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Schizophrenia-Like Psychosis in Thyroid Crisis

  • Steven Greer (a1) and Victor Parsons (a1)


Very few cases of thyrotoxic psychoses have been reported during the last twenty years. Recent authoritative reviews on the management of thyrotoxicosis and its complications (Ingbar, 1966; Trotter, 1967) scarcely mention psychotic reactions. It seems that such conditions have become increasingly rare since the advent of modern anti-thyroid treatment. The present report attempts to summarize what is known about these disorders, and describes the clinical features, treatment and subsequent course of a schizophrenia-like psychosis which developed during thyroid crisis.



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Basedow, C. A. (1840). “Exophthalmos durch Hypertrophie des Zellgewebes in der Augenhøhle.” Wschr. ges. Heilk., March 28, Cited by Major, R. H. (1959).
Bluestone, H. (1957). “Hyperthyroidism masquerading as functional psychosis.” Amer. Practnr. Dig. Treat., 8, 557558.
Bradley, P. B. (1965). “Some aspects of drug action on brain stem mechanisms.” In: Proc. Leeds Symp. on Behavioural Disorders (ed. Jenner, ). Dagenham, Essex: May and Baker.
Bradley, P. B., Wolstencroft, J. H., Høsli, L., and Avanzino, G. L. (1966). “Neuronal basis for the central action of chlorpromazine.” Nature, 212, 14251427.
Bursten, B. (1961). “Psychoses associated with thyrotoxicosis.” Arch. gen. Psychiat., 4, 267273.
Connell, P. H. (1958). Amphetamine Psychosis. Maudsley Monogr. No. 5. London: Chapman & Hall.
Conrad, A. (1934). “The psychiatric study of hyperthyroid patients.” J. nerv. ment. Dis., 79, 505529.
Cossa, P., and Sassi, P. (1938). “Les formes psychiques pures et prévalentes de l'hyperthyroïdie.” Presse méd., 46, 493495.
Danowski, T. S., Heineman, A. C., Bonessi, J. V., and Moses, C. (1964). “Effects of thyroid hormone excesses on pressor activity and epinephrine responses.” Metabolism, 13, 747752.
De Risio, C., and Murmann, W. (1967). “Anxiety and the pulse.” Brit. med. J., i, 373.
Dewhurst, W. G. (1965). “On the chemical basis of mood.” J. psychosom Res., 9, 115127.
Dunlap, H. F., and Moersch, F. P. (1935). “Psychic manifestations associated with hyperthyroidism.” Amer. J. Psychiat., 91, 12151236.
Earll, J. M., and McDonald, H. B. (1965). “Severe thyrotoxicosis (thyroid crisis).” South West Med., 46, 373375.
Ewen, J. H. (1932). “A case of psychosis with hyperthyroidism treated with ergotamine.” Lancet, i, 342.
Foss, H. L., and Jackson, J. A. (1924). “The relationship of goitre to mental disorders.” Amer. J. med. Sci., 167, 724734.
Gaffney, T. E., Braunwald, E., and Kahler, R. L. (1961). “Effects of guanethidine on tri-iodothyronine-induced hyperthyroidism in man.” New Engl. J. Med., 265, 1620.
Granville-Grossman, K. L., and Turner, P. (1966). “The effect of propranolol on anxiety.” Lancet, i, 788790.
Graves, R. J. (1835). “Newly observed affection of the thyroid gland in females.” Lond. med. surg. J., 7, 516517.
Gregory, I. (1956). “Mental disorder associated with thyroid dysfunction.” Canad. med. Ass. J., 75, 489492.
Harrison, T. S., Siegel, J. H., Wilson, W. S., and Weber, W. J. (1967). “Adrenergic reactivity in hyperthyroidism.” Arch. Surg., 94, 396402.
Hill, D. (1953). “Psychiatric disorders of epilepsy.” Med. Press, 229, 473475.
Ingbar, S. H. (1966). “Thyrotoxic storm.” New Engl. J. Med., 274, 12521254.
Ingham, S. D., and Nielsen, J. M. (1931). “Thyroid psychosis: difficulties in diagnosis.” J. nerv. ment. Dis., 74, 271277.
Jamieson, G. R., and Wall, J. H. (1936). “Psychoses associated with hyperthyroidism.” Psychiat. Quart., 10, 464480.
Johnson, W. O. (1928). “Psychosis and hyperthyroidism.” J. nerv. ment. Dis., 67, 558566.
Kety, S. S. (1966). “Catecholamines in neuropsychiatric states.” Pharmacol. Rev., 18, 787798.
Kleinschmidt, H. J., Waxenberg, S. E., and Cuker, R. (1956). “Psychophysiology and psychiatric management of thyrotoxicosis: a two-year follow-up study.” J. Mt. Sinai Hosp., 23, 131153.
Lahey, F. H. (1931). “Apathetic thyroidism.” Ann. Surg., 93, 10261036.
Lancet (1967). Annotation: “Central action of chlorpromazine.” i, 553.
Levine, R. J., and Sjoerdsma, A. (1963). “Estimation of monoamine oxidase activity in man.” Ann. N.Y. Acad. Sci., 107, 966974.
Lidz, T., and Whitehorn, J. C. (1949). “Psychiatric problems in a thyroid clinic.” J. Amer. med. Ass., 139, 698701.
Locke, W. (1967). “Unusual manifestations of Grave's disease.” Med. Clin. N. Amer., 51, 915924.
McGee, R. R., Whittaker, R. J., and Tullis, I. F. (1959). “Apathetic thyroidism: review of the literature and report of four cases.” Ann. int. Med., 50, 14181432.
McGhie, A. (1967). “Studies of cognitive disorder in schizophrenia.” In: Recent Developments in Schizophrenia (eds. Coppen, and Walk, ). Ashford, Kent: The Royal Medico-Psychological Association.
Major, R. H. (1959). Classic Descriptions of Disease, 3rd edn., pp. 276279 and 282–284. Illinois: Thomas.
Marley, E. (1966). “Behavioural and electrophysiological effects of catecholamines.” Pharmacol. Rev., 18, 753768.
Marsden, C. D., Foley, T. H., Owen, D. A. L., and McAllister, R. G. (1967). “Peripheral beta-adrenergic receptors concerned with tremor.” Clin. Sci., 33, 5365.
Martin, E. A. (1963). “Thyrotoxic confusional state.” Irish J. med. Sci., 448, 187196.
Mayer-Gross, W., Slater, E., and Roth, M. (1960). Clinical Psychiatry, 2nd Ed. p. 327. London: Cassell.
Mittelman, B. (1933). “Psychogenic factors and psychotherapy in hyperthyreosis and rapid mental imbalance.” J. nerv. ment. Dis., 77, 465484.
Murmann, W., Almirante, L., and Saccani-Guelfi, M. (1966). “Central nervous system effects of four beta-adrenergic receptor blocking agents.” J. Pharm. Pharmacol., 18, 317318.
Packard, F. H. (1909). “An analysis of the psychosis associated with Grave's Disease.” Amer. J. Insan., 66, 189202.
Parry, C. H. (1825). Collections from the Unpublished Medical Writings, Underwoods, London, vol. II, pp. 111120, Cited by Major, R. H. (1959).
Parsons, V., and Jewitt, D. E. (1967). “The effects of adrenergic blockade in thyrotoxic crisis and arrhythmias.” Postgrad. med. J., 43, 756762.
Pond, D. A. (1957). “Psychiatric aspects of epilepsy.” J. Ind. med. Prof., 3, 1441.
Reisner, H. (1963). “Melancholie und Morbus Basedow.” Schweiz. Arch. Neurol. Psychiat., 91, 233238.
Rowlands, D. J., Howitt, G., and Markman, P. (1965). “Propranolol (Inderal) in disturbances of cardiac rhythm.” Brit. med. J., i, 891894.
Rulison, E. T., White, J. D., and Stalker, L. K. (1941). “Mental disorder associated with hyperthyroidism.” Amer. J. Surg., 54, 499501.
Sattler, H. (1909). Die Basedowsche Krankheit. Leipzig: Engelman.
Scheibel, M. E., and Scheibel, A. B. (1962). “Hallucinations and the brain stem: Reticular core.” In: Hallucinations (ed. West, ). New York: Grune and Stratton.
Slater, E., Beard, A. W., and Glithero, E. (1963). “The schizophrenia-like psychoses of epilepsy.” Brit. J. Psychiat., 109, 95150.
Staehelin, B. (1964). “Psychosomatische Aspekte bei Hyperthyreose.” Schweiz. med. Wschr., 94, 10541059.
Trotter, W. R. (1967). “The treatment of thyrotoxicosis.” Hosp. Med., 1, 680690.
Turner, P., Granville-Grossman, K. L., and Smart, J. V. (1965). “Effect of adrenergic receptor blockade on the tachycardia of thyrotoxicosis and anxiety state.” Lancet, ii, 13161318.
Vaughan Williams, E. M. (1967). “Central nervous system effects of beta-adrenergic blocking drugs.” Ann. N.Y. Acad. Sci., 139, 808814.
Voloshin, I. A. M., and Ermulovich, I. A. V. (1965). “K voprosu o taktike pri tireoidnom psikhoze.” Sovet. Med., 28, 118121.
Wahlberg, P., and Lamberg, B. A. (1963). “Iodine metabolism in a case of thyrotoxic crisis.” J. clin. Endocr., 23, 397400.
Weaver, J. A., Jones, A., and Smith, R. A. (1956). “Thyrotoxic coma (apathetic crisis).” Brit. med. J., i, 2023.
Welti, H., Baruk, H., and Mathey, Y. (1938). “Diagnostic des troubles psychiques Basedowiens et des faux syndromes mentaux d'apparence thyroidienne.” Presse méd., 46, 10361038.
Wiswell, J. G., Hurwitz, G. E., Coronho, V., Bing, O. H. L., and Child, D. L. (1963). “Urinary catecholamines and their metabolites in hyperthyroidism and hypothyroidism.” J. clin. Endocrinol., 23, 11021106.


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Schizophrenia-Like Psychosis in Thyroid Crisis

  • Steven Greer (a1) and Victor Parsons (a1)
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