RESUMO
BACKGROUND: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunction/ataxia, and oculomotor abnormalities. OBJECTIVE: We describe Caine-positive WKS prevalence among psychiatric inpatients and compare pretreatment-versus-posttreatment neurocognitive improvement to an unaffected group. METHODS: This 6-month quality-improvement evaluation included two-stage screening for Caine-positive WKS, administering high-dose intravenous thiamine (day 1: 1200 mg; days 2-4: 200 mg) with reexamination on day 5. We used descriptive statistics and fitted random effects models to examine rate-of-change differences in pre-/posttreatment Montreal Cognitive Assessment (MoCA), delayed 5-item recall, and gait/coordination scores between treated Caine-positive patients with WKS and untreated Caine-negative patients. RESULTS: Of 262 patients, 32 (12%) had Caine-positive WKS; 17 (53%) used alcohol currently. Treated Caine-positive WKS (n = 26) versus Caine-negative comparison (n = 34) before and after treatment observed a mean change (standard deviation) in the MoCA score of 3.6 (2.5) versus 1.8 (2.5) (P < 0.01); 5-item recall: 1.8 (1.4) versus 0.5 (1.4) (P < 0.001); gait/coordination scores: -0.6 (1.2) versus -0.1 (0.6) (P < 0.001). Oculomotor abnormalities were infrequent (n = 4 in Caine-positive WKS, n = 2 in Caine-negative comparison groups). CONCLUSIONS: Caine-positive WKS prevalence among psychiatric inpatients was 12%; only half used alcohol. Patients treated with high-dose thiamine demonstrated clinically significant neurocognitive improvement.
Assuntos
Ataxia/fisiopatologia , Encefalopatias/fisiopatologia , Síndrome de Korsakoff/epidemiologia , Oftalmoplegia/fisiopatologia , Adulto , Síndrome Alcóolica de Korsakoff/diagnóstico , Síndrome Alcóolica de Korsakoff/tratamento farmacológico , Síndrome Alcóolica de Korsakoff/epidemiologia , Síndrome Alcóolica de Korsakoff/fisiopatologia , Doenças Cerebelares/fisiopatologia , Delírio/fisiopatologia , Feminino , Hospitalização , Humanos , Síndrome de Korsakoff/diagnóstico , Síndrome de Korsakoff/tratamento farmacológico , Síndrome de Korsakoff/fisiopatologia , Masculino , Desnutrição/epidemiologia , Programas de Rastreamento , Transtornos da Memória/fisiopatologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/fisiopatologia , Prevalência , Tiamina/uso terapêutico , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/fisiopatologia , Magreza/epidemiologia , Resultado do Tratamento , Complexo Vitamínico B/uso terapêutico , Redução de PesoRESUMO
: The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that methadone clinics are scrambling to give "take-home" doses where they would typically not. The rapid transition away from in-person examination, dosing and group therapy in an era of social isolation calls for adjustments to clinical practice, including emphasizing patient-provider communication, favoring new inductees on buprenorphine and leveraging technology to optimize safety of medication treatment.