SLEEPY SICKNESS

Taranaki Daily News, 7 April 1931, Page 9

SLEEPY SICKNESS

ILLUSTRATIVE CASES. CHARACTER CHANGE. (Contributed by the Mental Hospitals Department.) Following are further observations in regard to sleepy sickness. An article published last week dealt with “Onset and Symptoms.” The three following cases occurring in adolescents in New Zealand illustrate both the mental and 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 was not suspected at first, with the result that the patients graduated for hospital treatment through prison. The first case was that of a, young man aged 19, who one year after a mild attack of encephalitis became quarrelsome and irritable and on impulse left home to wander round the country, eventually becoming convicted as a rogue and vagabond. His conduct in prison was. soon noticed to be so foolish and annoying to. others that he was mentally examined. This examination resulted in committal to a mental hospital, where later hb exhibited typical post-encephali-tic signs. -The second case is even more typical. A boy of 16, following an attack of encephalitis would fall asleep continuously during the day and be unable to sleep by night (a . characteristic symptom), and apart from this he failed to give satisfaction at his work owing to his inability : to settle to any task. This was quite different from his previous character. Job succeeded job, as he was always being dismissed for the above reasons. He also became quarrelsome and irritable, and, like the preceding case, impulsively left home. He was quite conscious of his character defects, but felt indifferent to them, feeling that his will had gone. While 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 first, and this factor delayed for some 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 capable. 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 the time of his admission to hospital, which followed psychiatric examination, he showed slight physical signs of the post-encephalitic condition, which became much more marked later. The third case was in an older subject with a history of mild encephalitis. This illness was followed by four years of irregular insomnia, towards the end of which period he 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 his mental state. Although intellectually unimpaired he 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 he found himself. On admission to hospital he showed definite physical changes associated with the post-encephalitic state. The purpose of the above observations and illustrative cases is not (jo give a detailed account of the post-encephalitic 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 with an influenzal outbreak, when they are apt t-o be mistaken for the latter disease. So, if the acute stage has been missed, or too slight for the patient to seek advice (as sometimes happens), and mental symptoms follow, they may not be associated with cerebral disease. This, together with the fact that the 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 the 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 mental diseases that cause and effect are so definitely connected. At this point it may be stated that the conduct (excluding physical symptoms) of these post-encephalitic cases is • practically identical with that of tlie social defective. In England, in recognition of this type of case the clause in the 1927 Mental Defectives Act relating to moral (social) defectives does not limit the cases to those existing from birth or an early age, as in previous Acts. If the defect has existed from before IS years of age the patient can be certified as a moral (social) defective. It has been observed that a number of cases originally diagnosed as socially defective could, upon examination oi the previous history, be placed in the post-encephalitic class. The close analogy between post-encephalitic conduct disorders and the social defective type of case will strengthen the view that the latter may have its source in

abnormal cerebral conditions, and is not solely due to the result of early social and psychological environment. The treatment of these cases may be summed up in protecting the patient from his environment, and 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 the abnormalities of movement in the 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 home, where emotional ties only serve 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 the 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 these cases do better, and under supervision about 50 per cent, will do some work, while 18 per cent, will work regularly. London has provided special hospitals and set aside certain wards in its mental hospitals for post-encephali-tics alone. 11l New Zealand the number of post-encephalitics is not sufficient to require such special measures; the incidence of alb cases who exhibit the above symptoms being only about 3 or 4 per cent. Still, cases are met with every now and then, in mental hospitals or their clinics, and as shown in the examples in police courts and prisons. The disease is a possibility which should .be kept in mind by those who deal with young delinquents, particularly where the previous conduct has been good, and no explanation can be found for the change. A careful examination of the his’ory, together with neurological examination, would in several instances avoid delay in placing the patient under appropriate treatment.