Abstract
A brief review of papers dealing with emotional disturbances associated with Addison's disease is presented. It is pointed out that interest in these disturbances is very recent though the disease has been known for over one hundred years. The evidence suggests, however, that minor disturbances such as apathy, depression, seclusiveness, irritability and negativism are common while major psychoses though rare have been described by a number of authors. These psychoses fall into two groups: those in which the state appears to be a confusional one associated with disturbed electrolyte and carbohydrate balance, and those in which there is no such clear cut relationship. In both types, it now seems to be agreed that cortisone gives superior results to DCA and salt therapy; however, in some cases, cortisone may itself induce psychotic disturbances.
A case is then presented of a paranoid reaction in a man of fifty five who had suffered from Addison's disease for ten years and had received DCA and salt therapy during this time. There have been no crises and biochemical changes were not striking. The mental disturbances commenced a year and a half after the onset of the disease and appeared to be running a slowly progressive course. When cortisone treatment was commenced, an interesting change took place and for a time the paranoid reactions alternated with a depressive picture. Finally, after four months of treatment including psychotherapy, the patient made an apparently complete recovery which was maintained over a follow-up period of eight months. Reasons are given for suggesting that the paranoid State represented a total personality reaction, the result of many factors and that psychotherapy and social therapy played an important part in bringing about the satisfactory outcome. The striking benefit received from the cortisone is also emphasized.
Finally, it is suggested that, in a disease such as Addison's, which may have such complex repercussions on the life of an individual, the possibility of using psychotherapy and social therapy in addition to the standard medical treatment should always be kept in mind.