GROUP VII. PSYCHOSES DUE TO DE VELOPMENTAL CHANGES IN THE BRAIN. (See also INFANTILE MYXCEDEMA.) Pubescent Insanity.
Definition.—Insanity occurring during the pubescent period of life.
By the "pubescent period" is not meant the arrival of the subject at the period of puberty, but the completion of the period during which the repro ductive function is fully developed. This would include that period commonly called adolescence. The completion of this period in the female sex has been established by Matthews Duncan at about the age of twenty-five years. Clouston assumes this to be correct for both sexes.
There is a variety of periodical insan ity beginning with puberty, coincident with disturbances of menstruation and ending when that function is regulated. It is to be differentiated from the usual forms of periodical menstrual insanity, and may be termed menstrual develop mental insanity. Friedmann (Schmidt's Jahrbiicher, Apr., '04).
Symptoms and Course. — By some authors a form of mental disturbance termed hebephrenia is described as the characteristic form of pubescent insanity.. Hebephrenia is, however, in the majority of cases simply another name for the first stage of paranoia. It includes the cases of so-called "moral insanity," which is usually merely a stage in the develop went of paranoia (q. v.). Clouston, who has made a philosophical study of this period of life, both in its normal and its pathological relations, describes pubes cent insanity as follows:— "The insanity of puberty in both sexes is characterized especially by motor rest lessness. Such patients never sit down by night or day and never cease moving. There is noisy and violent action, some times irregular movements, or, in the few melancholic forms and melancholic stages of the maniacal cases, cataleptic rigidity. The mental symptoms consist most frequently in a kind of incoherent delirium rather than any fixed delusional state. In boys the beginning of an at tack is frequently ushered in by a dis turbance in the emotional condition— dislike to parents or brothers or sisters expressed in a violent, open way; there is irrational dislike to and avoidance of the opposite sex. The manner of a
grown-up man is assumed, and an offen sive 'forwardness' of air and demeanor. This soon passes into maniacal delirium, which, however, is not apt to last long. It alternates with periods of sanity and even with short periods of depression." According to my observation, this is a true picture of the insanity of the pubes cent period. The patients often recover in a short time after the beginning of the attack, but relapses are frequent. In girls, exacerbations are likely to occur in connection with the mentrual periods.
In those cases which do not recover, a mild form of dementia, resembling im becility, follows. Maniacal states are, on the whole, more frequent than those of depression. When the latter are present they often have a religious tinge.
Masturbation, which most authors re gard as an important concomitant, has probably little importance as a symptom.
Adolescent insanity is a pure psy chosis, dependent upon hereditary fac tors and acquired conditions which espe cially inhibit the higher psychical centres and later the sensory motor functions of the cortex; the vasomotor and trophic centres are involved in it; the sympa thetic, nervous function is disturbed, from which it is apt to end eventually, in the female, in suppressed menstrua tion, or even excitation, producing nymphomania; masturbation is a com plication which, in the male, is apt to cause reflexes; there is no period in life more important than adolescence. F. P. Norbury (Nashville Jour. of Med. and Surg., Nov., '97).
Prognosis.—Authors usually give a very unfavorable prognosis in pubescent insanity. Excluding those cases, how ever, in which, from their symptoma tology, belong to paranoia, I regard the prognosis as favorable. Under appropri ate management pubescent insanity is a hopeful form of mental disturbance. Clouston reports, that about one-half of his cases recovered.