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Letters   |    
Schizophrenia-Like Alcoholic Dementia or Dementia Praecox
Luís Fonseca, M.D.; Joaquim Duarte, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2011;23:E11-E11.

To the Editor: A clear distinction between schizophrenia and some clusters of dementia is sometimes difficult to establish in clinical practice.

A 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.

Alcohol 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.2,3

Beginning 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.5

The 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.

Green  AI;  Drake  RE;  Brunette  MF  et al:  Schizophrenia and co-occurring substance use disorder.  Am J Psychiatry 2007; 164:402–408
[PubMed]
[CrossRef]
 
Ruitenberg  A;  van Swieten  JC;  Witteman  JC  et al:  Alcohol consumption and the risk of dementia: the Rotterdam study.  Lancet 2002; 359:281–286
[PubMed]
[CrossRef]
 
Kosten  T;  Ziedonis  D:  Substance abuse and schizophrenia: editors' introduction.  Schizophr Bull 1997; 23:181–186
[PubMed]
 
Moriyama  Y;  Mimura  M;  Kato  M  et al:  Primary alcoholic dementia and alcohol-related dementia.  Psychogeriatrics 2006; 6:114–118
[CrossRef]
 
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) 194:298–305
[PubMed]
[CrossRef]
 
 Emil Kraepelin: A Demência Precoce: 1a parte.  Climepsi Editores , 2004
 
 Emil Kraepelin: A Demência Precoce: 2a parte, parafrenias.  Climepsi Editores , 2004
 
References Container
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References

Green  AI;  Drake  RE;  Brunette  MF  et al:  Schizophrenia and co-occurring substance use disorder.  Am J Psychiatry 2007; 164:402–408
[PubMed]
[CrossRef]
 
Ruitenberg  A;  van Swieten  JC;  Witteman  JC  et al:  Alcohol consumption and the risk of dementia: the Rotterdam study.  Lancet 2002; 359:281–286
[PubMed]
[CrossRef]
 
Kosten  T;  Ziedonis  D:  Substance abuse and schizophrenia: editors' introduction.  Schizophr Bull 1997; 23:181–186
[PubMed]
 
Moriyama  Y;  Mimura  M;  Kato  M  et al:  Primary alcoholic dementia and alcohol-related dementia.  Psychogeriatrics 2006; 6:114–118
[CrossRef]
 
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) 194:298–305
[PubMed]
[CrossRef]
 
 Emil Kraepelin: A Demência Precoce: 1a parte.  Climepsi Editores , 2004
 
 Emil Kraepelin: A Demência Precoce: 2a parte, parafrenias.  Climepsi Editores , 2004
 
References Container
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