Substance Use Disorders — MCQs

Q: An alcoholic patient presents with psychosis and memory loss. What is the probable diagnosis?

Wernicke-Korsakoff syndrome. **Explanation:** The patient presents with the classic clinical picture of **Wernicke-Korsakoff Syndrome (WKS)**, which is a spectrum of neurological disorders caused by **Thiamine (Vitamin B1) deficiency**, most commonly seen in chronic alcoholics. **1. Why Wernicke-Korsakoff Syndrome is correct:** WKS represents the progression from an acute phase (Wernicke’s Encephalopathy) to a chronic phase (Korsakoff Psychosis). The presence of **memory loss** (specifically anterograde and retrograde amnesia) and **psychosis** (often manifesting as **confabulation**—filling memory gaps with fabricated stories) are the hallmark features of the Korsakoff component. Pathologically, this is associated with lesions in the **mammillary bodies** and the dorsomedial nucleus of the thalamus. **2. Why other options are incorrect:** * **Wernicke's Encephalopathy:** This is the acute, reversible phase characterized by a classic triad: **Ophthalmoplegia** (ataxia), **Global Confusion**, and **Ataxia**. While it is part of the spectrum, it does not typically include the permanent memory deficits or confabulation seen in this patient. * **Acute Psychosis:** While the patient has psychotic symptoms, "Acute Psychosis" is a broad psychiatric descriptor. In the context of alcoholism and memory loss, a nutritional/organic cause (WKS) is the specific medical diagnosis. **Clinical Pearls for NEET-PG:** * **The Triad of Wernicke:** Confusion, Ataxia, Ophthalmoplegia (nystagmus). * **The Pentad of WKS:** The triad + Amnesia and Confabulation. * **Treatment Rule:** Always administer **Thiamine before Glucose** in an alcoholic patient. Giving glucose first can precipitate Wernicke’s by consuming the remaining B1 stores during glycolysis. * **MRI Finding:** High signal intensity in the mammillary bodies.

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Neurobiology of Addiction

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Alcohol Use Disorder

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Opioid Use Disorder

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Psychosocial Interventions

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