ON THE PREVENTION OF LOSS OF WEIGHT IN THE PSYCHOSES

Abstract

One of the problems that confronts the physician who treats mental disorders is how to prevent the loss of weight that occurs in acute mental cases. In manic-depressive psychosis the body weight often steadily diminishes during the course of the illness so that death due to exhaustion is a not infrequent termination of the disorder.’ Schizophrenics, too, are commonly poorly nourished. At the beginning of the psychosis patients with schizophrenia often diminish in weight to an alarming degree. Patients with catatonic excitement present the most difficult problem of nutrition in the schizophrenic group. Qinical evidence of dehydration is present, such as dry skin, a dry parched tongue and a foul mouth odor. Frequently these patients refuse food and have to be tube-fed. In the manic phase of manic-depressive psychosis and in catatonic excitement the diminution of weight may continue despite all efforts to maintain the nutrition. This may be due to the hyperactivity presented by these patients. However, I have also observed a diminution in weight in the inactive schizophrenic in the acute stage. This somtimes occurs despite an apparently sufficient food intake. Bamford 2 reports cases of acute schizophrenia in which there was a progressive loss of weight with no sign of physical disease. “In all cases, whether stupor or excitement predominates, the rapid and profound physical wasting constitutes a very prominent feature of the disease. Unless this be attributed to severe metabolic disturbances of endocrine origin, it is difficult to find a satisfactory cause. Throughout the course of the illness, one looks in vain for symptoms and physical signs of any associated bodily disease to account for the emaciation.” As a working hypothesis it seems reasonable to assume that the factor responsible for the diminution in weight is a disturbance in metabolism, particularly that of water.