Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
Redlich described the psychoses associated with cerebral growths
as being epileptiform in character and origin and resembling
post-epileptic psychoses in their symptomatology, with irritability,
excitement or violence, confusion, delirium and hallucinations, often
followed by partial amnesia. Epileptic manifestations may occur in the
form of equivalents during the development of the growth. Bernhardt and
Oppenheim have called attention to episodes of vertigo, irritability,
excitement, clouding and occasional delirium with amnesia following
intense paroxysms of headache. These attacks also strongly suggest
the characteristics of epileptic psychoses. Nothnagel, Bernhardt,
Oppenheim, Schuster, Ziehen and others attribute the mental symptoms
associated with brain tumor to increased intracranial pressure
producing an anaemia. Klippel, Maillard, Vigouroux, Kaplan and others
believe that they are due to toxins originating in the growth. This
view is based largely on the appearance of psychoses similar to the
Korsakow syndrome. Knapp in 1906 called attention to the prominence of
mental symptoms in growths occurring in the anterior portion of the
corpus callosum. These may be associated with intellectual defects,
apraxia, speech disturbances and stupor. Gianelli found mental
disturbances in 209 of 318 cases examined.
Kraepelin[195] attributes the mental symptoms of growths to an injury
of the brain structure, changes in intracranial pressure, circulatory
disturbances, and the absorption of toxic substances. A growth of
considerable size but of slow development may permit of a readjustment
of pressure, etc., and show few symptoms. On the other hand, a
small neoplasm on account of its site or rapidity of growth may be
accompanied by profound mental disturbances resulting from chemical
irritation, obstruction of the aqueduct of Sylvius, or circulatory
interferences. Kraepelin quotes Schuster (1902) as finding psychotic
symptoms in all cases of growths in the corpus callosum, in two-thirds
of those of the hypophysis, in one-third of those of the cerebellum and
in one-fourth of the cases with involvement of the brain stem. These he
looks upon as pressure symptoms except in the case of the callosal
neoplasms. Schuster was of the opinion that growths in the cortex
usually lead to actual psychoses and those in the deeper areas to
dementia. He found a general mental deterioration in 423 out of a total
of 775 cases of brain tumor. The patients were indolent, inattentive,
clumsy, forgetful, dull, tired easily and lost more and more their
capacity and inclination for sustained exertion. Thought, decision and
mental processes generally, required an unusual amount of effort. The
patients usually became somewhat confused and disoriented in regard to
time, place and person, as well as incoherent in speech. In many cases
there is a marked memory disturbance with a tendency to fabrication
suggesting Korsakow's psychosis. Delirious states with hallucinations
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