Intoxication Psychoses

INTOXICATION PSYCHOSES. (518 psychiatric institutions were not encountered from 1917 to 1923.) Conversely, cases of pathological intoxication were relatively frequent in 1917, 1918, and 1920 (according to German and Austrian data). In Belgium, the total number of alcoholic psychoses decreased by 35–40% compared to pre-war figures. The number of cocaine psychoses reached a maximum in the post-war years. In 1913–18, cocaine users accounted for only 0.06% of admissions to the Berlin psychiatric clinic, whereas their number increased to 0.7% in 1919–24. During 1918–26, 15 cocaine users were admitted in Hamburg, whereas only two had passed through psychiatric institutions before that. Aronovich in Leningrad observed 9 cocaine psychoses in the single year of 1919. An even greater number of cocaine users with mental disorders passed through the psychiatric hospitals of Moscow. Among Moscow offenders, there were 9% and even 12% cocaine users. In recent years, cocaine psychoses have again become rarer, but the spread of hashish is somewhat increasing in some localities. According to Antsiferov's data in Turkestan (1923), up to 5 poods of hashish are consumed per 1,000 inhabitants. In recent literature, Landau describes 6 cases of this type of psychosis. In recent years, morphine is often replaced by heroin and pantopon. Pathological anatomy. Each of the narcotic poisons has a special affinity for nerve tissue, mainly for its lipoids, and produces certain pathological changes in it, especially distinct during chronic consumption. In alcoholic intoxication psychoses, pictures of chronic damage to nerve elements are observed in the form of thinning of the cortex, cell death, etc. In cocainism, in the case of acute poisoning, more or less pronounced hyperemia of internal organs is observed; but hyperemia of the brain and thickening of the pia mater have also been described. In chronic poisoning, numerous small hemorrhages, thromboses, chromatolysis of nerve cells, fatty degeneration, and general degenerative changes were observed in the brain. It should be noted that the brain of cocaine users has been little studied, and the cited observations were obtained mainly from the study of animals poisoned with cocaine. There is also little information on the pathological anatomy of morphinism. Pathogenesis of intoxication psychosis is far from clear. As already indicated in the etiology, one poison is not always enough for the development of psychosis. Morphine, for example, even with many years of consumption, generally does not produce ordinary psychoses. For the development of alcoholic or cocaine psychoses, years and some extraneous factors are often required. Poisoning psychoses have repeatedly served as a subject of experimental research, especially in their acute phases of intoxication. In this regard, observations on the action of hashish and even more so mescaline are of particular interest. Doses of the latter produce pictures resembling schizophrenic psychoses.

The clinical pictures of intoxication psychoses can be divided into acute reactions to the direct action of the poison and various diseases during its prolonged consumption. Acute reactions are reduced mainly to states of "intoxication." Intoxication, whether alcoholic, ether, cocaine, etc., is a short-term mental disorder with some clouding of consciousness and phenomena of psychomotor agitation. During intoxication, cortical elements are inhibited and subcortical activity is revealed. Intoxication is a dislocation and dispersion of the conscious and thinking "I," the elimination of control and inhibitions, and the discovery of subconscious and instinctive impulses. "Intoxication is as if a dream provoked outward" (Legrain), sometimes taking on the character of a nightmare. In addition to ordinary cases of intoxication, states of particularly severe intoxication, or as they are commonly called, pathological intoxication, are observed in pathological subjects. These are usually violently occurring outbursts, similar to epileptic twilight states. They are distinguished by a rapid onset, a short course, their destructive tendencies, a sharp change in consciousness, and are accompanied by amnesia. Pathological intoxication is mostly dangerous in its manifestations, as it is often associated with criminal acts, for example, inflicting injuries, violence, murder, which is why it is of great forensic medical interest. Pathological intoxication is especially often observed in persons intolerant to alcohol, in particular in epileptoid psychopaths. On the basis of chronic poisoning, both acute and more protracted intoxication psychoses arise. As a rule, such a patient has somatic changes—disorder of gastrointestinal activity, disease of the liver, kidneys, changes in the nervous system. If the psychosis disappears, the changes in the organs still remain to one degree or another. The mental picture of acute intoxication psychoses is predominantly delirious in nature. Delirious states are mostly combined with clouding of consciousness. On the affective side, a feeling of fear, apprehension, and helplessness is usually observed, but there is also euphoria. Consciousness of the disease, especially at the beginning, is present. In individual cases, there is often a state of agitation, less often—catatonic symptoms: negativism, verbigeration, stereotypy, etc. Usually, before an outbreak of acute psychosis, prodromal phenomena occur in the form of drowsiness, lethargy, and loss of strength. Often with intoxication psychoses, epileptic or epileptoid seizures are observed. Chronic or protracted intoxication psychoses resemble hallucinosis with paranoid features, the picture of Korsakoff's or amnestic syndrome with memory impairment and confabulations, or finally, they bear the character of neurasthenic weakness, moral-ethical degradation, and dementia. It can be said that if acute intoxication psychoses are colorful and rich in their picture, then, conversely, chronic ones are monotonous and pale. The picture of both acute and chronic intoxication psychoses is determined not only by the doses and characteristics of the poison consumed but to some extent also by the structure of the personality. The diagnosis of states of intoxication and acute outbursts is mostly not difficult. A well-collected anamnesis helps to clarify the etiology. Confusion is possible with infectious deliriums; in this case, the resolution of the question about the nature of the mental disorder is facilitated by measuring temperature and a general somatic examination. Chronic and protracted forms are sometimes not easy to separate from schizophrenic and paranoid diseases. The prognosis of acute outbursts is usually favorable. In chronic or protracted cases, the prediction is less favorable. Moral-ethical defects of a personality destroyed by intoxication are difficult to change, and even more so are states of dementia. The general somatic state of the patient, the work of his heart, other organs, as well as the care of the patient and his treatment, are of great importance in terms of prognosis. Therapy is reduced to the elimination of the poison, its neutralization, general strengthening, support of the heart, hydrotherapeutic procedures (mainly warm baths), and subsequently to systematic psychotherapy (re-education of the personality). In individual cases, hypnosis can be used in terms of subsequent weaning from the poison, although its value is very limited. Psychoanalysis is of great importance. Acute psychoses are subject to treatment in psychiatric institutions, chronic ones—depending on the picture and course. In most cases, a special hospital is also appropriate here. Prevention in psychoneurology in general, as well as in intoxication psychoses, is of greater importance than therapy. Limiting the production of poisons not needed in medicine and even more so in everyday life, strict control over their smuggling, caution in prescribing narcotic drugs by doctors, the fight against alcoholism as the most common form of intoxication, general socio-economic measures, sanitary-educational measures, in particular, sufficient propaganda of correct ideas in the medical and pedagogical environment, and finally, the fight against psychopathies and care for psychohygiene and proper upbringing—all this can contribute to the reduction of intoxications. Among these measures, measures for the general improvement of the environment and living conditions, the elimination of prejudices and remnants of the old past, and the widest possible development of the psychohygienic movement are especially important. Literature: Antsiferov L., Hashishism in Turkestan and psychoses in connection with it, Turkest. med. zh., vol. II, No. 10-12, 1923; Aronovich G., Observations and impressions among cocaine users, Nauchn. med., 1920, No. 8; Kutanin M., On the question of poisoning psychoses—Chronic cocainism (Works of the Psych. Clinic of the Imp. Moscow Univ., vol. III, 1916); same author, Narcomanias, Sarat. vestn. zdravookhr., vol. II, iss. 5-8, 1921; Landau L., Poisoning with "hashish", Sovr. psikhonevrologiya, vol. IV, No. 4, 1927; Prozorov L., Mental illnesses and alcoholism, Mosk. med. zh., 1923, No. 3; Sereyskiy M., Constitution of drug addicts (Works of the Psych. Clinic of the 1st Moscow State Univ., iss. 1, M., 1925); Sokolov A., Everyday alcoholism based on materials from the drug dispensary, Sovr. psikhonevrologiya, vol. VII, No. 6-7, 1929; Achard Ch., Notions generales sur les intoxications (Traite de pathologie medicale et de therapeutique appliquee, publ. sous la direction de E. Sergent, L. Ribadeau-Dumas et L. Babonneix, t. XXII, P., 1922); Bonhoeffer K., Die akuten Geisteskrankheiten der Gewohnheitstrinker, Jena, 1901; Joel E., Die Behandlung der Giftsuchten, Alkoholismus, Lpz., 1928; Joel E. u.

Frankel F., Konstitution und Konstellation in ihrer Bedeutung für den Missbrauch der Rauschgifte (Die Biologie der Person, edited by Th. Brugsch and F. Lewy, Vol. IV, Berlin-Vienna, 1929); Kraepelin E. and Lange J., Psychiatrie, Vol. II—Die Vergiftungen, Leipzig, 1927; Legrain M., Les grands narcotiques sociaux, Paris, 1925; same author, Alcoolisme (Traité de pathologie médicale et de thérapeutique appliquée, published under the direction of E. Sergent, L. Ribadeau-Dumas and L. Babonneix, Vol. XXII, Paris, 1922); Lewin L., Phantastica, Berlin, 1924; Meggendorfer F., Intoxikationspsychosen (Handbuch der Geisteskrankheiten, edited by O. Bumke, Vol. VII, Part 3, Berlin, 1928); Pohlisch K., Die Persönlichkeit und das Milieu Delirium-tremens-Kranker der Charité aus den Jahren 1912-25, Monatsschrift für Psychiatrie und Neurologie, Vol. LXIII, 1927; same author, Über psychische Reaktionsformen bei Arzneimittelvergiftungen, ibidem, Vol. LXIX, 1928; Serko A., Im Meskalinrausch, Jahrbuch für Psychiatrie und Neurologie, Vol. XXXIV, 1913; Schroeder P., Intoxikationspsychosen (Handbuch der Psychiatrie, edited by G. Aschaffenburg, Section 3, Half 1, Leipzig-Vienna, 1912); Stertz G., Zur Frage der exogenen Reaktionstypen, Deutsche Zeitschrift für Nervenheilkunde, Vol. XCVI, 1917.