The Wernicke-Korsakoff syndrome: a reappraisal in Queensland with special reference to prevention

The Wernicke-Korsakoff syndrome occurs most frequently in alcoholic patients when they become thiamin deficient. First admissions to psychiatric units with the chronic component of this syndrome, Korsakoff's psychosis, peaked in Queensland in 1975-1976. The fall in hospital admission rates since this time could relate to a decline in per-capita alcohol consumption in Australia, or to more awareness of the thiamin needs of drinkers. Alternatively, the improvement may be illusory: although many cases of Wernicke's encephalopathy are being diagnosed, many of these patients are not receiving psychiatric assessment and treatment, perhaps because admission to psychiatric hospital beds is more difficult than it was formerly. Patients who are diagnosed as having Korsakoff's psychosis fare badly in the community, and have a greatly increased mortality rate than do such patients in hospital. Optimal care for such patients is necessarily costly of medical resources. Of available preventive measures, evidence is presented to support the fortification of beer with thiamin and the provision of community educational programmes. The fortification of flour with thiamin may have little impact on the thiamin-deficiency syndromes that arise in problem drinkers in Queensland.