A Case of Shoshin Beriberi: Lessons Old and New for the Psychiatrist

摘要

In the field of psychosomatics, medical and psychiatric problems sometimes merge in acute and disastrous ways. Thiamine deficiency is one such crossroad. Classic presentations of thiamine deficiency include Wernicke's encephalopathy and beriberi. Beriberi classically has two manifestations. These are a "dry" form, in which a peripheral neuropathy dominates, and a "wet" form, in which congestive heart failure dominates. When wet beriberi develops in an acute and fulminant manner, it is sometimes called "shoshin beriberi." Shoshin beriberi is rare. Yet its antecedents are not. As many as 80% of patients with alcohol dependence are deficient in thiamine.1 Surprisingly, up to 30% of U.S. citizens may be deficient in thiamine intake as defined by the U.S. recommended dietary allowances of 1989.2 Thiamine deficiency is not rare.