Schizophrenia-Like Alcoholic Dementia or Dementia Praecox

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Back to table of contents Previous article Next article LettersFull AccessSchizophrenia-Like Alcoholic Dementia or Dementia PraecoxLuís Fonseca, M.D., and Joaquim Duarte, M.D.Luís FonsecaSearch for more papers by this author, M.D., and Joaquim DuarteSearch for more papers by this author, M.D.Published Online:1 Jan 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A clear distinction between schizophrenia and some clusters of dementia is sometimes difficult to establish in clinical practice.Case ReportA 38-year-old man with a history of alcohol dependence (alcohol consumption started at the age of 6 years) was admitted to our unit for generalized tremor; sweating; agitation; auditory, visual, and kinesthetic hallucinations; thought-broadcasting; and persecutory delusion. He was medicated with diazepam, 20 mg, and thiamine, 200 mg. Agitation and the vegetative symptoms gradually subsided within 48 hours. Lab work showed no significant changes, and EEG and ECG were normal. A brain MRI showed generalized cortical atrophy. Seven days after the admission, we prescribed olanzapine 10 mg because the psychotic symptoms had persisted. There was a gradual improvement, and, 26 days after admission, the patient was discharged home asymptomatic. Two months later he was admitted to a medical unit for a grand mal seizure after a 48-hour period of abstinence. After medical stabilization, psychiatric evaluation elicited the same previous psychotic symptoms. Olanzapine, 10 mg, was again prescribed, with symptomatic improvement. A neuropsychological study, requested during follow-up because of his cognitive impairment, revealed a severe frontotemporal cognitive defect.During the year before the admission, the patient presented with auditory and kinesthetic hallucinations, thought-broadcasting, and persecutory delusions. Also, he had continued drinking large amounts of alcohol daily during this period.DiscussionAlcohol has not been identified as a possible etiological factor for schizophrenia. Also, the high comorbidity between alcohol abuse and schizophrenia remains obscure.1 Alcoholic dementia is controversial. Long-term alcohol abuse appears to elicit its onset later in life through a mechanism of continuous brain insult.2,3Beginning his alcohol consumption at the age of 6, cognitive deterioration, and generalized cortical atrophy shown in the brain MRI suggest an alcoholic dementia.4 However, maintenance of typical positive schizophrenia symptoms beyond delirium tremens as with alcohol abstinence fulfills DSM-IV diagnostic criteria for schizophrenia. Also, the same neuropsychological deficits encountered in our patient are described in early-onset frontotemporal dementia presenting as schizophrenia-like psychosis in young people.5The difficulty in clearly distinguishing schizophrenia from some dementias may be because, as Kraepelin stated in the 19th century, schizophrenia is itself a form of early dementia. His concept of dementia praecox6,7 is supported nowadays by the knowledge acquired from several neuropsychological and neuroimaging tests that a progressive cognitive deterioration occurs in schizophrenic patients. Our case also supports this phenomenological concept of dementia praecox, independently of the associated etiological mechanisms.Psychiatry and Mental Health Department, Braga Hospital, Portugal1. Green AI , Drake RE , Brunette MF, et al.: Schizophrenia and co-occurring substance use disorder. Am J Psychiatry 2007; 164:402–408Crossref, Medline, Google Scholar2. Ruitenberg A , van Swieten JC , Witteman JC, et al.: Alcohol consumption and the risk of dementia: the Rotterdam study. Lancet 2002; 359:281–286Crossref, Medline, Google Scholar3. Kosten T , Ziedonis D: Substance abuse and schizophrenia: editors' introduction. Schizophr Bull 1997; 23:181–186Crossref, Medline, Google Scholar4. Moriyama Y , Mimura M , Kato M, et al.: Primary alcoholic dementia and alcohol-related dementia. Psychogeriatrics 2006; 6:114–118Crossref, Google Scholar5. Velakoulis D , Walterfang M , Mocellin R: Frontotemporal dementia presenting as schizophrenia-like psychosis in young people: clinicopathological series and review of cases. The British Journal of Psychiatry (2009) 194:298–305Crossref, Medline, Google Scholar6. Emil Kraepelin: A Demência Precoce: 1a parte. Climepsi Editores, 2004Google Scholar7. Emil Kraepelin: A Demência Precoce: 2a parte, parafrenias. Climepsi Editores, 2004Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 23Issue 1 Winter 2011Pages E11-E11 Metrics PDF download History Published online 1 January 2011 Published in print 1 January 2011