Okayama Igakkai Zasshi (Journal of Okayama Medical Association)
Online ISSN : 1882-4528
Print ISSN : 0030-1558
A case of atypical psychosis characterized by periodic stupor, with marked epileptic factors
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1969 Volume 81 Issue 1-2 Pages 71-83


A 16-year old girl. It is said that there was a psychotic case in the relatives on the paternal side of the patient. Her hereditary history remains obscure, but her own history is uneventful.
A review was made of this case who had episodes of stuporous state six times, and episodes of delutional-hallucinatory state twice since the age of 13. Clinical and EEG observations were carried out from Nov. 1965 to Aug. 1966, and from March 1967 to July 1967 when she was admitted to our clinic. The results are breifly summarized as follows.
The stuporous state which presented mutism and akinesia as the principal symptom was difficult to differentiate from the stupor observable in schizophrenia, and it developed in a day or two at the onset, which lasted for about two weeks and then was alleviated. During this period of episodes she showed no noteworthy symptom of disturbed consciousness and she could recall what had happened to her precisely.
Her EEG revealed that paroxysmal abnormal waves characterized by spike wave were inhibited during the stuporous state, but in the stage of remission paroxysmal abnormal waves appeared spontaneously and were activated easily by hyperventilation.
This stuporous state could be alleviated transiently by the administration of amytal sodium, and also with a large dose of valium it was improved. On the contrary, anti-epileptic agents had no effect at all on the stuporous state.
From the characteristic features of the psychotic state, this case could be construed as a type of atypical psychosis, but paroxysmal abnomality on EEG was similar to that of epilepsy, and so this was the case that had clearly shown to stand on the boundary line between atypical psychosis and epilepsy. Therefore, it seemed that epileptic factors of atypical psychosis should be dicided only after long, continuous observations of the case.
Some discussion was made on physiological mechanism inducing a stuporous state. Namely, the mechanism that induced a stuporous state seemed to have a close relation to the excitation of system which tried to inhibit the abnormal EEG, and this system was provably the reticular formation system of the midbrain.

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