James H. Wall

Some psychiatric aspects of suicide

Society today seems baffled by the problem of suicide. The commonly expressed rationalizations to account for its increase in times of depression, a determined effort on the part of relatives and others through dread or embarrassment of its implications to conceal true facts, together with a general misconception of its deeper significance, combine to render inadequate the advice and assistance of those who could do much toward decreasing its incidence. As psychiatrists we find suicide so often a factor to deal with among our patients that we necessarily have to recognize it as an important part of our responsibilities. We hope to show, in presenting this group of patients who committed suicide in a psychiatric hospital, or at least were under treatment there at one time, that certain principles of practical value may be observed. There is undoubtedly a defin:ite correlation between the suicidal drives of these patients and the suicidal desires of a larger number of persons who never came to the hospital for treatment, but the problem has many aspects and only certain features are emphasized at this time. Our group of patients was obtained from a survey of cases dating back to 1912. Over this period of 20 years 11 men and 3 women died by suicide in the hospital. Compared to those under treatment during these years, this number represents a minute percentage of the whole. How many cases discharged during this period eventually committed suicide is not known. The group used to complete our 25 cases was selected from hospital records of patients discharged in recent years to which follow-up notes, including suicidal data, had been added. Various statistical studies of suicide have been made and the features observed by others are for the most part in keeping with our small number. For instance, age is regarded as a significant factor, the suicide rate increasing with advancing years. Children rarely commit suicide, but beginning with adolescence each decade

Psychoses associated with hyperthyroidism

Psychoses due to thyroid disease are not very colmnon, particularly with myxedema and cretinism (hypofunction). In exophthalmic goitre and toxic adenoma (hyperfunetion) there is more or less nervous tension and irritability, with a varying degree of emotional instability. Usually, if the thyroid condition responds satisfactorily to treatment, these symptoms disappear gradually. On the other hand, an occasional patient will show more serious nervous or mental manifestations. The psychosis which develops with hyperthyroidism may simulate a variety of clinical syndromes, so far as mood and trend are concerned. Its organic nature is indicated by defects in orientat-ion and memory, but the life history of the patient needs careful study and consideration to obtain adequate criteria for diagnosis and treatment. Nevertheless, the relationship between hyperthyroidism and an associated psychosis is not always clear. Hammes 1 has stated that he believes that psychoses encountered with hyperthyroidism could readily be classified with, and have the usual characteristics of, the ordinary p~ychoses; in other words, that hyperthyroidism is only an associated condition, and not an etiological factor in the mental picture. Walker 2 believed that when a psychosis and hyperthyroidism were associated, the thyrotoxicosis was etiologicM. White 3 stated that mental symptoms accompanying exophthalmic goitre are those of fear and apprehension, not infrequently associated with hallucinations of hearing and vision. Nolan D. C. Lewis 4 has stated that all symptoms of hyperthyroidism, including the chemical, physiological, and psychological, are exact duplicates of those of fear. Foss and Jackson, 5 in presenting datu on a large Series of cases of goitre, expressed the opinion that goitre is rarely the cause of mental disorders, and stated that out of 1,700 cases there were only two patients showing

Toxic states as complications in functional psychoses etiology and treatment

Toxic psychoses are frequently seen and toxic symptoms of more or less intensity are noted in other psychoses at intervals. However, it is not of these that we especially refer at present, but to a group of cases in which the toxic picture covered for the time being an already established psychosis. Undoubtedly if a review of the statistical diagnoses of a year or more admissions were made in any psychiatric hospital there would be found cases labeled toxic-exhaustive or drug psychoses who seemed to have continued psychotic or who have shown an unusually prolonged so-called transitional state through the convalescent period. Again certain cases are noted on admission as being semidelirious with a temperature, considerable dehydration, leucocytosis and other signs of a toxemia, all of which is accepted as inevitable due to the patient s original disturbed condition. We have had a number of such cases under our observation at Bloomingdale and have studied them with the following in mind. What caused the so-called toxic condition? Is it any different than the usual toxic-exhaustive state ? Does it affect the ultimate course of the psychosis ? What is the treatment and could it have been prevented? We have selected t h e following four cases, presenting them in brief summary as examples of the study.