Disturbances of Glucose Tolerance and of the Acid-Base Equilibrium in Manic-Depressive Insanity

Abstract

It has been recognized for many years that in certain cases of mental disorder there is a demonstrable disturbance of carbohydrate metabolism. Among early observations may be mentioned those of Raimann (1902), Schultz and Knauer (1909) and Laudenheimer (1898). These workers reported the presence of sugar in the urine of patients suffering from depressive and anxiety states, and noted that the glycosuria often varied with the severity of the mental disturbances and disappeared with them. They remarked, however, that the phenomenon was of little diagnostic importance, inasmuch as it could be found in depressive states associated with many different types of mental illness. Such observations were of value as an indication for further research, but until it was established that the glycosuria was not due to a derangement of the renal mechanism of sugar excretion, it could not be claimed that the findings indicated such a fundamental metabolic disturbance as is now known to exist. Although Santenoise and Tinel (1923) stated that the renal threshold varies according to the mental state of the patient, many more recent workers have shown that the increased sugar excretion is always associated with a greater or less degree of hyperglycæmia, and, although agreement on this point is not complete, the balance of evidence favours the belief that such hyperglycæmia is alimentary in origin, and not spontaneous. As the earliest workers appeared to recognize, the metabolic disturbance is found mainly in states of depression, which may be retarded or agitated, and in certain cases of schizophrenia, which, too, may be stuporose or restless. Some investigators are of the opinion that the same disturbance may be found in states of mania as well as or even to the exclusion of depressive states, but this is a view which is held only by a minority.