Myxedema With Psychosis

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Abstract
SINCE the earliest clinical descriptions by Gull1 and Ord,2 emotional difficulties have been described as part of the syndrome of myxedema. In the Clinical Society of London Report of 1888,3 an extensive discussion based on 109 cases investigated over a five-year period concluded "Delusions and hallucinations occur in nearly half the cases, mainly where the disease is advanced. Insanity, as a complication, is noted in about the same proportion as delusions and hallucinations. It takes the form of acute or of chronic mania, dementia or melancholia, with a marked predominance of suspicion and self-accusation. Agoraphobia is present in a smaller proportion than the mental changes previously noted." Kraepelin,4 in a discussion of patients with what he considered to be a specific "myxedematous insanity," stated "In emotional attitude it is characteristic for them to be anxious, dejected, and at times fearful. Sometimes

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