementation of hygiene procedures, compliance with the regime, and physical activity. Bedridden patients require special care to resist the development of pressure ulcers and hypoventilation pneumonia.
5. Physiotherapy. Massage, hardware, gymnastics to prevent complications of diseases of internal organs, alleviate polyneuritis, stop muscle atrophy.

After the exacerbation has resolved, further observation is possible in a hospital setting or at home, if relatives and friends guarantee compliance with doctors’ orders.

Therapy rules

Of course, the patient’s relatives and friends are concerned about whether such a pathology can be treated. As a rule, therapy should take place in a hospital setting, since the patient requires specialized assistance from narcologists and psychiatrists. Therapy will definitely be complex. The first point, naturally, is to stop drinking alcohol. Against this background, they begin to carry out detoxification so that toxic substances do not affect the body so actively. This part of the addict’s rehabilitation program begins upon admission to the hospital.

Also, the task of doctors is to restore the balance of B vitamins in order to minimize the effects of mental disorders. If a person with addiction is in serious condition, hospital staff, as part of therapy, also provide specialized care, including hygiene procedures, etc.

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They may also offer physiotherapy to correct the situation - exercise therapy, massage - anything that will help get rid of muscle atrophy.

If we talk about prognosis, then with such treatment and against the background of giving up alcohol, the person will gradually begin to recover. If you start therapy in a timely manner, you can achieve very good results when the negative manifestations of the pathology noticeably decrease and even the person’s ability to work is restored. But, unfortunately, this does not happen often. Therefore, in most cases, relatives of such a patient may note persistent mental and intellectual disorders. In complex cases, the development of dementia will be noted against the background of organic brain damage. As for prevention, we are talking about abstaining from alcohol.

Forecast and prevention of Korsakoff psychosis

In general, if the prescribed treatment is followed, the prognosis is favorable. Korsakoff psychosis tends to have a regressive course, especially in middle-aged and young patients. If the severity of amnesia does not decrease, then successful learning to compensate for impaired memory function is possible. Partial restoration of working capacity is possible in most cases, complete restoration is extremely rare. Some intellectual and emotional problems persist. Adverse consequences are possible if medical care is not provided in a timely manner: dementia, transition of the disease to a malignant form with a fatal outcome within 1–2 years.

The only prevention is absolute lifelong abstinence from drinking alcohol.

YourNarcologist: Prodromal period and onset of disease development

The prodromal period of a psychotic disorder, that is, the stage of the first signs, is characterized by the appearance of general symptoms. The patient may complain of headache, bad mood, decreased concentration and memory, restless sleep with scary dreams. Alcoholic polyneuropathy manifests itself in the form of decreased sensitivity, mainly in the distal parts of the lower extremities, a sensation of goosebumps on the skin, and mild tingling in the legs.

The launch of an active process can occur independently or during an exacerbation of somatic diseases, emotional stress, or trauma. The initial period is manifested by delirium, accompanied by true hallucinations; they can be both auditory and visual, most often with a frightening plot, so during delirium a person can be dangerous to others. At the end of the delusional state, a typical clinical picture of Korsakov psychosis develops, in which signs of memory impairment predominate.

Risk factors and prognosis

There are risk factors for developing Korsakoff psychosis:

• experience of alcohol abuse for more than 10 years;
• alcoholic encephalopathy;
• mental disorders;
• exhausting diet;
• AIDS;
• pulmonary tuberculosis;
• abscess formation of the abdominal organs.

There is a direct relationship between the duration of the disease and the severity of the course, therefore, with timely initiation of therapy, complete recovery is possible.

If treatment is ineffective or the patient is unable to give up alcoholic beverages, the prognosis is unfavorable.

Development of the disease

Wernicke's syndrome is an encephalopathy that develops against the background of cerebral edema and small hemorrhages, usually in the subcortical formations: thalamus opticus, mastoid bodies. The midbrain and medial hypothalamus are also involved in the pathological process. Degradation of white matter occurs - demyelination of the pathways connecting nerve cells with each other.

The intercellular substance of the thalamus, hypothalamus, and midbrain suffers from thiamine deficiency due to the fact that it is in these areas that the vitamin is used as a transketolase cofactor. The lack of this nutrient leads to energy deficiency in the brain, and especially in the above-mentioned areas.

Hypovitaminosis of vitamin B1 leads to the accumulation of an excitotoxic substance - glutamic acid, which has an exciting effect on neurons. Its excessive influence is the cause of further disruption of the functioning of nerve cells and their death.

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The hypothalamus regulates autonomic function, which is responsible for vascular tone. Its defeat in Wernicke syndrome leads to swelling and hemorrhage of the brain. Dead cells and white nerve fibers are subsequently replaced by glia, i.e., intercellular substance.

Encephalopathy also affects the cerebellar vermis, the centers of the oculomotor, abducens and vestibulocochlear nerves.