Organic cerebral reactions in alcoholism: psychobiological aspects of treatment.

The paper considers the rational biological basis for treatment of alcohol withdrawal reactions, alcoholic hallucinosis and the Wernicke-Korsakoff syndrome. Both clinical and experimental data indicate that the alcohol withdrawal reaction reflects a state of hyper-reactivity of the central nervous system. The evidence comprises physiological, electrophysiological and biochemical findings. Magnesium, vitamins and antipsychotics are not specific in the treatment of the alcohol withdrawal reactions per se; rational treatment comprises drugs that may substitute for the suppressive effects of alcohol in the CNS during readaptation to the alcohol free condition (e.g. barbiturates or benzodiazepines). Alcoholic hallucinosis is characterised by acutely developed auditory hallucinations of an evil or reproachful nature. The condition may develop during or shortly after excessive alcohol consumption in chronic alcoholics. Suggestibility and unclear consciousness is not part of the condition. Tentatively three subgroups are suggested to occur: a) a withdrawal reaction; treatment with sedatives is recommended; the prognosis is good, b) a toxic reaction occurring during the drinking bout; this condition should be treated with antipsychotics until symptoms have disappeared. The prognosis is fairly good, c) a schizophreniform condition. Long-term treatment with antipsychotics must be applied. The Wernicke-Korsakoff syndrome is described. The condition often occurs during or shortly after an acute withdrawal reaction. The biochemical role of the etiological factor thiamine in glucose metabolism suggests that precautions (thiamine treatment) must be taken when giving a glucose load to alcoholics. Finally focus is set on the recent suggestion that the syndrome may in some cases result from an inborn enzymatic abnormality comprising low binding of thiamine pyrophosphate to transketolase. Psychobiological aspects of treatment in alcoholism may apply to a very large spectrum of conditions involving symptoms of cerebral, hepatic, gastrointestinal, cardial and peripheral nervous system origin. In the present expose we shall concentrate on organic cerebral reactions partly or exclusively presenting with psychiatric symptoms and signs. Thus the review will consider the rational biological basis for treatment of alcohol withdrawal reactions (including delirium tremens), alcoholic hallucinosis and the Wernicke-Korsakoff syndrome.