Binswanger states that tuberculosis, aside from miliary tuberculosis or
meningitis, produces no mental disorder except phenomena of the amentia of
exhaustion.
Ballet states that there exists a peculiar mental state in the tuberculous.
It is compounded as rule of sadness, of looking on the dark side and of
profound egoism. This readily leads to mistrust and suspicion which may be
pronounced enough to constitute a sort of persecutory delusional state or a
state of melancholic depression (Clouston, Ball). More rarely there are
phenomena of excitation explained in part by fever. In its slightest degree
this phenomenon of excitation is characterized by a feeling of well-being,
of euphoria, which even at the point of death may give the patient the
illusion of a return to health, or there may be a more pronounced excitation
with impulsive sexual and alcoholic tendencies. Autointoxication may lead to
the usual train of confusional symptoms.
If we compare the accounts in the literature of the two conditions here in
question, namely, nephritis and phthisis, we must be convinced, that aside
from so-called autotoxic phenomena, renal disorder seems to be marked by a
tendency to depressive emotions but that phthisis shows not only depressive
emotion but also euphoric and hyperkinetic phenomena.
So far as these results thus hastily reviewed are concerned, they are
consistent with the appearances in the present group of cases. Both the
nephritic and phthisical groups need further intensive study.
As to the question of the spreading inwards or outwards of delusions from
the standpoint of the patient, no analysis is here attempted. It is plain,
however, that the theopaths, as James calls them, or victims of theomania,
to use the French phrase, will be of importance in this analysis because of
the equivocal character of the emotions felt in cases of religious delusion.
SUMMARY AND CONCLUSIONS
The paper deals with delusions of a personal (autopsychic) nature and is one
of a series based upon certain statistics of Danvers State Hospital cases
(previous work published on somatic, environmental (allopsychic) delusions
and those characteristic of General Paresis). The previous work had
suggested that somatic delusions are perhaps more of the nature of illusions
in the sense that somatic bases for somatic false beliefs are as a rule
found. On the other hand, delusions respecting the environment (allopsychic
delusions) had appeared to be more related to essential disorder of
personality than to actual environmental factors.
The fact that cases of paresis with delusions were found to have their
lesions in the frontal lobe, whereas non-delusional cases showed no such
marked lesions, is of interest in the light of the present paper because
three cases of senile psychosis were found to have delusions of grandeur
and, although they are demonstrably not paretic, they also show mild frontal
lobe changes supported by microscopic study.
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