Benign Stupors: A Study of a New Manic-Depressive Reaction TypeHoch, August
Science
Benign Stupors: A Study of a New Manic-Depressive Reaction Type
Hoch, August
Manic-depressive illness; Stupor
In any functional psychosis an offhand diagnosis is dangerous. When one
deals with such a condition as stupor, however, the problem is exacting,
for, although “stupor” may be seen at a glance, what is seen is really
only a symptom or a few symptoms. “Stupor,” then, is more of a
descriptive than a diagnostic term. The real problem is to determine the
psychiatric group into which the case should be placed. This is a
difficult task, for the differential diagnosis rests on the observation
and utilization of minute and unobtrusive details. A correct
interpretation can be only reached by obtaining a complete history of
the onset and observing the behavior and speech of the patient for a
long period, usually of weeks, sometimes of months. With these
precautionary words in mind, it may be well to summarize briefly the
diagnostic problems in connection with benign stupor.
In the first place one naturally considers the differentiation from
conditions of organic stupor or coma. Since psychotic stupors never
develop without some signs of mental abnormality, the history is usually
a sufficient basis for final judgment. In case no anamnesis is
obtainable the functional nature of the trouble may be recognized by the
absence of those physical signs which characterize the organic stupors.
One sees no violent changes in respiration, pulse or blood-pressure,
such as are present in the intoxication comas of diabetes or nephritis.
There is no characteristic odor to the breath, and the urine is
relatively normal. The unconsciousness of trauma or apoplexy is
accompanied by focal neurological signs. Even in aerial concussion (so
frequently seen in the war) where no one part of the brain is
demonstrably affected more than another, there are neurological
evidences of what one might call “physiological” unconsciousness. The
eyes roll independently, the pupils fail to react to light. On the other
hand, there are definite symptoms characteristic of the functional
state. Mental activity is evidenced by a muscular resistiveness or
retention of urine. Even in states of complete relaxation the eyes move
in unison, the pupils react to light, and almost universally the corneal
reflex is present. The patient appears in a deep sleep rather than
actually unconscious.
The post-epileptic sleep may resemble a stupor strongly. But this
condition is temporary and the situation and appearance of the patient
betrays the fact that he has just had a convulsion. Rarely, protracted
stuporous states occur in epilepsy which closely resemble the conditions
described in this book. In fact it is probable the true stupors may
occur in epilepsy just as in dementia præcox or manic-depressive
insanity.
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