Psychiatric Diseases

These are disturbances of the mental functions, muscular incoordination, and finally unconsciousness, with deep though rarely stertorous breathing. The face may be flushed or pale, and the pulse is usually slow and full. The pupils are equally dilated. The temperature is rarely elevated, not infrequently subnormal. In uncomplicated cases convulsions are rare, although slight muscular twitching may be present. The odour of the breath is characteristic. When the condition is well-marked there is a nearly complete loss of voluntary muscular power. By persistent effort the patient may be aroused to incoherent speech, followed almost immediately by a return to the narcotized condition.

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine: A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed, pp. 1142). New York: D. Appleton & Co.

Created by: Taha Jilani, 06/09/2021

Entered by: Rachel Johnson, 07/13/2021

[…] occurring mostly in young women, and characterised by extreme emaciation […] chiefly between the ages of 16 and 23. […] occasionally seen it in males at the same age. […] amenorrhea, slow pulse, slow breathing. Physical  examination of the chest and abdomen discovered nothing abnormal. All the viscera were apparently healthy.  Notwithstanding the great emaciation and apparent weakness, there was a peculiar restlessness, difficult, I was informed, to control. […] When the emaciation is at the extremest, edema may supervene in the lower extremities - the patient may become sleepless - the pulse become quick, and death be approached by symptoms of feeble febrile reaction. […] inability to digest food in the state of inanition, without the aid of external heat […] The want of appetite is, I believe, due to a morbid mental state. I have not observed in these cases any gastric disorder to which the want of appetite could be referred. I believe, therefore, that its origin is central and not peripheral. That mental states may destroy appetite is notorious, and it will be admitted that young women at the ages named are specially obnoxious to mental perversity. […] The treatment required is obviously that which is fitted for persons of unsound mind. The patients should be fed at regular intervals. and surrounded by persons who would have moral control over them […].

Gull, W. (1873). V. -Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica). Obesity: Research, 5. Pg. 498-501.

Entered by: Ayushi Chintakayala, 01/25/2021

There is unsteadiness of the muscles, particularly those of the legs, hands, and tongue, manifested by tremor, which for a time can be temporarily overcome by taking alcohol. There gradually develop mental sluggishness, impaired judgement and memory, with irritability of temper and a progressive change in moral character. Indigestion and catarrhal gastritis are early and constant findings. The breath has a peculiar odour, the bowels are constipated, the tongue is furred, and there is anorexia. Gastrectasia is not uncommon in habitual beer drinkers. The most constant change occurring in the liver is cirrhosis, preceded, sometimes for years, by enlargement and tenderness. The eyes are watery and red, and acne rosacea is common.

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine: A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed, pp. 1142). New York: D. Appleton & Co.

Created by: Taha Jilani, 06/09/2021

Entered by: Rachel Johnson, 07/13/2021

As the name indicates, it is a disease of early life. More than sixty per cent of the cases appear before the twenty-fifth year. […] In the hebephrenic form sixty-four per cent of the cases are men, in catatonia, and paranoid forms women slightly predominate. Defective heredity is a prominent factor, […].

External impressions are correctly perceived, the patients being able to recognize their environment and to comprehend most of what takes place about them. [...] they remain quite well oriented, as to time, place, and person. During the acute or subacute onset of the disease, apprehension is affected, and there is some disorientation. […]

Occasionally delusions entertained by the patient lead to a misinterpretation of some of their surroundings. They may be days or years ahead of the correct time, their nurses may be called by fictitious names, or the hospital may be regarded as a nunnery, while in other respects the orientation is correct.

Apprehension is always more or less distorted by hallucinations, especially in acute and subacute development of the disease. These usually disappear late in the course of the disease, but may persist into the end stages. Hallucinations of hearing are most prominent, next come hallucinations of sight, and at rare intervals we find those of touch. Hallucinations at first are distressing, resulting in fear; but later in the course of the disease they do not excite much interest, [...]. Some patients seem to take pleasure in listening to the voices, whose communications are both incoherent and silly. […]

Consciousness is usually clear. […] On the other hand, there is pronounced impairment of voluntary attention, which is one of the most fundamental symptoms. […] In spite of the fact that the patients perceive objects about them correctly, they do not observe them closely or attempt to understand. [...] when an object is held before them for observation they stare vacantly about or close their eyes tightly.

There is a characteristic and progressive, but not profound, impairment of memory [...]. Memory images formed before the onset of the disease are retained [...]. Though their reproduction is increasingly more difficult, unusual stimulation or excitement may occasion the recollection of events […]. The formation of new memory images is increasingly difficult with the advance of the disease. […]

In the earlier stages of the disease thought shows a characteristic incoherence and looseness. One finds even in the mild cases some distractibility, a rapid transition from one thought to another without an evident association […]. In severe cases there is genuine confusion of thought with great incoherence and the production of new words. In cases of the catatonic form especially, we meet with evidences of stereotypy; the patients cling to one idea, which they repeat over and over again. Besides, there is occasionally noticed a tendency to rhyme or to repeat senseless sounds.

[…] patients believe that they are the objects of persecution, and they may have delusions of reference and self-accusation. […] At first the delusions may be rather stable, but later they tend to change their content frequently, adding new elements suggested by the environment. […] In most cases the wealth of delusions so apparent at first gradually disappears. […] In the paranoid forms, however, there persists from the beginning a great wealth of delusions, but these become more and more incoherent. [...]

Parents and friends notice that there is a change in the disposition, a laxity in morals, a disregard for formerly cherished ideas, a lack of affection toward relatives and friends, an absence of their accustomed sympathy, and above all an unnatural satisfaction with their own ideas and behavior. […] patients express neither joy nor sorrow, have neither desires nor fears, […] sometimes silently gazing into the distance, at others regarding their surroundings with a vacant stare. […] Food, however, continues to attract them until deterioration is far advanced. […]

Besides this characteristic inactivity, there may appear a tendency to impulsive acts. […] In this condition, which is called negativism, the patients resist everything that is done for them, such as dressing and undressing, they refuse to eat when food is placed before them, […]. In extreme conditions there may even be retention of urine and feces. […] It is not unusual to see the patients suddenly relieved of it, […] and again after an interval of a few hours or days relapse gradually into the negativistic state. [...]

Physical Symptoms - The patients suffer from anorexia, […]. The sleep is usually much disturbed. The heart’s action is sometimes retarded, sometimes accelerated […]. The menses almost always cease. The pupils occasionally dilated, and especially during conditions of excitement and stupor. The tendon reflexes are usually increased as well as the myotatic irritability. All of these symptoms tend to disappear later in the course of the disease […]. Some observers have reported fainting and epileptiform attacks […]. Hysteroid convulsions and paralyses and localized contractures have also been noted."

Kraepelin, E. & Defendorf, A.R. (1904) Clinical Psychiatry: a Text-Book for Students and Physicians: Abstracted and Adapted from the 6th German Edition of Kraepelin's "Lehrbuch Der Psychiatrie": Macmillan. Pg. 152-161.

Entered by: Ayushi Chintakayala, 6/22/2020

This term is applied to that mental disorder which recurs in definite forms at intervals throughout the life of the individual and in which a defective hereditary endowment seems to be the most prominent etiological factor.

[…] Previous to the onset of the psychosis, many patients have displayed peculiarities, some having been abnormally bright, while others have been eccentric or overpious. […] Individual attacks, except the first, almost always appear independently of external causes. […]

Thus far observation has failed to reveal any characteristic anatomical pathological changes. This fact, together with the recurrence of individual attacks, mostly independent of external causes, has led to the conclusion that the disease depends upon a neuropathic basis, which in the vast majority of cases is hereditary. […]

The apprehension and comprehension of external impressions show more or less disturbance in maniacal forms, except in the lightest – hypomania. This disturbance is due largely to the great distractibility of the attention. The patients lose the ability to select and elaborate their impressions, because each striking sensory stimulus forces itself upon them so strongly that it absorbs their entire attention for a moment, while next instant another stimulus takes its place. […] Under these circumstances, consequently, the environment is never fully apprehended, and the picture remains disconnected and incomplete, although there is no serious disorder of the perceptive process. The central susceptibility to external impressions is, however, diminished, as is seen in the remarkable insensibility to heat and cold, to hunger, and to pain. […]

Hallucinations are very rarely present except in the delirious form, and in the more marked stuporous conditions, but even here they are neither a prominent nor persistent feature. Delusions also play an unimportant part in the maniacal forms. When present they are unstable and appear in the form of playful boasts and exaggerations. A few patients elaborate delusions of persecution, especially directed against the family, or of poisoning, which are held for some time. In great excitement many variable expansive ideas may be expressed. In the depressive phases, on the other hand, the delusions of persecution and self-accusation, as well as hypochondriacal ideas, are usually present. These delusions rarely become fantastic.

There is usually some insight into the disease ; but while the patient appreciates, they have undergone a change, they attribute it to misfortune and abuse rather than to mental illness.

The disturbance of thought is a prominent symptom. In the maniacal forms a definite line of thought cannot be followed out ; ideas pass abruptly from one subject to another, and the line of discourse is lost in a mass of detail. A short question may be answered correctly, but with the addition of a host of details and side remarks that have only a distant relation to the subject. It is impossible for the patients to relate any event coherently without frequent inquiries and suggestions on the part of the listener to draw him back from his digressions. There is a lack of voluntary guidance of the train of thought, hence there are quick leaps in the succession of ideas influences by objects that happen to come into the field of vision, or by sounds caught up from the surroundings. On the whole, there is a multitude of ideas, but they are not well connected. Ideas seem to crowd each other, but in reality, they do not. There is no controlling goal idea. […]

The emotional attitude of the maniacal forms is more or less happy. There is a feeling of well-being with a tendency to joke and to make facetious remarks. Expressions of the emotions are unrestrained. Irritability is prominent, giving rise at times to outbursts of anger from trivial causes, but even more characteristic are the rapid changes in the emotional attitude ; in the midst of joy patients become tearful, complaining of abuse and misfortune ; in spite of profound misery they burst out into boisterous laughter. These varying states appear and disappear with greatest rapidity. Depression of the spirits may appear even for a few hours, indicating a close relationship between the maniacal and depressed phases. In this form depression is the predomination feature, and there is despair, gloom, and often anxiety ; but even in their dejection one sometimes encounters moments when there are feeble attempts at laughter and even gayety. The mixed forms present stupor with silent mirth, or restless mischievousness with anxiety. […]

The increased conveyance of stimuli into action gives rise to pressure of activity. Every sort of impulse leads to an action, completely inhibiting all normal volitional impulses, or even if a volitional action is begun, it is overwhelmed before half accomplished. Furthermore, almost imperceptible impulses excite the greatest variety of movements, which are executed with unusual energy. In the lightest forms this appears a characteristic restless activity and excessive display of energy over trifles. If the disease is more severe, the actions become disconnected. New impulses intrude before any one object can be accomplished. In the severest excitement the actions change as rapidly as the ideas, and are quite aimless. […] Unrestrained activity tends to increase the excitement. The ready release of the motor impulses perhaps accounts for the unusual absence of fatigue in these conditions, which may persist for weeks or even months without any signs of exhaustion. […]

Defendorf, A. (1904). Clinical Psychiatry (pp. 282-291). London: Macmillan & Co., LTD.

Created/Entered by: Rachel Johnson, 07/22/2021

The majority of cases occur between the ages of forty and sixty. […] Sixty per cent are women. […] Defective heredity occurs in a little over one-half of the patients. […]

The First Group of cases is the more common. Prodromal symptoms very often exist for many months, of which the most prominent are persistent headache, vertigo, indefinite pains, general debility, loss of appetite, constipation,  palpitation of the heart, and increasing difficulty to work. […] The patients become sad, dejected, and apprehensive, and find no enjoyment in their work or home environment. They are overpowered by doubts, fears, and self-accusations, refusing to be consoled by friends. They feel ill, complain of being dumb, confused, and forgetful, and find it difficult to do anything. […] Patients become retrospective, many misdeeds are referred to in going over their past life, which are held as an adequate basis for their depression. […] Remote and often insignificant facts are recalled, […] which now cause them the greatest anxiety. […]

A religious strain is very prominent in many. […] The patients believe themselves damned by God; Sometimes they even exaggerate their misdeeds and confess crimes which they have never committed, […].

In other cases, the delusions are hypochondriacal in nature. […] They give up everything because they have only a short time to live. […] The consciousness is usually clear. Thought is coherent and relevant, but the content is usually centred about the depressive ideas […]. There is usually some insight into their illness, the patients complaining that their head is not right, […]. They may be indolent, […]. Very many are restless, attempting to remain at work and to busy  themselves in order to drive away their bad feelings. […] Attempts at suicide are frequent […].

The Second Group of cases is characterized by a greater predominance of delusions of fear, which are apt to be extremely silly, and sometimes even nihilistic, […] The onset may be more rapid […]. The slight depression soon gives way to extreme dejection. The patients accuse themselves of horrible crimes, […]. The hypochondriacal ideas are apt to be extremely absurd. […] Hallucinations of both hearing and sight are very prominent. […] Consciousness in this group of cases is usually clouded, showing disorientation for time, place, and persons. […] The basis for this emotional depression seems to be fear, a feeling of oppression, and inner anxiety. […] The fear is increased by association with those who are accustomed to arouse in them the deepest feelings, while strangers and new environment create little emotional reaction. […]

Course - In cases of recovery, the whole course lasts at least twelve months to two years. Short remissions […] occur throughout the whole course. […] Even when convalescence is well established, it is not unusual for them to have “bad days”, during which they are troubled and apprehensive.

Kraepelin, E. & Defendorf, A.R. (1904) Clinical Psychiatry: a Text-Book for Students and Physicians: Abstracted and Adapted from the 6th German Edition of Kraepelin's "Lehrbuch Der Psychiatrie": Macmillan. Pg. 254-262.

Entered by: Ayushi Chintakayala, 6/19/2020

[…] Thinking is difficult to the patient, a disorder, which he describes in the most varied phrases. He cannot collect his thoughts or pull himself together ; his thoughts are as if paralysed, they are immobile. His head feels heavy […] as if a board were pushed in front on it, everything is confused. He is no longer able to perceive, or follow the train of thought of a book or conversation, he feels weary, enervated, inattentive, inwardly empty ; he has [diminished] memory, he has no longer command of knowledge formerly familiar to him, he must consider a long time about simple things […]

The patient frequently describes a change in their inward state […] Their presentations lack sensuous colouring. The impressions of external world appear strange, as though from a great distance, awake no response in them ; there own body feels as if not belonging to them ; their features stare quite changed from the mirror ; their voice sounds leaden. Thinking and acting go on without the co-operation of the patient ; he appears to himself to be an automatic machine. […]

Mood is sometimes dominated by profound inward dejection and gloomy hopelessness […] The patient’s heart is heavy, nothing can permanently rouse his interest, nothing gives him pleasure. He has no longer any humour or any religious feeling, - he is unsatisfied with himself, has become indifferent to his relatives and to whatever he formerly liked best. Gloomy thoughts arise, his past and even his future appear to him in a uniformly dim light. He feels that he is worth nothing, neither physically nor mentally, he is no longer of any use […]

Everything has become disagreeable to him ; everything wearies him, company, music, travel, his professional work. Everywhere he sees only the dark side and difficulties ; the people round him are not so good and unselfish as he thought. Life appears aimless […]

The total absence of energy is very specially conspicuous. The patient lacks spirit and will-power, like a wheel on a car, which simply runs but in itself has no movement or driving power. He cannot rouse himself, cannot come to a decision, cannot work any longer, does everything the wrong way about […]

Sometimes a veritable passion for lying in bed all day is developed ; the patients ever again promise to rise to-morrow, but have always new excuses to remain in bed. […] The wish to die very frequently occurs. It is only with the disappearance of inhibition energy returns while depression still continues, that the attempts at suicide become more frequent and dangerous. […]

Insight- Sense and orientation are in spite of the great difficulty in perception and thinking completely retained. […]

Kraepelin, E.(1919). Einführung in die psychiatrische Klinik (pp.75-79) (Barclay M. Trans.) E. & S. Livingstone. (Original work published 1916)

Created/Entered by: Rachel Johnson, 07/22/2021