Myxedema With Psychosis

SINCE the earliest clinical descriptions by Gull¹and Ord,²emotional difficulties have been described as part of the syndrome of myxedema. In the Clinical Society of London Report of 1888,³an extensive discussion based on 109 cases investigated over a five-year period concluded "Delusions and hallucinations occur in nearly half the cases, mainly where the disease is advanced. Insanity, as a complication, is noted in about the same proportion as delusions and hallucinations. It takes the form of acute or of chronic mania, dementia or melancholia, with a marked predominance of suspicion and self-accusation. Agoraphobia is present in a smaller proportion than the mental changes previously noted." Kraepelin,⁴in a discussion of patients with what he considered to be a specific "myxedematous insanity," stated "In emotional attitude it is characteristic for them to be anxious, dejected, and at times fearful. Sometimes