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fects than in failure of the mitralis. The symp-
toms of mental disturbance here partake more of
the nature of mania, and resemble the delirium of
alcoholic pneumonia. Extreme irritability, ex-
citement, fretfulness, restlessness, inconsistency,
querulousness, make it allopurinol 20 mg sometimes very difficult
to control- the patient. The contrast between his
usual ways of acting allopurinol online and thinking, and the ob-
served change in temper not infrequently amount-
ing to violence, is so striking, that suspicions of allopurinol cost
insanity even enter the mind of cost of allopurinol those who take buy allopurinol online
care of him. These suspicions are often too well
founded, and become confirmed in the outbreak
of a real mania with all the distressing features
and consequences of this special form of psycho-
sis. Troublesome and exhaustive sleeplessness
is especially noticeable in aortic insufficiency.
A strict correspondence between the variety of
heart disease and the allopurinol rxlist form of insanity, is naturally
not to be expected, allopurinol 150 mg although Mickle" has made the
attempt to divide the different cardiac affections
in nine groups, according to the more or less typi-
cal mental disorders that they are apt to produce.
It is not always that these disorders run the same
course in the cardiac aft'ections with which they
are connected. Almost every case of mania, as
has been rightly said, commences with a stage of
depression. Hypochondriacal ideas may grad-
ually and ultimately allopurinol uk develop into delusions, gen-
eral irritability turn into maniacal excitement.
A classification of mental and cardiac disturb-
ances in their respective dependence on one an-
other would, therefore, prove a difficult and un-
grateful task.
Looking over the literature of the subject, in
which the bulk of contributions belongs to the
alienists, we find that the mental disturbances in
cardiac patients have not escaped the attention
of both the specialists and the clinicians in gen-
eral. Aside from the standard te.xt-books on
medicine which devote from a few lines to half
a page to this complication, mention of it is, of
course, largely made in most of the works on
mental diseases. Altogether, one gets the im-
pression that not much importance is attached to
the direct influence of valvular and heart dis-
orders on the appearance and development of ab-
normal mental conditions. Osier' says : "In gen-
'VV. Julius Mickle, Insanity in Relation to Cardiac and Aortic
Disease. Gulstonian Lectures, Lancet, 188S, p. 9:1; also Tuke's
Dictionary of Psychological Medicine.
'Principles and Practice of Medicine, 3d Ed., p. 713.
July 2y, 1901.]
ZEDERBAUM: MENTAL DISTURBANCES.
157
eral medical practice we seldom find marked men-
tal symptoms (in connection with heart affec-
tions), except toward the close of the disease,
when there may be delirium, hallucinations, and
morbid impulses. We do meet insanity, break- allopurinol brand names
ing out in patients with aortic and mitral disease,
in the stage allopurinol brand name of compensation, which appears to be
related definitely to the allopurinol generic name cardiac disease." In the
most excellent French cyclopaedia of Charcot,
Bouchard, and Brissaud", in the chapter on mania,
melancholia, and other forms of psychoses, car-
diac disease is not enumerated among the setio-
logic factors occasionally responsible for these
mental conditions. In the chapters on anaemia
and hyperemia of the brain, Brissaud'" considers
it probable that circulatory derangements orig-
inating allopurinol pharmacology from heart disease may sometimes have
something starting allopurinol allopurinol tablets 100mg to do with insanity, but he adds that
there is not always foundation in what is allopurinol 300 mg the belief that
the mental excitability in these cases is actually
associated with congestion. Yet, the expression
folie cardiaque is of French origin (Lasegue, Hu-
chard), and designates the acute delirium ob-
served in connection with cerebral congestion
when the heart is asystolic. Savage^^ is more ex-
plicit on the allopurinol 50 mg subject. He says : "With aortic, or brand name for allopurinol
both aortic and mitral disease, the symptoms may
be either melancholic or maniacal ; but I am in-
clined to think order allopurinol that with simple aortic disease,
with hypertrophy of the left ventricle, it is at least
not uncommon to meet with acute mania and ex-
altation of ideas. In doubtful cases of men with
exaltation of ideas, I expect to find allopurinol iv post mortem
hypertrophy of the left ventricle and atheroma of
the aorta with more or less brain change."
Most of the writers express themselves very
cautiously with regard to the close relation be-
tween mental and cardiac disturbances. That
incompetency of the aortic valves is more liable to
affect the brain than pathological conditions of
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