900 HAEVEY G. BECK 



General Pressure Symptoms 



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Psychic Disturbances. Manifestations of psychic disturbances may 

 result (1) from increased intracranial pressure, especially from a growth 

 involving the temporal and frontal lobes, and (2) from insufficient glandu- 

 lar secretion. Some of the former have been enumerated under neigh- 

 borhood symptoms, but in addition states of excitement, depression, psy- 

 choneurosis, and even hallucinations may develop. Lassitude, torpidity, 

 and drowsiness are among the earliest symptoms. 



Lesions involving the frontal lobes gives rise to such symptoms as im- 

 pairment of memory, disorientation, untidiness, apathy, and stupor. 

 Children suffering with hypopituitarism are usually temperamentally dull 

 and apathetic, and are backward in their studies. They are usually 

 irritable and often have difficulties with their playmates because of their 

 lack of self-reliance and self-control. 



As a result of insufficiency of the pituitary gland mental symptoms 

 frequently develop, which vary from a mild psychosis to advanced forms 

 of epilepsy and insanity. Beverly Tucker ascribes to the pituitary cer- 

 tain psychoses of adolescence some of which he attributes to hyper- 

 pituitarism, others to hypopituitarism. The latter he divides into two 

 groups. The commonest psychosis resembles dementia praecox. The pre- 

 adolescent symptoms are negligible. The patients begin to be dull in their 

 studies, seclusive, and self-absorbed. Repetition of movements is com- 

 mon ; hallucinations and delusions may or may not be present. They have 

 difficulty in expressing themselves in writing, and are usually unemotional 

 and unaffectionate, and obstinate and irritable when disturbed. There 

 is thickening and enlargement of the clinoid processes, but the sella is 

 about normal in size. To another group belong those cases in which the 

 psychosis is not very profound. It consists chiefly of irritability, mental 

 dullness, tardiness, truancy, and general lack of ambition, and in some 

 cases epileptiform seizures. Eontgenograms show a small crowded fossa. 

 A special form of hypophyseal psychosis has been described with con- 

 fusional states and narcolepsy as the chief symptom (Tom Williams). 

 Other psychic manifestations are lack of emotional inhibition, highly 

 excitable states alternating with sluggishness, frequently phobias and com- 

 pulsions, and moral and sexual obliquities, characteristics modified by 

 pituitary feeding ( Timme ( b ) ) . 



The narcoleptic attacks are not attributed to a secretory disturbance 

 of the pituitary gland. They are a p'art of a syndrome in which symp- 

 toms of cardiovascular irregularities occur; namely, tachycardia, arrhyth- 

 mia, extrasystoles, embryocardia, and hypertension in addition to poly- 

 uria and polydipsia; according to the experimental observations of Ash- 

 ner(a), J. Camus and G. Eoussy(a) the entire syndrome can be produced 



