"Under this heading are brought together those mental disorders which appear to depend directly upon some physical disturbance or somatic disease not already provided for in the foregoing groups.
"In the types designated below under (a) to (e) inclusive, we have essentially deliria or states of confusion arising during the course of an infectious disease or in association with a condition of exhaustion or a toxaemia. The mental disturbance is apparently the result of interference with brain nutrition or the unfavorable action of certain deleterious substances, poisons or toxins, on the central nervous system. The clinical pictures met with are extremely varied. The delirium may be marked by severe motor excitement and incoherence of utterance, or by multiform hallucinations with deep confusion or a dazed, bewildered condition; epileptiform attacks, catatonic-like symptoms, stupor, etc., may occur. In classifying these psychoses a difficult problem arises in many cases if attempts are made to distinguish between infection and exhaustion as etiological factors. For statistical reports the following differentiations should be made:
"Under (a) 'Delirium with infectious diseases' place the initial deliria which develop during the prodromal or incubation period or before the febrile stage as in some cases of typhoid, small-pox, malaria, etc.; the febrile deliria which seem to bear a definite relation to the rise in temperature; the post-febrile deliria of the period of defervescence including the so-called 'collapse delirium.'
"Under (b) 'Post-infectious psychoses' are to be grouped deliria, the mild forms of mental confusion, or the depressive, irritable, suspicious reactions which occur during the period of convalescence from infectious diseases. Physical asthenia and prostration are undoubtedly important factors in these conditions and differentiation from 'exhaustion deliria' must depend chiefly on the history and obvious close relationship to the preceding infectious disease. (Some cases which fail to recover show a peculiar mental enfeeblement.) In this group should be classed the 'cerebropathica psychica toxaemica' or the non-alcoholic polyneuritic psychoses following an infectious disease as typhoid, influenza, septicaemia, etc.
"Under (c) 'Exhaustion deliria' are to be classed psychoses in which physical exhaustion, not associated with or the result of an infectious disease, is the chief precipitating cause of the mental disorder, e.g., hemorrhage, severe physical over-exertion, deprivation of food, prolonged insomnia, debility from wasting disease, etc.
"Of the psychoses which occur with diseases of the ductless glands, the best known are the thyroigenous mental disorders. Disturbance of the pituitary or of the adrenal function is often associated with mental symptoms.
"According to the etiology and symptoms the following types should therefore be specified under 'Psychoses with Other Somatic Diseases':
"(a) Delirium with infectious disease (specify)
"(b) Post-infectious psychosis (specify)
"(c) Exhaustion delirium
"(d) Delirium of unknown origin
"(e) Cardio-renal disease
"(f) Diseases of the ductless glands (specify)
"(g) Other diseases or conditions (to be specified)."
A study of 480 cases of psychoses with other somatic diseases reported from the New York state hospitals during 1918 and 1919 shows the following types represented:—
| Number | Percentage | |
|---|---|---|
| Delirium with infectious diseases | 68 | 14.16 |
| Post-infectious psychoses | 102 | 21.25 |
| Exhaustion delirium | 94 | 19.58 |
| Delirium of unknown origin | 36 | 7.50 |
| Cardio-renal diseases | 69 | 14.37 |
| Diseases of the ductless glands | 20 | 4.16 |
| Other conditions | 91 | 18.90 |