Neurobehavioral Disturbances Associated with Disorders of the Pancreas

  • Christopher M. Ryan
Part of the Critical Issues in Neuropsychology book series (CINP)


Concerned primarily with the digestion of food and the metabolism of carbohydrates, the pancreas appears at first glance to be a most unlikely source of neuropsychiatric disturbances. Yet an extensive clinical literature has reported significant mental-status changes in individuals with several different pancreatic disorders. Severe depression and anxiety are often seen in patients with cancer of the pancreas long before any other somatic symptoms of their carcinoma are evident. Profound impairments affecting both emotional and intellectual domains have been reported in patients with pancreatitis, and severe inflammation of the pancreas is said to produce a “pancreatic encephalopathy.” Impairments on various cognitive measures are also seen in children and adults with diabetes mellitus, though these intellectual changes tend to be far less severe than those associated with pancreatitis, and they appear to be restricted to a relatively small subset of diabetic patients. In addition, mental confusion, slurred speech, motor incoordination, and a number of other symptoms of central nervous system (CNS) dysfunction are typically found in patients with hyperinsulinism secondary to islet cell tumors (insulinomas).


Pancreatic Cancer Blood Glucose Level Acute Pancreatitis Chronic Pancreatitis Pancreatic Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ack, M., Miller, I., and Weil, W. B. (1961). Intelligence of children with diabetes mellitus. Pediatrics, 28, 764–770.PubMedGoogle Scholar
  2. Arbitman, R. (1972). Psychiatric manifestations of carcinoma of the pancreas. Psychosomatics, 13, 269–271.PubMedGoogle Scholar
  3. Bale, R. N. (1973). Brain damage in diabetes mellitus. British Journal of Psychiatry, 122, 22–39. Barnett, A. H., Eff, C., Leslie, R. D. G., and Pyke, D. A. (1981). Diabetes in identical twins: A study of 200 pairs. Diabetologia, 20, 87–93.Google Scholar
  4. Benos, J. (1973). Encephalopathia pancreatica: Zwei weitere Fälle korperlich begründbarer Psychosen bei akuter und chronish rezidivierender Pankreatitis. Münchener medizinische Wochenschrift, 115, 1842–1844.Google Scholar
  5. Benos, J. (1974). Funktionspsychosen und neurologische Ausfälle bei Pankreatitis. Medizinishe Klinik, 69, 1185–1192.Google Scholar
  6. Benos, J. (1976). Neuropsychiatrische Storüngen bei Erkrankungen des exokrinen Pankreas. Fortschritte der Neurologie Psychiatie, 44, 683–701.Google Scholar
  7. Best, J. D., Chisholm, D. J., and Alford, F. P. (1978). Insulinoma: Poor recognition of clinical features is the major problem in diagnosis. Medical Journal of Australia, 2, 1–5.Google Scholar
  8. Breidahl, H. D., Priestley, J. T., and Rynearson, E. H. (1955). Hyperinsulinism: Surgical aspects and results. Annals of Surgery, 142, 698–708.Google Scholar
  9. Brooks, F. P. (1979). Diseases of the pancreas. In P. B. Beeson, W. McDermott, and J. B. Wyngaarden (Eds.), Cecil textbook of medicine: Vol. 2 ( 15th ed., pp. 1550–1560 ). Philadelphia: W. B. Saunders.Google Scholar
  10. Brown, G. W. (1938). The development of diabetic children, with special reference to mental and personality comparisons. Child Development, 9, 175–183.Google Scholar
  11. Cahill, G. F., and Arky, R. A. (1983). Diabetes mellitus. In E. Rubenstein and D. D. Federman (Eds.), Medicine (pp. 1–21 ). New York: Scientific American.Google Scholar
  12. Cahill, G. F., and McDevitt, H. O. (1981). Insulin-dependent diabetes mellitus: The initial lesion. New England Journal of Medicine, 304, 1454–1465.Google Scholar
  13. Camperlengo, H. A. (1961). Pancreatic islet cell adenoma presenting as neuropsychiatric problems. New York Journal of Medicine, 61, 3327–3331.Google Scholar
  14. Cancer Statistics. (1986). CA: A Cancer Journal for Clinicians, 36, 9–25.Google Scholar
  15. Carter Center. (1985). Closing the gap: The problem of diabetes mellitus in the United States. Diabetes Care, 8, 391–406.Google Scholar
  16. Clarke, M., Crofford, O. B., Graves, H. A., and Scott, H. W. (1972). Functioning beta cell tumors (insulinomas) of the pancreas. Annals of Surgery, 175, 956–974.Google Scholar
  17. Craighead, J. E. (1978). Current views on the etiology of insulin-dependent diabetes mellitus. New England Journal of Medicine, 299, 1439–1445.PubMedGoogle Scholar
  18. Crain, E. L., and Thorn, G. W. (1949). Functioning pancreatic islet cell adenomas: A review of the literature and presentation of two new differential tests. Medicine, 28, 427–446.Google Scholar
  19. Daggett, P., and Nabarro, J. (1984). Neurological aspects of insulinomas. Postgraduate Medical Journal, 60, 577–581.Google Scholar
  20. Dandona, P., James, I. M., Newbury, P. A., Woollard, M. L., and Beckett, A. G. (1978). Cerebral blood flow in diabetes mellitus: Evidence of abnormal cerebrovascular reactivity. British Medical Journal, 2, 325–326.Google Scholar
  21. Daneman, D., Wolfson, D. H., Becker, D. J., and Drash, A. (1981). Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes. Journal of Pediatrics, 99, 847–853.PubMedGoogle Scholar
  22. Dashiell, J. F. (1930). Variations in psycho-motor efficiency in a diabetic with changes in blood-sugar level. Journal of Comparative Psychology, 10, 189–197.Google Scholar
  23. Delbridge, L. (1975). Educational and psychological factors in the management of diabetes in childhood. Medical Journal of Australia, 2, 737–739.Google Scholar
  24. Dikmen, S., Matthews, C. G., and Harley, J. P. (1975). The effect of early versus late onset of major motor epilepsy upon cognitive-intellectual performance. Epilepsia, 16, 73–81.PubMedGoogle Scholar
  25. Drash, A. L., and Becker, D. (1978). Diabetes mellitus in the child: Course, special problems, and related disorders. In H. M. Katzen and R. J. Mahler (Eds.), Diabetes, obesity, and vascular disease: Metabolic and molecular interrelationships (pp. 615–643 ). New York: Wiley.Google Scholar
  26. Dunn, S. M., and Turtle, J. R. (1981). The myth of the diabetic personality. Diabetes Care, 4, 640646.Google Scholar
  27. Dumphy, J. E. (1940). Early diagnosis of cancer of the pancreas. American Journal of Digestive Diseases, 7, 69–70.Google Scholar
  28. Eeg-Olofsson, O. (1977). Hypoglycemia and neurological disturbances in children with diabetes mellitus. Acta Paediatrica Scandinavica (Suppl. 270 ), 91–95.Google Scholar
  29. Eeg-Olofsson, O., and Petersen, I. (1966). Childhood diabetic neuropathy: A clinical and neurophysiological study. Acta Paediatrica Scandinavica, 55, 163–176.Google Scholar
  30. Emhart, C. B., Graham, F. K., Eichman, P. L., Marshall, J. M., and Thurston, D. (1963). Brain injury in the preschool child: Some developmental considerations: II. Comparisons of brain injured and normal children. Psychological Monographs: General and Applied, 77, 17–33.Google Scholar
  31. Estrada, R. V., Moreno, J., Martinez, E., Hernandez, M. C. Gilsanz, G., and Gilsanz, V. (1979). Pancreatic encephalopathy. Acta Neurologica Scandinavica, 59, 135–139.Google Scholar
  32. Fajans, S. S., and Thorn, G. W. (1970). Hyperinsulinism, hypoglycemia, and glucagon secretion. In M. M. Wintrobe, G. W. Thorn, R. D. Adams, I. L. Bennett, E. Braunwald, K. J. Isselbacher, and R. G. Petersdorf (Eds.), Harrison’s principles of internal medicine ( 6th ed., pp. 542–549 ). New York: McGraw-Hill.Google Scholar
  33. Fällström, K. (1974). On the personality structure of diabetic children aged 7–15 years. Acta Paediatrica Scandinavica (Suppl. 251 ), 1–70.Google Scholar
  34. Fitzgerald, P. J. (1980). Medical anecdotes concerning some diseases of the pancreas. In P. J. Fitzgerald and A. B. Morrison (Eds.), The Pancreas (pp. 1–29 ).Google Scholar
  35. Baltimore: Williams and Wilkins. Franceschi, M., Cecchetto, R., Minicucci, F., Smizne, S., Baio, G., and Canal, N. (1984). Cognitive processes in insulin-dependent diabetes. Diabetes Care, 7, 228–231.Google Scholar
  36. Fras, I., Litin, E. M., and Pearson, J. S. (1967). Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. American Journal of Psychiatry, 123, 1553–1562.PubMedGoogle Scholar
  37. Fras, I., Litin, E. M., and Bartholomew, L. G. (1968). Mental symptoms as an aid in the early diagnosis of carcinoma of the pancreas. Gastroenterology, 55, 191–198.PubMedGoogle Scholar
  38. Freinkel, N. (1979). Hypoglycemic disorders. In P. B. Beeson, W. McDermott, and J. B. Wyngaarden (Eds.), Cecil textbook of medicine: Vol. 2 ( 15th ed., pp. 1989–1995 ). Philadelphia: W. B. Saunders.Google Scholar
  39. Galbut, D. L., and Markowitz, A. M. (1980). Insulinoma: Diagnosis, surgical management, and long-term follow-up. American Journal of Surgery, 139, 682–690.Google Scholar
  40. Gilhaus, K. H., Daweke, H., Lülsdorf, H. G., Sachsse, R., and Sachsse, B. (1973). EEG-Veränderungen bei diabetischen Kindern. Deutsche Medizinische Wochenschrift, 98, 1449–1454.PubMedGoogle Scholar
  41. Glickman, M. H., Hart, M. J., and White, T. T. (1980). Insulinoma in Seattle: 39 cases in 30 years. American Journal of Surgery, 140, 119–123.PubMedGoogle Scholar
  42. Gray, G. M. (1983). Diseases of the pancreas. In E. Rubenstein and D. D. Federman (Eds.), Medicine (pp. 1–10 ). New York: Scientific American.Google Scholar
  43. Greenberger, N. J., and Toskes, P. P. (1983). Approach to the patient with pancreatic disease. In R. G. Petersdorf, R. D. Adams, E. Braunwald, D. J. Isselebacher, J. B. Martin, and J. D. Wilson (Eds.), Harrison’s principles of internal medicine ( 10th ed., pp. 1832–1836 ). New York: McGraw-Hill.Google Scholar
  44. Greenberger, N. J., Toskes, P. P., and Isselbacher, K. J. (1983). Diseases of the pancreas. In R. G. Petersdorf, R. D. Adams, E. Braunwald, D. J. Isselebacher, J. B. Martin, and J. D. Wilson (Eds.), Harrison’s principles of internal medicine ( 10th ed., pp. 1836–1848 ). New York, McGraw-Hill.Google Scholar
  45. Grey, M. J., Genel, M., and Tamborlane, W. V. (1980). Psychosocial adjustment of latency-aged diabetics: determinants and relationship to control. Pediatrics, 65, 69–73.PubMedGoogle Scholar
  46. Greydanus, D. E., and Hofmann, A. D. (1979). Psychological factors in diabetes mellitus: A review of the literature with emphasis on adolescence. American Journal of Disease in Childhood, 133, 1061–1066.Google Scholar
  47. Grishaw, W. H., West, H. F., and Smith, B. (1939). Juvenile diabetes mellitus. Archives of Internal Medicine, 64, 787–799.Google Scholar
  48. Haumont, D., Dorchy, H., and Pelc, S. (1979). EEG abnormalities in diabetic children: Influence of hypoglycemia and vascular complications. Clinical Pediatrics, 18, 750–753.Google Scholar
  49. Hauser, S. T., and Pollets, D. (1979). Psychological aspects of diabetes mellitus: A critical review. Diabetes Care, 2, 227–232.Google Scholar
  50. Hauser, S. T., Jacobson, A. M., Noam, G., and Powers, S. (1983). Ego development and self-image complexity in early adolescence: Longitudinal studies of psychiatric and diabetic patients. Archives of General Psychiatry, 40, 325–332.Google Scholar
  51. Hiltmann, H., and Lüking, J. (1966). Die Intelligenz bei diabetischen Kindern im Schulalter. Acta Paedopsychiatrica, 33, 11–24.PubMedGoogle Scholar
  52. Hirabayashi, S., Kitahara, T., and Hishida, T. (1980). Computed tomography in perinatal hypoxic and hypoglycemic encephalopathy with emphasis on follow-up studies. Journal of Computer Assisted Tomography, 4, 451–456.PubMedGoogle Scholar
  53. Holmes, C. S. (1986). Neuropsychological profiles in men with insulin-dependent diabetes. Journal of Consulting and Clinical Psychology, 54, 386–389.Google Scholar
  54. Holmes, C. S., Hayford, J. T., Gonzalez, J. L., and Weydert, J. A. (1983). A survey of cognitive functioning at different glucose levels in diabetic persons. Diabetes Care, 6, 180–185.PubMedGoogle Scholar
  55. Holmes, C. S., Koepke, K. M., Thompson, R. G., Gyves, P. W., and Weydert, J. A. (1984). Verbal fluency and naming performance in Type I diabetes at different blood glucose concentrations. Diabetes Care, 7, 454–459.PubMedGoogle Scholar
  56. Holmes, C. S., Mann Koepke, K., and Thompson, R. G. (1986). Simple versus complex performance impairments at three blood glucose levels. Psychoneuroendocrinolgy, 11, 353–357.Google Scholar
  57. Illangasekera, V. L. U. (1981). Insulinoma masquerading as carotid transient ischemic attacks. Postgraduate Medical Journal, 57, 232–234.Google Scholar
  58. Ingram, T. T. S., Stark, G. D., and Blackburn, I. (1967). Ataxia and other neurological disorders as sequels of severe hypoglycemia in childhood. Brain, 90, 851–862.PubMedGoogle Scholar
  59. Jackson, R. L., Ide, C. H., Guthrie, R. A., and James, R. D. (1982). Retinopathy in adolescents and young adults with onset of insulin-dependent diabetes in childhood. Ophthalmology, 89, 7–13.PubMedGoogle Scholar
  60. Jacobsson, L., and Ottosson, J-O. (1971). Initial mental disorders in carcinoma of pancreas and stomach. Acta Psychiatrica Scandinavica (Suppl. 221 ), 120–127.Google Scholar
  61. Jaspan, J. B., Wollman, R. L., Bernstein, L., and Rubenstein, A. H. (1982). Hypoglycemic peripheral neuropathy in association with insulinoma: Implication of glucopenia rather than hyperinsulinism. Medicine, 61, 33–44.Google Scholar
  62. Johnson, D. A., and Tong, N. T. (1977). Pancreatic encephalopathy. Southern Medical Journal, 70, 165–167.PubMedGoogle Scholar
  63. Johnson, S. B. (1980). Psychosocial factors in juvenile diabetes: A review. Journal of Behavioral Medicine, 3, 95–116.Google Scholar
  64. Joslin, E. P., Root, H. F., White, P., and Marble, A. (1940). Treatment of Diabetes Mellitus ( 7th ed. ). Philadelphia: Lea and Febiger.Google Scholar
  65. Kant, O. (1946). A deceptive psychoneurosis. Psychiatric Quarterly 20, 129–134.PubMedGoogle Scholar
  66. Keynes, W. M., and Keith, R. G. (1981) The Pancreas. London: William Heinemann. Kimball, C. H. (1971). Emotional and psychosocial aspects of diabetes mellitus. Medical Clinics of North America, 55, 1007–1018.Google Scholar
  67. Kovacs, M., Fineberg, T. L., Paulauskas, S., Finkelstein, R., Pollock, M., and Crouse-Novak, M. (1985). Initial coping responses and psychosocial characteristics of children with insulin-dependent diabetes mellitus. Journal of Pediatrics, 106, 827–834.PubMedGoogle Scholar
  68. Kubany, A. J., Danowski, T. S., and Moses, C. (1956). The personality and intelligence of diabetics. Diabetes, 5, 462–467.PubMedGoogle Scholar
  69. Kupfer, D. J., Detre, T. P., Swigar, M. E., and Southwick, W. O. (1971). Adjustment of patients after hip surgery. Journal of the American Geriatrics Society, 19, 709–720.PubMedGoogle Scholar
  70. LaPorte, R. E., Fishbein, H. A., Drash, A. L., Kuller, L. H., Schneider, B. B., Orchard, T. J., and Wagener, D. K. (1981). The Pittsburgh insulin-dependent diabetes mellitus registry: The incidence of insulin-dependent diabetes mellitus in Allegheny county, Pennsylvania (1965–1976). Diabetes, 30, 279–284.PubMedGoogle Scholar
  71. Lastchevker, V. (1965). Les troubles mentaux au cours de la pancreatite aigue. Z. Nevropat. Psickiat. Korsakow, 65, 434 [Russian with French summary].Google Scholar
  72. Latter, K. A., and Wilbur, D. L. (1937). Psychic and neurologic manifestations of carcinoma of the pancreas. Proceedings of the Mayo Clinic, 12, 457–463.Google Scholar
  73. Lawson, J. S., Williams Erdahl, D. L., Monga, T. N., Bird, C. E., Donald, M. W., Surridge, D. H. C., and Letemendia, F. J. J. (1984). Neuropsychological function in diabetic patients with neuropathy. British Journal of Psychiatry, 145, 263–268.PubMedGoogle Scholar
  74. Lawton, M. P., and Phillips, R. W. (1955). Psychopathological accompaniments of chronic relapsing pancreatitis. Journal of Nervous and Mental Disease, 122, 248–253.Google Scholar
  75. LeShan, L. (1959). Psychological states as factors in the development of malignant disease: A critical review. Journal of the National Cancer Institute, 22, 1–18.Google Scholar
  76. Levine, P. M., Silberfarb, P. M., and Lipowski, Z. J. (1978). Mental disorders in cancer patients: A study of 100 psychiatric referals. Cancer 42, 1 385–1391.Google Scholar
  77. Lichty, W. and Klachko, D. (1985). Memory in Type 1 diabetics [abstract]. Diabetes, 34 (Suppl. 1). 19.Google Scholar
  78. Lin, R. S., and Kessler, I. I. (1981). A multifactorial model for pancreatic cancer in man. Journal of the American Medical Association, 245, 147–152.Google Scholar
  79. Lipowski, Z. J. (1975). Psychiatry of somatic diseases: Epidemiology, pathogenesis, classification. Comprehensive Psychiatry, 16, 105–124.Google Scholar
  80. Lishman, W. A. (1978). Organic psychiatry. Oxford: Blackwell Scientific Publications. MacMahon, B., Yen, S., Trichopoulos, D., Warren, K., and Nardi, G. (1981). Coffee and cancer of the pancreas. New England Journal of Medicine, 304, 630–633.Google Scholar
  81. Maddison, D., and Raphael, B. (1971). Social and psychological consequences of chronic disease in childhood. Medical Journal of Australia, 2, 1265–1270.PubMedGoogle Scholar
  82. McCraw, R. K., and Tuma, J. M. (1977). Rorschach content categories in juvenile diabetics. Psychological Reports, 40, 818.PubMedGoogle Scholar
  83. McGavin, A. P., Schultz, E., Peden, G. W., and Bowen, B. D. (1940). The physical growth, the degree of intelligence, and the personality adjustment of a group of diabetic children. New England Journal of Medicine, 223, 119–127.Google Scholar
  84. McGlone, J. (1980). Sex differences in human brain asymmetry: A critical survey. Behavioral and Brain Sciences, 3, 215–227.Google Scholar
  85. Meuter, F., Thomas, W., Gruneklee, D., Gries, F. A., and Lohmann, R. (1980). Psychometric evaluation of performance in diabetes mellitus. Hormone and Metabolic Research (Suppl,. 9 ), 9–17.Google Scholar
  86. Moertel, C. S. (1969). Natural history of gastrointestinal cancer. In C. G. Moertel and R. J. Reitemeier (Eds.), Advanced gastrointestinal cancer: Clinical management and chemotherapy (pp. 1–14 ). New York: Harper and Row.Google Scholar
  87. O’Leary, D. S., Lovell, M. R., Sackellares, J. C., Berent, S., Giordani, B., Seidenberg, M., and Boll, T. J. (1983). Effects of age of onset of partial and generalized seizures on neuropsychological performance in children. Journal of Nervous and Mental Disease, 171, 624–629.Google Scholar
  88. Peiner, L. (1947). Carcinoma of the pancreas-A disease that may closely mimic a psychosomatic illness. Gastroenterology, 8, 92–94.Google Scholar
  89. Perlas, A. P., and Faillace, L. A. (1964). Psychiatric manifestations of carcinoma of the pancreas. American Journal of Psychiatry, 121, 182.PubMedGoogle Scholar
  90. Perlmuter, L. C., Hakami, M. K., Hodgson-Harrington, C., Ginsberg, J., Katz, J., Singer, D. E., and Nathan, D. M. (1984). Decreased cognitive function in aging non-insulin-dependent diabetic patients. American Journal of Medicine, 77, 1043–1048.PubMedGoogle Scholar
  91. Pirart, J. (1978). Diabetes mellitus and its degenerative complications: A prospective study of 4,400 patients observed between 1947 and 1973. Diabetes Care, 1, 252–263.Google Scholar
  92. Plumb, M. M., and Holland, J. (1977). Comparative studies of psychological function in patients with advanced cancer: I. Self-reported depressive symptoms. Psychosomatic Medicine, 39, 264–276.Google Scholar
  93. Pohl, S. L., Gunder-Frederick, L., and Cox, D. J. (1984). Area review: Diabetes mellitus. Behavioral Medicine Update, 6, 3–7.Google Scholar
  94. Pomara, N., and Gershon, S. (1984). Treatment-resistant depression in an elderly patient with pancreatic carcinoma: Case report. Journal of Clinical Psychiatry, 45, 439–440.Google Scholar
  95. Ranson, J. H. C., Roses, D. G., and Fink, S. D. (1973). Early respiratory insufficiency in acute pancreatitis. Annals of Surgery, 178, 75–79.PubMedGoogle Scholar
  96. Raskin, P., Pietri, A. O., Unger, R., and Shannon, W. A. (1983). The effect of diabetic control on the width of skeletal-muscle capillary basement membrane in patients with Type I diabetes mellitus. New England Journal of Medicine, 309, 1546–1550.Google Scholar
  97. Reichlin, S. (1983). Somatostatin. New England Journal of Medicine, 309, 1495–1501, 1556–1563.Google Scholar
  98. Rennick, P. M., Wilder, R. M., Sargent, J., and Ashley, B. J. (1968). Retinopathy as an indicator of cognitive-perceptual-motor impairment in diabetic adults [Summary]. Proceedings of the 76th Annual Convention of the American Psychological Association, 3, 473–474.Google Scholar
  99. Reske-Nielsen, E., Lundbaek, K., and Rafaelsen, O. J. (1965). Pathological changes in the central and peripheral nervous system of young long-term diabetics. Diabetologia, 1, 232–241.Google Scholar
  100. Rickles, N. K. (1948). Functional symptoms as first evidence of pancreatic disease. Journal of Nervous and Mental Disease, 101, 566–571.Google Scholar
  101. Rothermich, N. O., and von Haam, E. (1941). Pancreatic encephalopathy. Journal of Clinical Endocrinology, 1, 872–881.Google Scholar
  102. Rovet, J. F., Ehrlich, R. M., and Hoppe, M. G. (1987). Specific intellectual deficits associated with the early onset of insulin-dependent diabetes mellitus in children. Diabetes Care, 10, 510515.Google Scholar
  103. Russell, P. N., and Rix-Trott, H. M. (1975). An exploratory study of some behavioural consequences of insulin-induced hypoglycaemia. New Zealand Medical Journal, 81, 337–340.PubMedGoogle Scholar
  104. Ryan, C., Vega, A., and Drash, A. (1985). Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics, 75, 921–927.PubMedGoogle Scholar
  105. Salmon, P. A. (1967). The significance of psychic symptoms in the early diagnosis of carcinoma of the pancreas. Canadian Medical Association Journal, 97, 767–772.Google Scholar
  106. Santiago, J. V. (1984). Effect of treatment on the long term complications of IDDM. Behavioral Medicine Update, 6, 26–31.Google Scholar
  107. Savage, C., Butcher, W., and Noble, D. (1952). Psychiatric manifestations in pancreatic disease. Journal of Clinical and Experimental Psychopathology, 13, 9–16.PubMedGoogle Scholar
  108. Savage, C., Noble, D. (1954). Cancer of the pancreas: Two cases simulating psychogenic illness. Journal of Nervous and Mental Disease, 120, 62–65.Google Scholar
  109. Schuster, M. M., and Iber, F. L. (1965). Psychosis with pancreatitis: A frequent occurrence infrequently recognized. Archives of Internal Medicine, 116, 228–233.Google Scholar
  110. Sharafeev, A. G. (1961). General cerebral disorders in acute pancreatitis. Klin. Med. (Moscow), 39, 86 [Russian with English summary].Google Scholar
  111. Sharf, B., and Levy, L. (1976). Pancreatic encephalopathy. In P. J. Vinken and G. W. Bruyn (Eds.), Handbook of clinical neurology: Metabolic and deficiency diseases of the central nervous system, (Vol. 27, Pt. I, pp. 449–458 ). Amsterdam: North-Holland.Google Scholar
  112. Shatney, C. H., and Grage, T. B. (1974). Diagnostic and surgical aspects of insulinoma: A review of twenty-seven cases. American Journal of Surgery, 127, 174–184.Google Scholar
  113. Simonds, J. F. (1977). Psychiatric status of diabetic youth matched with a control group. Diabetes, 26, 921–925.PubMedGoogle Scholar
  114. Shirley, H. F., and Greer, I. M. (1940). Environmental and personality problems in the treatment of diabetic children. Journal of Pediatrics, 16, 775–781.Google Scholar
  115. Skenazy, J. A., and Bigler, E. D. (1984). Neuropsychological findings in diabetes mellitus. Journal of Clinical Psychology, 40, 246–258.PubMedGoogle Scholar
  116. Sparagana, M., and Rubnitz, M. E. (1972). Hypoglycemia presenting with neuropsychiatric symptoms. Postgraduate Medicine, XX, 192–196.Google Scholar
  117. Steinhauser, H., Borner, S., and Koepp, P. (1977). The personality of juvenile diabetics. In Z. Laron, (Ed.), Pediatric and adolescent endocrinology, (Vol. 3, pp. 1–7 ).Google Scholar
  118. Steinke, J. (1971). Hypoglycemia. In A. Marble (Ed.), Joslin’s diabetes mellitus ( 11th ed., (pp. 797–817 ). Philadelphia: Lea and Febiger.Google Scholar
  119. Sterky, G. (1963). Family background and state of mental health in a group of diabetic schoolchildren. Acta Paediatrica, 52, 377–390.PubMedGoogle Scholar
  120. Stewart-Brown, S., Haslum, M., and Butler, N. (1983). Evidence for increasing prevalence of diabetes mellitus in childhood. British Medical Journal, 286, 1855–1857.PubMedGoogle Scholar
  121. Sullivan, B. J. (1978). Self-esteem and depression in adolescent diabetic girls. Diabetes Care, 1, 18–22.PubMedGoogle Scholar
  122. Swift, C. R., Seidman, F., and Stein, H. (1967). Adjustment problems in juvenile diabetes. Psychosomatic Medicine, 29, 555–571.Google Scholar
  123. Tattersall, R. B. (1981). Psychiatric aspects of diabetes: A physician’s view. British Journal of Psychiatry, 139, 485–493.Google Scholar
  124. Tavormina, J. B., Kastner, L. S., Slater, P. M., and Watt, S. L. (1976). Chronically ill children: A psychologically and emotionally deviant population. Journal of Abnormal Child Psychology, 4, 99–110.Google Scholar
  125. Taylor, D. C., and Ounstead, C. (1972). The nature of gender differences explored through ontogenetic analysis of sex ratios in disease. In C. Ounstead and D. C. Taylor ( Eds. ), GenderGoogle Scholar
  126. Differences: Their ontogeny and significance (pp. 215–240). Edinburgh: Churchill Livingstone.Google Scholar
  127. Teagarden, F. M. (1939). The intelligence of diabetic children with some case reports. Journal of Applied Psychology, 23, 337–346.Google Scholar
  128. Ternand, C., Go, V. L. W., Gerich, J. E., and Haymond, M. W. (1982). Endocrine pancreatic response of children with onset of insulin-requiring diabetes before age 3 and after age 5. Journal of Pediatrics, 101, 36–39.PubMedGoogle Scholar
  129. Teuber, H-L., and Rudel, R. G. (1962). Behavior after cerebral lesions in children and adults. Developmental Medicine and Child Neurology, 4, 3–20.Google Scholar
  130. Titchener, J. L., Zwerling, I., Gottschalk, L., Levine, M., Culbertson, W., Cohen, S., and Silver, H. (1956). Psychosis in surgical patients. Surgery, Gynecology, and Obstetrics, 102, 59–65.Google Scholar
  131. Trapnell, J. (1972). The natural history and management of acute pancreatitis. Clinical Gastroenterology, 1, 147–166.Google Scholar
  132. Ulett, G., and Parsons, E. H. (1948). Psychiatric aspects of carcinoma of the pancreas. Journal of the Missouri Medical Association, 45, 490–493.Google Scholar
  133. Victor, M., Adams, R. D., and Collins, G. H. (1971). The Wernicke-Korsakoff syndrome. Philadelphia: F. A. Davis.Google Scholar
  134. Vogel, F. S. (1951a). Cerebral demyelination and focal visceral lesions in a case of acute hemorrhagic pancreatitis. Archives of Pathology, 53, 355–362.Google Scholar
  135. Vogel, F. S. (1951b). Demyelinization induced in living rabbits by means of a lipolytic enzyme preparation. Journal of Experimental Medicine, 93, 297–304.PubMedGoogle Scholar
  136. Volk, B. W., and Allen, R. A. (1985). Embryology, anatomy, histology, and anomalies of the pancreas. In J. E. Berk (Ed.), Gastroenterology ( 4th ed., pp. 3834–3843 ). Philadelphia: W. B. Saunders.Google Scholar
  137. Yaskin, J. C. (1931). Nervous symptoms as earliest manifestations of carcinoma of the pancreas. Journal of the American Medical Association, 96, 1664–1668.Google Scholar
  138. Young, R. J., Ewing, D. J., and Clarke, B. F. (1983). Nerve function and metabolic control in teenage diabetics. Diabetes, 32, 142–147.PubMedGoogle Scholar
  139. Zeltzer, L., Kellerman, J., Eilenberg, L., Dash, J., and Rigler, D. (1980). Psychological effects of illness in adolescence. II. Impact of illness in adolescents—crucial issues and coping styles. Journal of Pediatrics, 97, 132–138.Google Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Christopher M. Ryan
    • 1
  1. 1.Department of Psychiatry, and Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghUSA

Personalised recommendations