Guirguis Medhat, Manning Stephen, Chavez Marina, Nelson Jessica, Baronia Regina, Bobba Sailatha, Ahmed Jafreen, Ajufo Ijeoma
Department of Psychiatry, Texas Tech University Health Sciences Center, 3601 4th St Stop 8103, Lubbock, TX 79430.
Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Prim Care Companion CNS Disord. 2017 Dec 28;19(6):17m02179. doi: 10.4088/PCC.17m02179.
Wernicke's encephalopathy is caused by thiamine deficiency and occurs predominantly in alcohol-dependent individuals but also develops in those who are malnourished due to other reasons including medical and psychiatric disorders. This study examined the frequency rate and management of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients admitted to a psychiatric hospital.
Data were retrospectively collected from electronic medical records of psychiatric inpatients admitted to a teaching hospital located in Texas between September 2013 and March 2014. The diagnostic criteria of Caine and colleagues and thiamine dosing strategies were used to identify cases of suboptimal management.
A total of 486 charts were reviewed. Nine patients (1.85%) had clinical signs of Wernicke's encephalopathy, and 36 (7%, n = 486) were at a high risk for developing the disorder. None of these patients received adequate doses of parenteral thiamine, and of those who were prescribed thiamine, the majority, including high-risk patients, were prescribed oral thiamine at the traditional dose of 100 mg/d.
The findings suggest that Wernicke's encephalopathy is underdiagnosed and undertreated. Our study also highlights the need for clarifying diagnostic criteria, identifying the risk factors for thiamine deficiency, and improving awareness among physicians about diagnosis, prevention, and adequate treatment of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients.
韦尼克脑病由硫胺素缺乏引起，主要发生于酒精依赖者，但也见于因包括医学和精神疾病在内的其他原因导致营养不良的人群。本研究调查了一家精神病医院收治的酒精依赖和非酒精依赖患者中韦尼克脑病的发生率及治疗情况。
回顾性收集2013年9月至2014年3月间德克萨斯州一家教学医院收治的精神科住院患者的电子病历数据。采用凯恩及其同事的诊断标准和硫胺素给药策略来确定管理欠佳的病例。
共审查了486份病历。9例患者（1.85%）有韦尼克脑病的临床体征，36例（7%，n = 486）有发生该疾病的高风险。这些患者均未接受足够剂量的胃肠外硫胺素，在那些被处方硫胺素的患者中——包括高风险患者在内——大多数被给予传统剂量100mg/d的口服硫胺素。
研究结果表明韦尼克脑病存在诊断不足和治疗不足的情况。我们的研究还强调了明确诊断标准、识别硫胺素缺乏的风险因素以及提高医生对酒精依赖和非酒精依赖患者中韦尼克脑病的诊断、预防及充分治疗的认识的必要性。
