Kraepelin states that many cases of tuberculosis show traits of alcoholic disease and says that the occurrence of polyneuritic forms of alcoholic mental disorder is favored by the association of tuberculosis with alcoholism.
Wernicke does not systematically consider the topic.
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.