GROUP VI. PSYCHOSES DUE TO TOXIC SUBSTANCES CIRCULATING IN THE BRAIN.
In this group are brought together not only those cases in which the cause can be clearly attributed to a poison circu lating in the blood,—such as alcohol, lead, and drugs (salicylic acid, opium, co caine),—but also those which are be lieved to be due to autogenetic or in fective toxins, such as puerperal and surgical sepsis, urmmia, the toxins of in fluenza, typhoid fever, pneumonia, in solation, etc.
The type of all the different toxaemic psychoses is that described by different authors under the names "acute de lirium," "acute delirious mania," "de lirium grave," "acute hallucinatory con fusion" and numerous other synonyms, but which will be here considered under the name suggested by H. C. Wood, "Acute Confusional Insanity." The general description will indicate the type, while variations will be mentioned under the specific forms.
Acute Confusional Insanity.
Definition.—An acute form of mental disturbance, beginning suddenly or with few prodromes, characterized by inco herence and confusion of thought, excite ment, or at times stupor, hallucinations, fever, and a tendency to exhaustion.
Symptoms.—Headache and insomnia may precede the outbreak. Usually, however, the only noticeable prodromic symptom is a state of irritability or anxiety. In most eases the patients sud denly become excited, talkative, have hallucinations or illusions, which are rarely of an agreeable character. They may see rats, snakes, spots of blood, etc. The visual hallucinations are often like those of delirium tremens, so graphically described by Kerr in the first volume of this CYCLOPEDIA. Auditory hallucina tions may also be present, but are infre quent. The hallucinations and illusions are usually of a changeable and fleeting character. Sometimes there are delu sions of suspicion and persecution, and occasionally delusions of grandeur. The patient soon becomes incoherent, loses all relation of time and space, does not recognize his surroundings, and con founds his own and others' personality. There may be sudden outbreaks of vio lence, which sometimes lead to homicidal acts, as in cases of puerperal and alcoholic insanity. The hallucinations and illu
sions are sometimes of an erotic char acter.
Temporary lucidity may occur, but is usually transitory.
Some patients are excessively loqua cious, chattering senselessly all the time, making nonsensical rhymes, or repeating a great number of words a similar sound. Thus, a remark that the patient looks bright will lead to a string of words like: "bright, light, sight, tight, fight, night, kite," as if read from a rhyming dictionary. At times the patient makes new and often bizarre words. This is perhaps a form of amnesic aphasia. At other times there is mutism with muscu lar rigidity, the patient being apparently in a cataleptic condition.
Frequently there is great motor rest lessness. The patient is kept in bed with difficulty, and, if allowed to get up, runs about the room or ward, shouts, laughs, pounds against doors, breaks windows and furniture, and tears his clothing. He does not control his sphincters and passes urine and fasces into the bed and clothing.
There is usually fever, with rapid, and, in advanced cases, feeble pulse. The tongue is dry and coated, there is loss of appetite and frequently refusal of food, although this can usually be overcome without resort to forcible feeding.
Causation.—Probably toxfemia in all cases. The poisonous materials may be absorbed from the intestinal canal, from wounds or septic areas, or may be formed in the blood, tissues, or glands. They may be autogenetic or introduced from without. In some cases (Pasori, Kyle, Babcock) organisms have been found, but their specificity has not been demon strated.
Acute confusional insanity occurs dur ing or after infectious diseases (typhoid fever, influenza, pneumonia, rheuma tism); after surgical operations, in the puerperium, during lactation, after cra nial and other traumatisms, neuritis; from the ingestion of alcohol, opium, co caine, lead, and other drugs; from the inhalation of certain poisonous gases,— sulphide of carbon, sulphuretted hydro gen, etc. Cerebral exhaustion, fright, anger, and other psychical shocks are also said to cause this form of mental dis turbance.