Descriptive Psychopathology: The Signs and Symptoms of ...

209 Chapter 8: Disturbances in emotional experienceas is very frequent, formed the prelude. The patient rapidly becomes restless, disconnected intheir talk, and perpetrate all sorts of curious actions. 49John Haslam, 50 recognizing the “stages of mania” more than 170 years beforeCarlson and Goodwin brought them again to the attention of psychiatry, 51detailed the unfolding symptoms. This is important for diagnosis, because in itsmost severe stage mania can be mistaken for a metabolic or toxic delirium or forparanoid schizophrenia, resulting in inappropriate treatments. 52On the approach of mania they first become uneasy, are incapable of confining their attention,and neglect any employment to which they have been accustomed; they get little sleep, they areloquacious, and disposed to harangue, and decide promptly and positively upon every subjectthat may be started. Soon after, they are divested of all restraint in the declaration of theiropinions of those, with whom they are acquainted. Their friendships are expressed with fervencyand extravagance, their enmities with intolerance and disgust. They now become impatientof contradiction and scorn reproof. For supposed injuries, they are inclined to quarrel andfight with those about them. They have all the appearance of persons inebriated ... At lengthsuspicion creeps in upon the mind, they are aware of plots, which had never been contrived, anddetect motives that were never entertained. At last the succession of ideas is too rapid to beexamined; the mind becomes crowded with thoughts, and confusion ensues. (Haslam, 1809/1976, pp. 41–3)Hammond also recognized that an episode of mania emerged with “a prodromaticstage” that lasted “several days, or even weeks.” Then:The most prominent symptoms which others observe in a person about to become the subjectof acute mania are excessive irritability of temper from very slight causes, a general conditionof unreasonableness, suspicions against those he has always esteemed and trusted, and markedchanges in his modes of feeling and of expression. His subjective symptoms are pain oruneasiness in the head, vague fears, for which he cannot account, an indisposition to indulgein mental efforts, and often an impossibility of concentrating the attention on any matterrequiring any considerable amount of thought, wakefulness, and sleep, when obtained, inquietand disturbed by morbid dreams.As the affliction advances to fuller development, these symptoms are all increased inviolence, and others make their appearance ... His dislike of friends and relations becomespronounced, and he either treats them with unnatural indifference, or exhibits a degree ofactive hostility productive of ill feelings and quarrels ... From having been economical, hebecomes prodigal; from having been temperate and sedate in language, he becomes extravagantand profane; from having held the most moral sentiments, he expresses licentious and obsceneviews; his ideas are expressed in incoherent language, and often the ideas themselves are illogicaland incomprehensible. His handwriting becomes more or less illegible, words are omitted, lettersare dropped, he misplaces the date and signature, and introduces phrases which have no relationto the subject ... (Hammond, 1883, p.53)