Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
Frequent contributions have been made from time to time to the
literature of psychiatry on the subject of dementia praecox. Voluminous
articles have been written on its pathology, psychological mechanisms,
etiology, etc. Many of the theories advanced are not in harmony with
what little definite information we possess. Many of the theses on
this subject have been based on the study of a surprisingly small
number of cases. The statement has been made[125] that attacks either
of a syncopal or epileptic nature are among the most important
physical symptoms of dementia praecox, and "occur in about eighteen
per cent of the cases." In his eighth edition Kraepelin speaks of
convulsive attacks of various sorts in sixteen per cent of all cases
of dementia praecox, and says that they also occur in a few cases of
manic-depressive insanity. These findings are certainly not consistent
with those of other observers. In a review of eight hundred cases, five
hundred of dementia praecox, one hundred and eighty of manic-depressive
insanity and sixty in each of the "allied to" groups, Simon[126] found
convulsions in less than one per cent of the total number of cases in
which epilepsy or organic conditions could be definitely excluded. In
a study of 367 cases of dementia praecox Ullman[127] found convulsive
manifestations in 2.7 per cent of the total. He also reported seizures
in 1.4 per cent of 340 cases of manic-depressive insanity. Kraepelin
formerly held that recovery was to be expected in about eight per cent
of the cases of hebephrenic dementia praecox and thirteen per cent of
the cases of katatonia (seventh edition). Notwithstanding this, he says
in his eighth edition in one place:[128] "Further investigations of a
series of observations carried on extensively and carefully for decades
must show how far the view, which is gaining in probability for myself,
is correct, that permanent and complete recoveries of dementia praecox,
though they may perhaps occur, still in any event belong to the
rarities." As Kraepelin himself suggests, the widely varying views on
this subject are due to different conceptions as to what constitutes
dementia praecox and what is to be considered a cure. Certainly we
are in need of further information. On June 30, 1918, there were
37,352 patients in the state hospitals of New York.[129] Twenty-one
thousand nine hundred and two cases were diagnosed as dementia
praecox. Fifty-four of these were discharged as recovered during the
year. This represents 3.2 per cent of the 1,687 cases discharged as
recovered, 2.8 per cent of the 1,883 cases of dementia praecox admitted
during that period (first admissions) and .2 per cent of the 21,902
cases of dementia praecox in the hospitals. The reports of the State
Psychopathic Hospital at the University of Michigan show 1.19 per cent
of recoveries in the cases of dementia praecox discharged during a
period of eleven years. Reference is made to these discrepancies not
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