PHYSIOLOGIC AND PSYCHOLOGIC STUDIES IN SPONTANEOUS HYPOGLYCEMIA

Abstract

The history is presented of an emotionally rigid, sensitive, and dependent person with considerable repressed aggression, who experienced recurrent episodes of confusion, dyskinetic movement and uninhibited emotional behavior. Initially diagnosed as hysterical fugue states, further observation and study determined that these phenomena were associated with hypoglycemia due to a benignislet cell adenoma of the pancreas. Following removal of the adenoma, these episodes were eliminated, although the essential nature of his personality structure remained unchanged. Attention is drawn to the fact that diagnostic error occurs frequently in the study of the neurotic person; that the principal sources of error lie in methods directed toward exclusion of positive data related to physical disease or psychosis. The need for the establishment of positive evidences of neurotic personality structure is emphasized. The relationship between the basic physiologic dysfunction (decreased cerebral metabolism) and the resultant intellectual, motor and emotional behavior is discussed. It is suggested that inhibition and repression may be the physiologic and psychologic expressions of a basic phenomenon. With loss or impairment of either, as in this patient, and possibly in all delirious patients, there is evidenced release of concrete intellectual activity, less integrated neurologic behavior and less repressed emotional expression. A further consideration was the relationship of this patient's behavior in particular to the problem of delirium in general. As in all deliria, the primary psychologic disturbance lay in the level of awareness. This disturbance of consciousness, together with the varied neurologic symptomatology, is of a more or less impersonal nature. The emotional behavior dependent for its expression on the degree of disturbance of consciousness is more individualized and specific, not to the noxious stimulus, but to the personality structure of the delirious patient.