Lecture 33

Abstract

By confused mania [W] we wish to identify a clinical picture that is manifest as an exaggeration, imposed at a peak of mania, and presenting as its external signs a motor impulse and conspicuous loquacity with confused content; but, in addition, as soon as we analyze its individual symptoms, it can certainly present with entirely different components. Crucial to our approach is therefore the practical and clinical perspective, that this is an acute psychosis, which can begin and end as mania, but in intervals between peaks of illness, which may predominate overwhelmingly, it often loses some typical features of mania and, in their place, acquires all manner of strange admixtures. In this complex clinical picture, the chief signs derived from mania, are flight of ideas, loquacity, and motor impulse. The foreign elements that are added range between two extremes, sometimes in pure form, usually in combination, are either psychosensory or psychomotor disorders of identification, dominated by symptoms of irritation. If confused mania is to be regarded as an independent illness, as is often in fact justified, when the initial or end stages of pure mania are only very short in duration, it could be called agitated confusion [W], and its subdivisions could be differentiated as confusion with sensory or motor agitation. In the first case agitation is based on an essentially reactive motor and speech impulse, that is, on those that can be traced back to sensory states of irritation; in the second case it takes on the guise of a hyperkinetic motility psychosis. In the vast majority of cases these two contrasting sets of phenomena occur in combination. The rarer exceptions are mainly purely sensory cases; existence of purely hyperkinetic ones must remain questionable.