The diagnosis of chronic mania was at one time one of the most common in psychiatry. To-day there can be no doubt that many cases formerly thus labeled belong to excited forms of dementia praecox, particularly catatonic excitements: many, but not all. Chronic mania, though rare, certainly infinitely more rare than was believed by older authors, constitutes none the less a reality. Cases exist presenting all the symptoms characteristic of the manic state - flight of ideas, excitement, morbid irritability, pressure of activity, etc. - and in which these symptoms, instead of being intermittent, become established in definitely chronic fashion.
Chronic forms are seen chiefly in elderly subjects, after the age of fifty. It is exceptional for a chronic manic state to-be installed as such from the beginning. More often it follows one or more acute attacks. The patient has one, two, three attacks from which he recovers completely; then comes on another attack in every way resembling the previous ones; the excitement subsides somewhat, periods of relative calm occur at intervals; recovery seems to be approaching, but the condition continues indefinitely and it finally becomes apparent that the acute maniac has become a chronic maniac. At times the chronic state is marked by extreme weakness of attention; this was observed in the following case, the history of which we shall cite briefly, and which may serve as a general type:
Mrs. C. J., two of whose cousins are insane, was born in 1844. In 1869, that is, at the age of twenty-five years, following a confinement, she had an attack consisting of a period of depression and one of excitement, the whole attack lasting eighteen months. She recovered and remained well until 1891, when, without apparent cause, she had a similar attack from which she recovered at the end of two years, following a surgical operation upon the uterus. In 1901 a third attack: period of depression lasting several months, later, following a trip on which she was taken for diversion, sudden appearance of the manic state. Another surgical operation upon the uterus was tried, but without any result. Since 1901 excitement, flight of ideas, and logorrhcea have persisted with intervals of lucidity which gradually became rarer and shorter. These intervals, which at first lasted several days, have not lasted longer than one or two hours during the first half of 1908. At the present time (September, 1908) they hardly exceed half an hour and, as already stated, they are notably more rare than during the first year of the disease. Moreover, even in the moments of lucidity which still occur from time to time, a certain degree of mental deterioration is observed.
Affectivity is reduced, recollections are lacking in precision, attention is fixed with some difficulty, and orientation of time is defective. There seems to be no doubt that we are here dealing with a state of chronic mania with slight mental deterioration. The most pronounced disorder, the one which especially characterizes the case in question and distinguishes it from ordinary manic-depressive cases is an extreme weakness of attention, a weakness which is out of all proportion to the motor excitement, and which makes it impossible to obtain a sensible reply even to the simplest questions, while at the same time it is easy to obtain relative psychomotor calm, sufficient, for instance, to keep the patient seated in a chair.