Complications of alcohol misuse are frequently encountered in the general hospital setting, as well as primary care and outpatient clinics. It is an essential part of the skillset of a consultation-liaison (CL) psychiatrist to be able to competently assess the scale of the problem, to offer advice and guidance on acute issues which may arise during intoxication and withdrawal and to orchestrate appropriate support and follow-up if a patient is willing to engage. This chapter aims to equip the reader with relevant epidemiology, some clinically useful biology and mathematics and a scaffold for building on previously acquired basics in terms of assessment and management of alcohol-related problems in the general hospital setting.

This chapter – focussing on adults – concerns the effects on brain and behaviour of deficiencies in vitamins, minerals and macronutrients, which cannot be synthesised in the body. Section 9.2 examines the neurobehavioural consequences of hypovitaminosis (intake below that recommended) and deficiency for each vitamin, including thiamine (Wernicke’s encephalopathy and Korsakoff’s syndrome), NAD (pellagra) and folate (depression). Section 9.3 covers mineral deficiencies, with notable impacts from iodine (hippocampal impairment and links to neurodegeneration in later life), selenium (hippocampal impairment) and zinc (depression). Section 9.4 examines the two essential macronutrient deficiencies. One covers omega-3 and omega-6 fatty acids, with deficiency linked to depression and neurodegeneration. The other covers the essential amino acids and the brain’s unique deficiency detection mechanism. Depression seems to be a common consequence of deficiency, and deficiency in mid-to-later life seems to link to neurodegeneration, but supplementation generally of individual micronutrients has not revealed much benefit in this regard.