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April 1948

The Metabolic Brain Diseases and Their Treatment.

Arch NeurPsych. 1948;59(4):565. doi:10.1001/archneurpsyc.1948.02300390122022

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This is a systematic presentation of the theory that the so-called functional psychoses are "metabolic encephalopathies." Under metabolic encephalopathies the author recognizes two main clinical subdivisions: (a) dysoxic encephalopathy, or dysoxia, and (b) dysglycic encephalopathy, or "dysglycia." The first group includes affective states; certain forms of paranoid, catatonic and mixed depressive-schizophrenic conditions; some forms of obsessional states, and conditions characterized by depersonalization. These conditions are due to disorders of the oxidative mechanisms and respond only to anoxic, i.e., convulsive, therapy. The second group ("dysglycia") comprises hebephrenia, "simple manic" conditions, paraphrenia and paranoia and is due to disorders of the glycolytic mechanisms. Such conditions respond only to hypoglycemic therapy, i.e., insulin shock.

"Metalobic encephalopathy is a curable and even preventable condition— provided diagnosis be early and treatment thorough and adequate... Our knowledge of cerebral physiology, the pathology of metabolic disorders, and the mechanism of neurometabolic therapy is as yet only in