SLEEPY SICKNESS

Evening Post, Volume CXI, Issue 70, 24 March 1931, Page 3

SLEEPY SICKNESS

JLLUST.RATIVE CASES

CHARACTER CHANGE

(Contributed by the Mental Hospitals; Department.) Following arc further observations in regard to sleepy sickness. An article published l;isl \vi;ck (ionIL with "Onset niul Symptoms." The three following cases occurring in adolescents in .New Zealand iJlustinto bolh Ihc menial siml physical changes which may follow epidemic encephalitis. The character changes in the first two cases preceded the physical by some months. Owing to the preservation of general intelligence* the abnormal mental condition wns not suspected at first, with the result that the patients graduated for hospital treatment through prison. The iirst case was that of a young man aged 11), who one year after a mild attack- ot! encephalitis became quarrelsome and irritable and on impulse loft home to wander round the country, eventually becoming convicted as a rogue and vagabond. His conduct in prison was soon noticed to bo .so foolish and annoying to others that he was mentally examined. This examination resulted in committal to a mental hospital, where later he exhibited typical post-omiephulitic signs. The second case is even more typical. A boy of ]0, following an attack of encephalitis would fall asleep continually during the day ami be unable to sleep by night (a characteristic, sympU.m), and apart from this he failed to give satisfaction at his work owing to inability to settle to any task. This was quite different from his previous character. .lob .succeeded job as he was always being dismissed for the above reasons. He also became quarrelsome and irritable, and-like the preceding case, impulsively lefl. home. He was quite- conscious of his character defects but felt indifferent to them, feeling that his will had gone. AVkile wandering about the country he was committed to the Borstal for vagrancy, and while there performed many foolish and mischievous misdeeds always being in trouble over his conduct. His misdeeds were- performed openly apparently from an inane sense of humour. He too showed no serious lack of general intelligence at iirst, and this factor delayed for pome time his admission to hospital. This delay was due to the impression that he was capable of understanding whether his conduct was right or -wrong. This was true, but he was not capalilo of controlling the abnormal emotional impulses to this conduct, nor could he experience the emotion of shame which might have helped to deter him, nor did he evince the slightest remorse afterwards. At tho time of his admission to hospital, which followed psychiatric examination, ho showed slight physical signs of the post-enecphalitie condition, which became much more marked later.

The third ease was in an older su 1 ■ - ;jcct with a history of mild encephalitis. This illness was followed by four years of irregular insomnia towards the cud of which period lie was noticed to suffer from slight continual trembling;. He came to hospital following a very stupid attempt to pass a cheque He had found. His behaviour when charged led to an investigation into liis mental state. Although intellectually unimpaired lie was found to be very, suggestible, and to have an easily aroused and' inane sense of humour which prompted him to. absurd acts. He was cheerfully indifferent to his conduct and to the position in which ho found himself. On. admission to hospital he showed definite physical changes associated with the post-encephalitic state. NEED OF ADVICE. 'Die purpose of the above observations and illustrative cases is not to give a detailed account of the posttsnccphalitie states, but rather to indicate the main features of the deleterious character changes that sometimes ensue. In the above account the following points are- of interest. ' The acute stage is not always easily diagnosed as mild cases of epidemic encephalitis, particularly should they coincide witv- tin influenza] outbreak when they are apt to be mistaken for the 'latter disease. So, if the acute stage has been missed or too slight for the pationt to seek advice (as sometimes happens), and mental symptoms follow they may not be associated with cerebral disease. This together with the fact that th© general intelligence may be preserved tends to prejudice those who first witness the subsequent abnormal conduct that the patient is wilful and naughty, or in older cases is an obstinate and perverse delinquent. The brief account of the effect of this disease on (ho brain is given because it is of interest in that we have a definite emotional, and volitional change produced in a patient by cerebral disease. It is in but few ineatal diseases that cause and effect are so definitely connected. At this point it may be stated that the conduct (excluding physical symptoms) of these cases is practically identical with that of the social defective. In England, in recognition of this typo of case the clause in the 1927 Mental Defectives Act relating _to moral (social) defective:? does not limit the cases to those- existing from birth or an early age as :in previous Acts. If iho defect lias existed from before 18 years of age the patient can be certified as a moral (social) defective. It has been observed that a number o£ cases originally diagnosed as socially defective could, upon examination of the previous history, bo placed in the post-encephalitic class. The close analogy between post-encephalitic conduct disorders find (ho social defectivetype of case will strengthen the view that the latter may liavn its source in abnormal cerebral conditions, and is not solely due- to tho result of carjy social and psychological environment. OUTLINES OF TREATMENT. Tho treatment of these cases may be summed up in protecting the patient from his environment, aud the environment from the patient. Drugs of a sedative character may be given to allay the excitement and restlessness when they occur, and other drugs are used which to a certain extent control tho abnormalities of movement in tbo cases with physical symptoms. The turbulent and impulsive- disposition of these patients has been described as has their resentment to discipline and parental control. It is therefore necessary for them to be removed from homo whore emotioual ties only servo to aggravate their already unstable character. Punishment too has little or no effect and only makes the patient more excitable; moreover, as there is emotional indifference to the consequences of their conduct, which is largely tho result of impulse little is to be effected from the deterrent.effect of punishment. 'It is found that under the firm but kindly discipline of a hospital environment those cases do better, and under supervision about SO per cent, will do BOine work, while IS per cent, will work regularly. London has provided special hospitals and set aside certain wards in its mental hospitals for post-cuee-phalitics alone. In New Zealand the number of post-encephalities is not siiflicieiil. to roqiuro such special meaBiivos; the incidence of all cases who exhibit the above symptoms being only about 3or i per cent. Still, cases are. .met -with w^eiy sffss' and. then,in mental' •hospitals-ui^'iiieiir clinics,-and-as .shown,

in the examples in Police Courts and prisons. '.Hie disease is a possibility ■which should }>o kept in mind by those who deal with young delinquents, particular-, ly where the previous conduct hu3 "been! good, and no explanation cart, bo found for the change. A careful examination of the history, together with nourolo* gical examination, would in several in» stances avoid, delay in placing tho pati* I tut under appropriate treatment.