The emotional tone of depression dominates the picture. Associated
symptoms are anxiety, fears, particularly of impending danger, the loss
of interest in the external world, with a concentration of attention
upon self; psychic distress is usually present, often to an extreme
degree, leading apparently to real mental pain, so-called psychalgia.
Delusions are usually present and manifold in variety; they mainly
refer to the patient himself and are of a self-accusatory nature;
they frequently refer to notions of sins having been committed, also
unworthiness of the patient, of poverty, nihilistic ideas, either about
his own body or external things. He may claim for example that he has
no stomach or kidney, or heart, that the external world is unreal and
the like. His motor reactions become retarded, or even in the more
extreme cases inhibited, producing a form of stupor. The inefficiency
which results along with the psychic pain and distress may determine
suicidal tendencies which are very frequent. Orientation is usually
good, the patient remaining aware of his own identity and that of his
surroundings; the judgment of course is impaired so that the patient
is unable to appreciate the unreality of his delusions; as a result
he sees no hope in the future and on account of present sufferings
prefers death to life. The patient may remain in a perfectly passive
mood, giving the appearance of extreme depression, paying no attention
to the surroundings, possibly mute, giving no regard to the necessity
of the toilet, paying no attention to his clothing and the like.
This may continue for hours or days. Food often has to be forced on
him, possibly even by the tube; the result is usually more or less
emaciation and may result in marked malnutrition; similarly the sleep
may be seriously interfered with, even though the patient is quiet.
The resulting loss of sleep and malnutrition sometimes lead to the
death of the patient. On the other hand, the patient may moan and wring
his hands in anguish, walking up and down, crying out that he is a
sinner and that he wants to die and the like. This is the so-called
melancholia agitata.
The physical symptoms of importance are sleep disturbances, poor
appetite, with emaciation, cyanosis, often a subnormal temperature, low
blood pressure, slowed heart action and weakened circulation. The hair
may become gray, the skin dry and harsh and indeed any of the signs of
senile decay may appear.
=Diagnosis and Prognosis.=—These depend partly upon the mental
symptoms, partly upon the physical. On the mental side is to be
emphasized marked depression, with the relatively clear orientation,
resembling the depressed phase of Manic Depressive insanity; also the
dominance of the self-accusatory delusions. On the physical side the
age period, and the evidence of previous attacks, even though very
slight. The prognosis from the study of the mental symptoms depends
on the presence or absence of signs of defect, or deterioration, as
for example foolish and silly delusions. On the physical side the
presence or absence of conditions like kidney or arterial disease; in
general, it may be said if the physical findings are negative and the
mental symptoms show no deterioration there should be a good outlook,
particularly if the condition has not become too chronic.
A favorable outlook is always possible if the disease is treated
early and the lesions disturbing the activities of the glands and of
nutrition and the circulation are corrected and if the other physical
findings are negative and signs of deterioration absent.
Since this is probably only a sub-group of the Manic Depressive
Psychoses, as has been mentioned above, the results obtained under
osteopathic treatment are noted under the Manic Depressive group.