Intoxic Psychoses

INTOXIC PSYCHOSES, mental disorders caused by the introduction of one or another exogenous poison. Exogenous poisonings usually act on the brain not directly, but through intermediate products - internal toxins produced as a result of exogenous intoxication. Thus, it is impossible to draw a strict division between intoxication in the direct sense and auto-intoxication. Intoxic psychoses are in many respects similar to infectious psychoses developing from the poisons of infection, and to auto-intoxic psychoses caused by endogenous poisonings. The isolation of Intoxic psychoses as a special, distinct group is dictated by practical, particularly medico-legal and therapeutic, as well as theoretical considerations. Intoxic psychoses belong to the exogenous type of reactions, i.e., to mental disorders caused by external factors; however, in their development, the constitutional factor undoubtedly plays a significant role. In a number of specific cases, it is quite difficult to determine whether a given disease is a purely endogenous psychosis or whether it is caused only by the poison consumed. An example can be various forms of alcoholic psychoses, especially forms of prolonged alcoholic delirium; some of these psychoses should be classified as diseases for the development of which a schizoid soil is apparently necessary or even the addition of a true schizophrenic process. Etiology. The pathogenic factor, i.e., the moment causing Intoxic psychoses, is the introduction of poisons into the body, of which the most important and widespread are: alcohol, ether, morphine, opium, heroin, cocaine, hashish, chloral hydrate, paraldehyde, veronal, mescaline, as well as lead, arsenic, carbon disulfide, gasoline, marsh gas, carbon monoxide, ergotin, poisons penetrating with food, poisons of fungi, animals, etc. It should be noted that the same poison (in the same doses) in one case leads to mental illness, while in another it does not create psychosis. Experience shows that the mere presence of a poison in the body is not yet sufficient to cause mental disorder. Among the mass of alcoholics, only a few show symptoms of true psychoses; lead poisoning very rarely creates a picture of mental illness, etc. In other words, for the development of Intoxic psychoses, the introduction of a poison, even if chronic, is insufficient. In most cases, additional conditions are needed, such as nutritional deficiency and other exhausting factors, injuries, infectious diseases, etc. Moreover, in a number of cases, the presence of psychopathic predisposition can be proven or assumed with great probability, which plays an important role in such poisonings also in another respect, namely: the craving for the poison is largely determined by the peculiarities of the morbid character of the personality. The passion for intoxication and narcotization is usually closely connected with a psychopathic constitution. Thus, delirium tremens, alcoholic hallucinosis, cocaine psychoses, pica, heroinism, etc., are to some extent also endogenously conditioned, although we do not know what constitutes the predisposition to Intoxic psychoses. But on the other hand, in intoxications more than anywhere else, the enormous importance of the environment and the entire sum of social conditions comes to the fore. Economic factors, living conditions, customs, surrounding environment, examples, imitation, fashion - all this influences the development and spread of intoxications. In addition, individual moments are also not without significance: moral shocks, life conflicts, various difficulties in personal, family and social life, loneliness, disappointment and as a result - the desire to induce artificial euphoria; all these moments contribute to narcotization and thus prepare the ground for Intoxic psychoses. It is known that morphinists become mainly persons of the medical profession or their relatives; alcoholics are especially numerous where alcoholic beverages are manufactured or sold, etc. Cocaine, and in recent years hashish, are particularly widespread in the criminal environment. External conditions, cheapness of the product, or conversely, its increased price or prohibition, contribute to the appearance or disappearance of one or another intoxication epidemic. Illustrations can be the outbreaks of drug addiction during the prohibition of alcoholic beverages, the replacement of cocaine addiction with hashish addiction, morphinism with heroinism, etc. Thus, the social factor plays a particularly large role in intoxications, which must be taken into account when discussing the prevention and treatment of intoxication psychoses. Statistics. The social factor in the development and spread of Intoxic psychoses finds its expression also in the numerical data relating to this question. True, statistics here are extremely conditional and imperfect. Very many, especially mild cases, escape calculation, ending in a short time in a home, rather than hospital setting. Despite the shortcomings of statistics, it can still be established that Intoxic psychoses differ among different peoples, in different countries, in different population groups, and in different historical periods. In women, Intoxic psychoses occur significantly less frequently than in men. The age range fluctuates between 25-45 years. However, in view of the fact that intoxications, like life conflicts, begin at a young age and that psychoses of poisoning develop only after several years of systematic use of the poison, the majority of Intoxic psychoses occur at the age of 30-40 years. If before the war Intoxic psychoses were represented mainly by alcoholic mental disorders, then the war and post-war years gave rise to cocaine, heroin and other forms of chronic poisoning. Fluctuations in figures in connection with the war and post-war political and social changes are very revealing. Thus, delirium tremens constituted 16-18% of admissions to psychiatric clinics (e.g. in Berlin) in 1901-02, whereas in 1915-16 these cases did not exceed 1-2%. In 1917-19, delirium tremens disappeared almost completely, and only from 1922 was a noticeable increase observed. The same phenomenon was noted in Russian hospitals and clinics. (In Saratov, for example, delirium tremens in