Introduction: Korsakoff Syndrome (KS) is a preventable memory disorder
that can occur after Wernicke’s encephalopathy (WE). There is scarce
information regarding KS in Malaysia. Method: Case report. Results: A 49
year-old Chinese lady with daily alcohol use in between 15-20 units for more
than 10 years became forgetful eight months prior to her admission due to
withdrawal symptoms and a fall when she attempted to cut down her alcohol
use to 7–8 units. Examination revealed confabulation, dysdiadochokinesia,
resting and intentional tremor but not confusion, ophthalmoplegia,
nystagmus or ataxia. Mini mental state examination result was 14/30.
Investigations revealed features of chronic alcohol use and cerebral atrophy
of bilateral frontotemporal lobe. Despite aggressive treatment with
intravenous and oral thiamine, the patient’s cognitive deficit persisted. Hence
KS was diagnosed. Discussion: There is no proven treatment that can
reverse KS other than prevention. Thiamine fortification may be
implemented locally to prevent this condition.
A case of rapid stabilization using electroconvulsive therapy (ECT) for a major
depressive disordered (MDD) patient with life-threatening low body mass index
(BMI) is reported. This case report focuses on a 55-year-old Malay housewife with
underlying hyperthyroidism in a euthyroid state who presented with MDD with
mood congruent psychotic features, which were precipitated by the death of her
husband. Her BMI was only 11 kg/m2
due to severe anorexia, and she was highly
suicidal. Peripheral total parenteral nutrition was started and ECT was commenced
for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout
admission. The patient was discharged at BMI of 13 kg/m2
with good appetite. ECT
was safe for very low BMI MDD patient.
Introduction: Grief may be complicated in patients with dementia, posing a challenge to caregivers and healthcare professionals. A case of major vascular neurocognitive disorder with pathological jealousy and major depressive disorder in grief is reported.
Case: A 73 year-old Malay lady with diabetes mellitus, hypertension, dyslipidemia, and right cerebrovascular
accident developed major vascular neurocognitive disorder with pathological jealousy and major depressive disorder. She presented with unmanageable agitation and depression after her late husband’s death. She also experienced
a bizarre delusion of her husband’s resurrection and infidelity. Her psychotropic medications were optimised and her bizarre delusion was challenged daily using validation and distraction techniques. Combined pharmacotherapy and behavioural therapy managed to resolve her psychiatric symptoms and facilitate her grief process.
Conclusion: Grief reaction in major vascular neurocognitive disorder patients is often atypical. Individualized treatment comprising both pharmacotherapy and behavioural therapy should be offered to treat atypical grief and the underlying disease.