These are the most severe and rapidly fatal forms of anxious excitements, as a rule developing suddenly and included now in his presenile group. "These cases are anxious, restless, sleepless, self-accusatory and show delusions of persecution." The delusional ideas are depressive, extravagant and hypochondriacal. "They have offended everybody; are eternally damned; Satan is coming and will take them; he is out there. Nature has changed, everything is different, no mercy can come from heaven; there are ghosts in the house; the patients find themselves in the infernal regions, are surrounded by hostile powers, are in a bewitched castle. They will be carried away, thrown into a fiery furnace, their arms and legs cut off, have their throats cut in the presence of a thousand students, and be buried alive. They have a cancer in the stomach, the husband is insane or has had a stroke." Suicidal attempts are frequent. Sometimes grandiose ideas are expressed, accompanied by hallucinations. Apprehension and orientation are usually not disturbed. This is ordinarily followed by a period of violent excitement with agitated wringing of the hands, striking the breast, tearing the hair, etc. Confusional conditions with clouding may appear, often terminating shortly in a pneumonia, erysipelas or heart failure. According to Nissl, widespread and well marked changes are to be found in the brain at autopsy. There is an extensive destruction of ganglion cells, although that cannot be definitely associated with the symptoms of the disease. Kraepelin leaves the question open as to whether this should be looked upon as some form of "acute delirium" such as manifests itself in the course of various psychoses. The disease is usually one of the sixth decade of life, much more common in the female sex, and cannot without further information be definitely excluded from the involutional processes. He concludes his discussion by saying that these conditions probably "have some relation to the similar delirious senile forms to be discussed later." This is, of course, a decided modification of his original views, although it is quite clear that he still feels that there is an involutional depression, now included, however, in the presenile group.