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A MECHANISM OF FATIGUE IN NEUROPSYCHIATRIC PATIENTS: Title and subTitle BreakA PRELIMINARY REPORT FREE

SIDNEY A. PORTIS, M.D.; IRVING H. ZITMAN, M.D.
[+] Author Affiliations

Read before the American Society for Research in Psychosomatic Problems, inaugural meeting, New York, Dec. 18, 1942.


Associate Professor of Medicine, University of Illinois College of Medicine; CHICAGO

From the Medical Department of the Michael Reese Hospital and the University of Illinois College of Medicine.


JAMA. 1943;121(8):569-573. doi:10.1001/jama.1943.02840080017004
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Fatigue is frequently observed in patients with neuropsychiatric complaints. The mechanism by which fatigue is produced has been little understood by either neuropsychiatrists or others. This preliminary report presents evidence suggesting one of the possible mechanisms and the animal experimentation on which the procedures adopted are based.

Spontaneous hypoglycemia has been noted by many investigators who have attempted to define the variety of settings in which it occurs. Previously Harris,1 Ross and Josephs2 and more recently Wauchope,3 Conn, Wilder and others have reviewed the subject.

Blood sugar levels may fall following interference with many factors in the normal homeostatic mechanism. Liver disease and disease of the pancreas, either from known adenoma or from hyperplasia of the islands of Langerhans, have been cited as the important factors which may cause spontaneous hypoglycemia. Faulty dieting, including errors in intake of carbohydrates and the lack of assimilable vitamins, has also

REFERENCES

Harris, Seale:  Hyperinsulinism and Dysinsulinism , J. A. M. A. 83:729 ( (Sept. 6) ) 1924;
 Hyperinsulinism and Dysinsulinism (Insulogenic Hypoglycemia) , Internat. Clin. 1:9 ( (March) ) 1932;.
Ross, S. G., and Josephs, H. W.:  Metabolism of Recurrent Vomiting , Am. J. Dis. Child. 28:447 ( (Oct.) ) 1924;.
Wauchope, G. M.:  Hypoglycemia: Critical Review , Quart. J. Med. 2: 117 ( (Jan.) ) 1933;.
Rennie, T. A. C., and Howard, J. E.:  Hypoglycemia and Tension-Depression , Psychosom. Med. 4:273 ( (July) ) 1942;.
Gentes, M.:  Notes sur les terminaisons nerveuses d'îlots de Langerhans du pancréas , Compt. rend. Soc. de biol. 54:212, 1902;.
McCrea, E. D.:  The Abdominal Distribution of the Vagus , J. Anat. 59: 18, 1924;-1925.
Britton, S. W.:  Studies on the Conditions of Activity in Endocrine Glands , Am. J. Physiol. 74:291 ( (Oct.) ) 1925;.
Dietrich, S.:  Untersuchungen über Diabetes und Insulinwirkung: XII. Mitteilung. Der direkte Nachweis der Insulin sekretion des Pancrease , Arch. f. exper. Path. u. Pharmakol. 125:336, 1927;.
Clark, G. A.:  The Influence of the Vagus on the Islets of Langerhans: Part I. Vagus Hypoglycemia , J. Physiol. 59:466 ( (March) ) 1925;.
La Barre, J.:  Sur l'augmentation de la teneur en insuline du sang veineux pancréatique après excitation du nerf vague , Compt. rend. Soc. de biol. 96: 193 ( (Jan. 28) ) 1927;.
La Barre, J.:  The Role of the Central Nervous System in the Control of Pancreatic Secretion: I. The Secretion of Insulin During Hypoglycemia , Am. J. Physiol. 94: 13 ( (July) ) 1930;.
Gayet, R., and Guillaumie, M.:  Expériences concernant l'effet de l'excitation électrique du vague sur l'insulino-sécrétion , Compt. rend. Soc. de biol. 112:1197 ( (April 1) ) 1933;.
Phillips, R. A.:  The Influence of the Vagus Nerve on the Glycemic Level , Am. J. Physiol. 105:257 ( (Aug.) ) 1933;.
Long, C. N. H., and Fry, Edith G.:  The Effect of Vagotomy on Muscle Glycogen Resynthesis , Am. J. M. Sc. 185:884 ( (June) ) 1933;.
Houssay, B. A.; Lewis, J. T., and Foglia, V. G.:  La fonction endocrine du pancréas normal ou énervé pendant l'hypoglycémie insulinique , Compt. rend. Soc. de biol. 101:239 ( (May 24) ) 1929;.
Soskin, Samuel; Allweiss, M. D., and Cohn, D. J.:  Influence of the Pancreas and Liver on the Dextrose Tolerance Curve , Am. J. Physiol. 109: 155 ( (July) ) 1934;.
Soskin, Samuel; Mirsky, I. A.; Zimmerman. L. M., and Heller, R. C.:  Normal Dextrose Tolerance Curves, in the Absence of Insulin, in Hypophysectomized Depancreatized Dogs , Am. J. Physiol. 114:648 ( (Feb.) ) 1936;.
Danielopolu, D.; Stoicescu, S., and Cimino-Bérenger:  Die Wirkung des Atropins auf die Glykämie beim Menschen , Klin. Wchnschr. 10: 311 ( (Feb. 14) ) 1931;.
Casanegra, A.:  Influencia de las diferentes dosis de atropina sobre el metabolismo glúcido , Semana méd. 1:803 ( (March 10) ) 1932;.
Wachholder, K.:  Zur Frage der blutzuckersenkenden Wirkung des Insulins nach Vagotomie bzw. nach Atropin , Arch. f. exper. Path. u. Pharmakol. 175:62-66 ( (March 21) ) 1934;.
Zagari and Pucci:  Influenza dell'atropina sull'uroglycemia insulinia , Riv. di pat. sper. 3: 161 ( (Feb. 15) ) 1935;.
Hrubetz, M. C.:  The Blood Sugar Level After Administration of Pilocarpine, Atropine and Acetylcholine , Am. J. Physiol. 114: 551 ( (Feb.) ) 1936;.
Hrubetz, M. C.:  The Blood Sugar Level After Administration of Physostigmine and Atropine , Am. J. Physiol. 118:300 ( (Feb.) ) 1937;.
Watanabe, F.:  Ueber die Unterdrücking der Pilokarpinhyperglykämie durch das Atropin , Tohoku J. Exper. Med. 27: 413 ( (Nov. 25) ) 1935;.
Watanabe, F.:  Ueber die hemmende Wirkung des Atropins auf die Peptonhyperglykämie , Tohoku J. Exper. Med. 27:416 ( (Nov. 25) ) 1935;.
Jordan, E. M.:  The Effect of Injected Glucose on Tolerance , Am. J. Physiol. 80:441 ( (April) ) 1927;.

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Harris, Seale:  Hyperinsulinism and Dysinsulinism , J. A. M. A. 83:729 ( (Sept. 6) ) 1924;
 Hyperinsulinism and Dysinsulinism (Insulogenic Hypoglycemia) , Internat. Clin. 1:9 ( (March) ) 1932;.
Ross, S. G., and Josephs, H. W.:  Metabolism of Recurrent Vomiting , Am. J. Dis. Child. 28:447 ( (Oct.) ) 1924;.
Wauchope, G. M.:  Hypoglycemia: Critical Review , Quart. J. Med. 2: 117 ( (Jan.) ) 1933;.
Rennie, T. A. C., and Howard, J. E.:  Hypoglycemia and Tension-Depression , Psychosom. Med. 4:273 ( (July) ) 1942;.
Gentes, M.:  Notes sur les terminaisons nerveuses d'îlots de Langerhans du pancréas , Compt. rend. Soc. de biol. 54:212, 1902;.
McCrea, E. D.:  The Abdominal Distribution of the Vagus , J. Anat. 59: 18, 1924;-1925.
Britton, S. W.:  Studies on the Conditions of Activity in Endocrine Glands , Am. J. Physiol. 74:291 ( (Oct.) ) 1925;.
Dietrich, S.:  Untersuchungen über Diabetes und Insulinwirkung: XII. Mitteilung. Der direkte Nachweis der Insulin sekretion des Pancrease , Arch. f. exper. Path. u. Pharmakol. 125:336, 1927;.
Clark, G. A.:  The Influence of the Vagus on the Islets of Langerhans: Part I. Vagus Hypoglycemia , J. Physiol. 59:466 ( (March) ) 1925;.
La Barre, J.:  Sur l'augmentation de la teneur en insuline du sang veineux pancréatique après excitation du nerf vague , Compt. rend. Soc. de biol. 96: 193 ( (Jan. 28) ) 1927;.
La Barre, J.:  The Role of the Central Nervous System in the Control of Pancreatic Secretion: I. The Secretion of Insulin During Hypoglycemia , Am. J. Physiol. 94: 13 ( (July) ) 1930;.
Gayet, R., and Guillaumie, M.:  Expériences concernant l'effet de l'excitation électrique du vague sur l'insulino-sécrétion , Compt. rend. Soc. de biol. 112:1197 ( (April 1) ) 1933;.
Phillips, R. A.:  The Influence of the Vagus Nerve on the Glycemic Level , Am. J. Physiol. 105:257 ( (Aug.) ) 1933;.
Long, C. N. H., and Fry, Edith G.:  The Effect of Vagotomy on Muscle Glycogen Resynthesis , Am. J. M. Sc. 185:884 ( (June) ) 1933;.
Houssay, B. A.; Lewis, J. T., and Foglia, V. G.:  La fonction endocrine du pancréas normal ou énervé pendant l'hypoglycémie insulinique , Compt. rend. Soc. de biol. 101:239 ( (May 24) ) 1929;.
Soskin, Samuel; Allweiss, M. D., and Cohn, D. J.:  Influence of the Pancreas and Liver on the Dextrose Tolerance Curve , Am. J. Physiol. 109: 155 ( (July) ) 1934;.
Soskin, Samuel; Mirsky, I. A.; Zimmerman. L. M., and Heller, R. C.:  Normal Dextrose Tolerance Curves, in the Absence of Insulin, in Hypophysectomized Depancreatized Dogs , Am. J. Physiol. 114:648 ( (Feb.) ) 1936;.
Danielopolu, D.; Stoicescu, S., and Cimino-Bérenger:  Die Wirkung des Atropins auf die Glykämie beim Menschen , Klin. Wchnschr. 10: 311 ( (Feb. 14) ) 1931;.
Casanegra, A.:  Influencia de las diferentes dosis de atropina sobre el metabolismo glúcido , Semana méd. 1:803 ( (March 10) ) 1932;.
Wachholder, K.:  Zur Frage der blutzuckersenkenden Wirkung des Insulins nach Vagotomie bzw. nach Atropin , Arch. f. exper. Path. u. Pharmakol. 175:62-66 ( (March 21) ) 1934;.
Zagari and Pucci:  Influenza dell'atropina sull'uroglycemia insulinia , Riv. di pat. sper. 3: 161 ( (Feb. 15) ) 1935;.
Hrubetz, M. C.:  The Blood Sugar Level After Administration of Pilocarpine, Atropine and Acetylcholine , Am. J. Physiol. 114: 551 ( (Feb.) ) 1936;.
Hrubetz, M. C.:  The Blood Sugar Level After Administration of Physostigmine and Atropine , Am. J. Physiol. 118:300 ( (Feb.) ) 1937;.
Watanabe, F.:  Ueber die Unterdrücking der Pilokarpinhyperglykämie durch das Atropin , Tohoku J. Exper. Med. 27: 413 ( (Nov. 25) ) 1935;.
Watanabe, F.:  Ueber die hemmende Wirkung des Atropins auf die Peptonhyperglykämie , Tohoku J. Exper. Med. 27:416 ( (Nov. 25) ) 1935;.
Jordan, E. M.:  The Effect of Injected Glucose on Tolerance , Am. J. Physiol. 80:441 ( (April) ) 1927;.
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