1) A study of alcoholics admitted to a general hospital psychiatric
unit over a period of 4 years (527 males and 148 females) is
presented. The various demographic, social and drinking
characteristics are given and the male and female alcoholics
are compared. The complications and associated physical
conditions were studied epidemiologically and with special
reference to blood vitamin levels in an attempt to elucidate their
aetiology. A follow-up study was carried out to find the causes
of death in these patients and at the same time the prognosis
studied to ascertain its relationship to these complications.2) There were more alcoholics in social classes I, II and 7
and in the widowed and divorced. The age pattern of alcoholics
was similar to other studios with an almost normal distribution
curve around the mean of 43.7 years in males and 45.4 years in
females. The religion of the patients was similar to that of the
surrounding area.3) Over half of the alcoholics were admitted as emergencies}
a quarter did not finish the course of in-patient treatment
and one-fifth of the total were re-admitted during the four year
period.4) Whisky was the preferred drink among male alcoholics and
"fortified wine" among females. The former had been drinking for
considerably longer than the latter (a mean of 16.2 years
compared to 9.9 years) and they drank, on average, much more, (the equivalent of a bottle of whisky a day compared to the
equivalent of a bottle of sherry per day).5) A quarter of all the patients were given an associated
psychiatric diagnosis of which most were in the personality
disorder group.6) There was a large incidence of behavioural disturbance,
so that only one-third of men, but two-thirds of women, had
no previous convictions. However more women (33%) than men
(18%) had previous suicide attempts and more abused
drugs than men (25% compared to 11%.7) Male and female alcoholics were shown to have a number of
differences especially in drinking habits noted above.
Female alcoholics were older, and they were admitted via other
hospital wards or by Alcoholics Anonymous, They stayed
longer in hospital and were admitted more frequently. They
had more spouses who were alcoholic than males. They showed
more evidence of malnutrition in the form of weight loss and
clinical signs of nutritional disease and they had a higher
incidence of alcoholic dementia and of the "rare" neuropsychiatric
disorders. They had a lower incidence of alcoholic
epilepsy, delirium tremens, alcoholic hallucinosis and E.E.G.
abnormalities, as well as hepatitis and previous gastric operations,
but similar incidences of cirrhosis, neuropathy and anaemia8) Only 18% of patients had no associated physical condition.
Almost one-fifth of the patients had each of the following:
anaemia, peripheral neuropathy, gastritis, hepatitis, severe
withdrawal signs and E.C.G. abnormalities and one-tenth had
cirrhosis. These results are very similar to other studies despite
differences in drinking habits and social class. There were
only 8 patients who had had previous venereal disease and 4 who had
previous pancreatic disease.9) There was no objective evidence of withdrawal in 40%
of the patients, on the other hand 20% had severe effects
including delirium tremens. Alcoholics with delirium tremens
tended to have associated cirrhosis, anaemia, peripheral
neuropathy and epilepsy, as well as abnormal levels of whole blood
thiamine and serum folate.More female patients had alcoholic dementia which was
related to increased age, increased length of excess drinking and
peripheral neuropathy as well as subnormal whole blood thiamine
and nicotinic acid levels.Alcoholic epilepsy was associated with delirium tremens and
with drug abuse, abnormal levels of S.G.O.T., S.G.P.T., serum
proteins, whole blood thiamine and serum folate levels.Alcoholic hallucinosis was associated only with paranoid
psychosis though there were more patients in this group with
raised S.G.O.T. levels and low whole blood thiamine levels.Thus the alcoholic psychoses as a whole appear to have a
relationship to nutritional factors.10) Peripheral neuropathy was associated with delirium tremens,
cirrhosis and dementia. Food intake was poorer in these patients
and on admission they had more evidence of wight loss, whole
blood thiamine levels were low in 70% of the patients and there
was an increase of abnormal protein levels. These findings confirm
that nutritional factors are of importance in the condition, but
there was also a relationship with the increased daily amount of
alcohol, especially of fortified wine, and with the length
of time of excess alcohol intake .`11) Whereas cirrhosis was related to delirium tremens, peripheral
neuropathy, alcoholic cardiomyopathy and E.C.G. abnormalities,
acute liver disease was related to no other physical condition.
Similarly an increased number of cirrhotics load abnormal whole
blood thiamine levels which were not found in patients with acute
liver disease. Patients with cirrhosis were older and had been drinking
for longer than other alcoholic patients.12) Gastritis, diagnosed on clinical grounds, was found in
17% of these alcoholics, was only related in male patients to
various behavioral abnormalities. Most patients with gastric
operations, found in 11% of male alcoholics and 4.5% of female
alcoholics had their operations years after the start of heavy
drinking. There was evidence of an increased incidence of
peptic ulceration in these alcoholics.15) Alcoholic cardiomyopathy was present in only nine male
alcoholics, all of whom had been drinking to excess for over
20 years and had a heavy daily intake of alcohol. However 113
patients were shown to have E.C.G. abnormalities usually of a
minor degree.14) Anaemia was found in one-fifth of the patients, but was
varied in nature, though in two-thirds of female alcoholics and
a half of male alcoholics it was iron deficient in type.
It was associated with increased alcohol intake, especially
"crude spirits". Nutritional factors were important and there was
an association with cirrhosis and delirium tremens.15) Female alcoholics were shown to have more evidence of
nutritional deficiencies on most of the parameters utilised
than male alcoholics. It would seem that nutritional deficiency
is important in delirium tremens, alcoholic dementia,
alcoholic epilepsy, cirrhosis and peripheral neuropathy.16) The average length of follow-up was four years, 10% of
patients were untraced. Twenty-five per cent of patients were
found to be improved, 20% worsened and 10% had died. The
indicators of good prognosis were those in social classes I and
II compared to social class V, decreased length of drinking and
absence of behavioral abnormalities. Female patients did no
better than male patients.17) Hale patients died mainly from cirrhosis, cardiovascular
or respiratory disorders, including carcinoma of the bronchus,
whereas females were much more likely to commit suicide.18) There were many associated physical and behavioral
abnormalities in this group of alcoholic in-patients. No
clear pattern as to exact aetiology of the different conditions
emerged though nutritional factors appear to play a part in the
conditions which are classically considered to be the "complications"
of alcoholism
