Bipolar disorder

“ Family history of suicide is among the risk factors for suicide, [10] and, as mentioned, the aviator’s mother had also taken her own life.
ASD, like all inventors, had a high creative capacity. There seems to be a relationship between bipolar disorder and creativity. In the study of the biographies of great artists, descriptions of what appear to be depressive and manic episodes, as well as suicides, are often found. When modern diagnostic criteria are applied in interviews with living artists, high rates of bipolar disorder are detected. ”

“ In this group should be classed the 'cerebropathica psychica toxaemica' or the non-alcoholic polyneuritic psychoses [407] 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. ”

“ Neither one can be accomplished by means of a medically effective treatment that is applied to the patient until a cure occurs.
A few emotional problems fall under the heading of true psychiatric disorders and result from physical causes. They include, for example, epilepsy, drug addiction, and Alzheimer's disease. But these conditions are in the minority; most emotional "disorders" have not been traced to underlying organic causes. There are several currently competing hypotheses relating to possible biochemical bases of schizophrenia, mania, depression, and anxiety disorders. ”

“ But after all, a large number of people whose mental processes are not normal, have only themselves, their poor emotions, their lazy wills, their hazy thinking to blame. We except what are called the heredity insanities—dementia præcox and the other dementias and the manic-depressive groups and paranoia and psychasthenia—for in these cases, possibly with the exception of the manic depressives, even the most perfect environment could probably not prevent the disorder from asserting itself. ”

“ Somatic delusions of a hypochondriacal nature occur. Insomnia is usually marked. The tendency of the disease is towards deterioration. Retardation and psychomotor inactivity are not to be expected. Melancholia is to be differentiated from manic-depressive insanity by the prominence of anxiety and apprehension, the absence of any retardation or psychomotor inhibition, the unusual frequency of self-accusation with ideas of sinfulness, the clearness of the sensorium, the comparatively unfavorable prognosis and the great frequency of suicidal impulses. ”

“ It is seldom that the entire economy does not sympathize with the psychic state. In exceptional cases some emotions are abnormally active, as in hypochondriasis; or there may be abnormally active muscular movements, as in melancholia agitata. Usually, depression is a part (a fundamental part, however) of a more complex symptom group, as in hypochondriasis, melancholia, hysteria, the prodromal stage of mania or paralytic dementia, etc.; but sometimes it constitutes a so-called disease—melancholia sine delirio. ”

“ The prognosis as to life in cases of mania is very good. Very few patients die during an attack of acute mania. At times there is a development of tuberculosis that proves fatal, because of the restlessness of the individual. Pneumonia or typhoid fever may also prove fatal.
Besides mania or melancholia, there is a third form of functional mental disease, which is a combination of these two forms. It is usually spoken of as circular insanity. The patient has usually first an attack of melancholia, then an attack of mania, and then after an interval melancholia and mania once more. ”

“ The same form of disease, too, is frequently not transmitted from parent to child or grandchild, but the neuroses, the psychoneuroses, and the cerebro-psychoses, the degenerative forms and the developed forms, are interchangeable. In the ancestry of insanity we find not only actual cerebro-mental disease, but epilepsy, brain disease due to syphilis, habitual drunkenness, any of the severe neuroses, apoplexy, pulmonary consumption, a closely-allied disease, and suicide. ”

“ They are very much increased after epileptiform or apoplectiform attacks, which, however, are uncommon so early in the case.
In the progress of the disease, as the mental impairment increases, the reaction of the nervous system to external conditions becomes less active, the mind weakens, the loss of flesh may be, at least in part, regained, a great portion of the irritability and active symptoms disappears, and as the patient grows worse he may seem for a while to his friends to improve.
The leading symptoms of general paralysis of the insane are— (1) vaso-motor, (2) mental, (3) physical. ”

“ In melancholia the shock, etc., causes depression, while in the mania the causes of mental injury tend to produce irritation and excitement. In dementia, the causes of insanity tend to exhaust the body and to mental failure, while in general Paresis "the shock of disease comes after long and unwise contact with worry, wine and women." Insufficient sleep often causes mania. ”

“ They become virtual psychoses. In cases in which the habit can be traced to a peripheral irritation, the cutting off of this by complete section of the afferent nerves leading to the irritable nerve centre will sometimes succeed in effecting a cure. In other cases in which the source of the disorder is probably largely central in the cerebral ganglia, nerve tonics, and sedatives, and generally corroborative treatment are the most obvious means of palliation. ”

“ When epileptics do become insane the insanity is generally one of the forms of mania. Either the patient suffers from sudden furious attacks of excitement in which consciousness is entirely abolished, or the mania is of the type of the elevated stage of folie circulaire (manic-depressive insanity) and alternates with periods of deep depression. In the elevated period the patient shows exaggerated self-esteem, with passionate outbursts of anger, and periods of religious emotionalism. While in the stage of depression the patient is often actively suicidal. ”

“ A state of enfeeblement of mind, or dementia.
But one of these first two states of feeling can be present at the same time, for a person cannot at any one moment be both exalted and depressed, though he have mania to day, and afterward be so changed in his feeling as to have melancholia to-morrow, or next week, or next month.
In a general way all disease is divided into acute and chronic forms. An acute disease is one of recent origin, and from which recovery is to be hoped for; a chronic disease is prolonged and does not tend to recovery; an acute disease may become chronic. ”

“ Alcohol, tobacco, morphine may produce a high grade of the disease, if their use is abused.
Symptoms.—These are varied. The most prominent symptom is fatigue. The patient feels so tired and complains of being unable to do any mental labor. It is almost impossible to put the mind on one subject for any length of time. There are headache, dizziness, want of sleep, and there is great depression of spirits; patient is gloomy, irritable in temper with manifestations of hysteria. Sometimes there are marked symptoms of spinal trouble. ”

“ The onset is gradual in the large majority of cases. Histories of sudden outbursts of mania can rarely be relied on, as the illness is almost invariably preceded by loss of body weight, sleeplessness, bad dreams, headaches and symptoms of general malaise, sometimes associated with depression. The actual onset of the mental symptoms themselves, however, are frequently sudden. A typical case of the fully developed disease is not easily mistaken. The patient is usually anaemic and thin, the expression of the face is unnatural, the eyes widely opened and bright ”

“ The studies of Meyer, Hoch, Kraepelin, Freud, Jung, Bleuler and many others have shown that in manic-depressive insanity, dementia praecox and various other psychoses we are dealing with very definite constitutional conditions, morbid temperaments, personality defects, etc., which are responsible for the maladjustments leading to the development of psychoses. Financial reverses, domestic difficulties, the death of near relatives, the ordinary hardships and disappointments of life, even ill health, do not as a rule mean the development of a psychosis in the normal, properly balanced individual. ”

“ The vaso-motor disturbances in the brain are indicated by transient congestions or local anæmia, dizziness, faintness, temporary outbursts of anger, excitement, or confusion, and rapid changes in the mental and emotional state. Convulsive attacks are not common in the early stage of the disease, except in those cases due to syphilis, but may occur, and may so resemble hysteria, petit mal, epilepsy, and apoplexy as to be confidently diagnosticated for those diseases. The emotional state is of indifference, despondency, gloom, melancholia, elation, a feeling of self-satisfaction, or mania. ”

“ The mental state is characterized by dulness, apathy and confusion, alternating with periods of irritability and restlessness. The depression is not so marked as in morphinism. Inability to concentrate the mind, loss of memory, and intellectual enfeeblement are terminal conditions. Occasionally in the worst cases hallucinations, delusions, clouding and states of excitement are observed. Abstinence symptoms are headache, insomnia, neuralgia, pains in the limbs, nervousness, restlessness and formication. A delirium similar to that of alcoholism has been referred to by various writers. ”

“ It is an established fact that drugs do not affect brain structure; and it is equally well known that, in most instances, insanity causes no deterioration in nerve tissue. In these facts lies strong collateral proof that the sources of mental disease are to be sought elsewhere than in the brain. Injuries and ailments that involve change in brain substance will necessarily interfere with brain function, and, in softening of nerve tissue or in any inflammation, there are organic alterations that may be seen and noted. ”

“ This may result, as Tanquerel des Planches [164] pointed out nearly half a century ago, in acute insanity of the confusional type followed very often by forms of mental disorder of a chronic type resembling paretic dementia. In some cases the patient recovers from the acute insanity to suffer thereafter from epilepsy. In other cases, as Kiernan has shown, [165] an irritable suspicional condition results, in which the patient may live for years, marry, and leave offspring. This last condition and the epileptic are the most dangerous as to the production of degeneracy. ”

“ Tilt holds the very plausible view that the too strong reaction of the sexual organs on the central ganglia of the sympathetic nervous system is their principal cause of disease. Puberty, menstruation, pregnancy, lactation, or the menopause almost always entail some derangement of this system which is sometimes sufficiently severe to lead to insanity and suicide. Debility underlies all affections of the sympathetic nervous system, in the same way as nervous irritability underlies all cerebral diseases. Sometimes there is an overpowering sense of exhaustion pervading the whole system. ”

“ The patients have some insight into their condition and complain of headache, difficulty of thought, etc. Occasional delusions are observed. These may be of a hypochondriacal type or grandiose in character. As a rule the mood is cheerful, but it may be depressed, anxious or fearful, with suicidal tendencies. Sleep is disturbed and there is considerable restlessness, usually at night. With all of these symptoms there are the physical signs of a severe cortical involvement, dizziness, fainting spells, twitchings, seizures or frank convulsions, occasional paralyses, etc. ”

“ Their nervous system and mental faculties are also affected. They are irritable, nervous, depressed, and melancholic; they do not sleep at night, partially lose their memories, they suffer from violent headaches, and can not settle to work; they have all kinds of nervous and subjective pains, hysterical symptoms, and, in short, all the phenomena of nervous and mental as well as of physical exhaustion and debility. If our patients be asked the cause of these ailments, they will with one accord say that it is the hard and constant brain-work, combined with worry and perpetual anxiety. ”

“ When it does not constitute the initial stage of other types of mental disease, especially severer forms of mania, circular insanity, general paralysis, or (in the neuropathic constitutions and at the critical ages) mental degeneration, the termination is in recovery in about 90 per cent. of the cases, although sometimes some moral impairment or deterioration in character remains for life. The recklessness incident to the disease leads to unusual risks, now and then to fatal accidents. Simple mania rarely becomes chronic. ”

“ It is equally true that a misbehaving brain can report sensations that have no external cause, that have not come in through the regular channel along the nerve. The pain feels just the same, is every bit as uncomfortable as though its cause were external.
Sometimes, instead of reporting false pains, the brain misbehaves in other ways. It seems to lose its power to decide, to concentrate, or to remember. Then the patient is almost sure to fancy himself going insane. But insanity is a physical disease, implying changes or toxins in the brain cells. ”