Wernicke's Disease and Schizophrenia: A Case Report and Review of the Literature

Objectives: A review of the neuropathology literature in schizophrenia suggests that some patients with this disease exhibit periventricular gliosis at postmortem examination. Several researchers have speculated that this finding is the remnant of either a prior viral infection or a gestational intraventricular hemorrhage. The present article uses a case report to hypothesize and discuss an alternate possibility to the putative gliosis, namely Wernicke's disease. Method: Based on the pathological findings of our patient and a review of the literature, the author summarizes several reasons why Wernicke's disease may occur, and still be unnoticed, in some schizophrenic patients. Results: Inefficient self-care and homelessness predisposes some patients with schizophrenia to poor dietary habits and malnutrition. Similarly, the high prevalence of concurrent alcoholism in patients with schizophrenia may propitiate thiamine deficiency. The resulting brain insult may be compounded by disturbances of carbohydrate metabolism which may be peculiar to the schizophrenic process itself, or acquired, as in coincidental diabetes. Conclusions: Since symptoms accrued to Wernicke's may often be subtle and obscured by other schizophreniform manifestations, clinicians should lower their threshold for suspecting this potentially fatal complication. The diagnostic possibility of Wernicke's should be especially entertained in schizophrenic patients who are alcoholics and/or diabetics.