Psychiatric aspects of liver disease.

The Babylonians (circa 2000 B.C.) attributed powers of augury and divination to the liver, designating it by the term used also for ' soul' or 'mood' (Baumann, 193 ), and clinical descriptions of an association between hepatic disease and mental disorders have been recorded since Hippocratic times. A patient with hepatitis' developed a state like rabies; he could not be held, said things which could not be comprehended and barked like a dog' (Morbis Internis), and the fatal illness of Hermocrates included a fluctuating delirium on the fifth day, followed by the appearance of jaundice on the sixth (Hippocrates, 460-370 B.C.). Hippocrates' concept of' madness on account of bile' survived until recently in the term ' cholaemia,' but failed to explain mental changes in the non-jaundiced patient with liver disease. Galen (A.D. 13 -200) implicated excess liver secretions as conducing to choleric and melancholic personalities and also contributed to a theory of hepatic function relevant to modern concepts of the liverbrain relationship. He considered that the liver prepared the blood from food in the stomach and that this blood spread into all parts of the body. Various psychiatric syndromes have now been recognized as incident to liver disease (Zillig, 1947) and certain neuro-psychiatric conditions can be related to disorders of functional anatomy of the liver and portal system.