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The Serum Cholesterol in Mental Disorders

Severalls Mental Hospital

ABSTRACT

Summary and Conclusions: This investigation was carried out on 336 cases of mental disorder of various types. It shows that in the dull, quiet group of dementia præcox cases the serum cholesterol is high, surpassing the normal limit in the majority of cases. It is also raised in most cases of manic-depressive insanity and involution melancholia, and still more so in these cases during a remission. In general paralysis it is variable, but much more frequently above than below the normal, and there is no constant change as the result of treatment. It is high in the majority of cases of psychosis associated with gross organic disease, in alcoholic mental disorders, and in most cases of senile psychosis. It is usually within normal limits in imbeciles, except when complicated by epilepsy. An increase is also found in "insanity with epilepsy." It appears that a high serum cholesterol value is to be expected in all types of mental disease, but not in imbecility.

The variations which occur with changes in the mental state are equally definite. Patients in a confused condition, or with excessive emotional reaction, have a lower serum cholesterol content than others in the same psychiatric group, unless the confusion is of very long duration, as in those epileptics who are always confused, when there is little difference. This diminished cholesterol is observed in the confusion or mood changes of dementia præcox, manic-depressive insanity, involutional melancholia and alcoholic psychoses, in the occasional confusion of epileptics, and frequently in association with the epileptic fit. By repeated tests on the same patient in varying states the fall in cholesterol associated with the acute condition was demonstrated in 52 out of 61 cases of dementia præcox, mood disorder, alcoholic psychosis and epilepsy (exclusive of the fit). It was also found in one imbecile thus investigated. It is not dependent on a high initial cholesterol value, since similar fluctuations occur when the cholesterol during the remission is within the normal limits. It is probable that such variations occur in all types of mental disorder, and it appears likely that a fall in blood cholesterol accompanies emotional reaction in the healthy individual.

So slight is our knowledge of cholesterol metabolism that it is impossible to do more than speculate on the cause of the increased blood cholesterol in mental diseases. The fall observed in acute mental states, and here suggested to be a normal accompaniment of emotion, indicates that the blood cholesterol is influenced by the central nervous system, probably by way of the sympathetic and endocrine gland systems. The nature of this influence and its biological value offer a wide field for research in cholesterol variations, not only in the insanities, but in the neuroses and in sound mental health. Further investigations are being carried out, and will be made the subject of a future communication.