[Delirium metabolicum and rigid involutional depression in older age]

A melancholic-schizophrenic mixed psychosis is described in a 64-year-old man. It was diagnosed as a 'rigid (or catatonic) involutional depression' (Medow, 1922), showing besides hypochondriacal, nihilistic and micromanic delusions, a transient delusional syndrome of 'Delirium metabolicum' (Mendel, 1902), with zo-anthropy. An attempt was made to avoid the differential diagnostic classification of that clinical picture into involutional melancholia (296.0) and paranoid psychosis of involutional age (197.1) which, as in so many psychoses of the older age groups, is quite inadequate. Thus the psychopathological phenomena of the psychosis, which after all are the only reliable data, were attributed on the one hand to the senile deterioration and slight but demonstrable arteriosclerosis of the brain, and on the other hand, to the conspicuous premorbid characteristics which correspond to an anankastic psychopathy with a depressive-inadequate basic mood. It was considered as likely that the Delirium metabolicum represented an exogenous (organic) psychotic syndrome, and that the precipitation of the psychosis as well as its development into an enfeebled endstate was due to an organic brain lesion, while the catatoniformpsychomotor phenomena and the melancholic stupor were crystalisations of traits in the premorbid personality.