The paramount importance of insomnia as a symptom of mental disease always places the discussion of the indications for and the use of hypnotic remedies foremost in the therapeutics of psychiatry.
In discussing the subject I shall consider two phases of insomnia: 1, The insomnia characteristic of the early stages of mental disturbances, and, 2, the insomnia encountered after the psychosis has become well established. The two differ from each other and demand radically different methods of treatment.
The insomnia of the prodromal period is an almost invariable symptom, varying in intensity from the simple mild form of sleeplessness to the most aggravating and intractable, demanding drastic procedure. It may exist for many months before the outbreak of the more acute symptoms. It has no marked distinguishing features, but is usually accompanied by some more or less definite head symptoms which tend to reveal its true character. The great