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Wernicke encephalopathy complicating catatonic schizophrenia

Published online by Cambridge University Press:  13 August 2021

C. Rihab
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia
S. Ellouze
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia
N. Messedi
Affiliation:
Psychiatry (b), Hedi Chaker University hospital, sfax, Tunisia
M. Turki
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia Psychiatry (b), Hedi Chaker University hospital, sfax, Tunisia
F. Ben Ali
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia
W. Abid
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia
M. Halouani
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia
J. Aloulou
Affiliation:
Psychiatry (b), Psychiatry (B), Hedi Chaker University hospital, sfax, Tunisia

Abstract

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Introduction

Wernicke’s encephalopathy is a potentially fatal neurological emergency caused by thiamine deficiency. Although it is often associated with chronic alcoholism, it can also occur in all situations that lead to a thiamine deficiency such as undernutrition and exclusive artificial feeding.

Objectives

In this work, we propose to study the clinical and treatment concerns of Wernicke’s encephalopathy complicating catatonic schizophrenia.

Methods

We retrospectively report the case of a patient who developed a Wernicke’s encephalopathy in the aftermath of catatonic schizophrenia.

Results

Mr H.L, a 47-year-old-male has been followed in psychiatric hospital since the age of 27 for catatonic schizophrenia. He has been hospitalized in July 2020 because of oral intake refusal, social isolation and lack of self-care with a poor compliance to treatment. Examination of the patient revealed catalepsy, mutism and negativism. He was treated with antipsychotics drugs, benzodiazepines and parenteral nutrition. About six weeks after his hospitalization, the patient developed horizontal nystagmus and ataxic gait. Magnetic resonance imaging was consistent with Wernicke encephalopathy. Vitamin B1 dosage was 32nmol/l. Parenteral thiamine replacement therapy was initiated with clinical improvement

Conclusions

Catatonic schizophrenia can be associated with severe malnutrition and thus with thiamine deficiency and Wernicke’s encephalopathy. An early intervention by supplying prophylactic thiamine given parenterally in high-risk patients is crucial to avoid Korsakoff syndrome, as well as cardiovascular and neuropsychiatric complications associated with thiamine deficiency.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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