Primary process thinking in myxoedema psychosis: A case study.

Abstract

The rapid mental changes taking {dace in a 17-year-old female patient suffering from myxoedema psychosis were investigated using the Holt scoring system for measuring primary process from Rorschach responses. As is typical for this condition, treatment with desiccated thyroid resulted in almost immediate improvement. Two examiners independently scored for primary process the three Rorschachs which were administered over a seven-month period. Results indicated satisfactory reliability between the two scorers. The most important finding was a drop in the amount of over-all formal level primary process thinking. This drop in the objective measures of pathological thinking reflected the improvement in the patient's clinical physical and mental state. Thyriod deficiency may precipitate a personality disorder ranging from mild anxiety and depression to the severe schizophrenic-like and manic states characterizing myxoedema psychosis. It is generally agreed that while the metabolic changes associated with myxoedema set off the psychotic reaction, the pattern of this reaction is determined by the preexisting personality structure. In many cases, treatment with desiccated thyroid results in almost immediate improvement. While some authors who describe such cases are impressed by their relative frequency (Berris & Owen, 1965), there are no adequate figures available which note the incidence in the general population or in the psychiatric institution. On the other hand, an estimate has been made that only 10 per cent of patients develop a psychosis when myxoedematous (Hollander et al., 1965). Certainly when a case does appear in the psychiatry department of a general hospital, interest is immediately aroused because of the infrequency with which this condition is diagnosed in such settings and especially because treatment gives us the opportunity to investigate extremely rapid personality changes over a short time span. The development of a scoring system for determining primary process thinking from Rorschach responses (Holt, 1962) provides us with an instrument for objectively measuring such rapid mental changes over a * We wish to express our appreciation to Dr. Robert R. Holt for his critique and helpful ideas, some of which have been incorporated in this article. f Present address: Jewish General Hospital, 3755 Cote St. Catherine Rd., Montreal 26, P.Q.