In the early days of the Texas Republic, candidates were known to call each other drunks and hog thieves. Elections haven't gotten much tamer since. A brutal Republican runoff for Texas lieutenant governor is shaping up as one of the nastiest races in the country, let alone the Lone Star State.

The feud hit a flashpoint just days before early voting got under way this week, as one candidate's private medical history -- including caregiver notes from a psychiatric facility -- was released to reporters. The development follows a round of political mudslinging and attack ads.

The verbal slugfest pits David Dewhurst, who has served as Texas lieutenant governor since 2003, against state Sen. Dan Patrick. The two are heading into a Republican runoff later this month.

"Just when you think this race couldn't get any nastier, it sinks into the depths of the sewer," said Mark Jones, political science professor at Houston's Rice University. "I can't recall this level of negativity on personal issues before."

The medical history on Patrick, drawn from a criminal and civil court case, was released by Texas Land Commissioner Jerry Patterson, who finished fourth in the primary but later endorsed Dewhurst. The records chronicle psychiatric hospital stays in 1982 and 1986 in which Patrick "needed sitters around the clock for being severely depressed." Patterson says the information was "not leaked, but in the public domain for 25 years."

"I don't work for the Dewhurst campaign. He is not paying me -- in fact, they're probably running from me because there could be a backlash," Patterson said in a phone interview. "However, the issue is not the chain of custody of documents, but whether Dan Patrick is the most fit to serve in arguably the most powerful position in the state."

Patterson acquired the documents through an attorney who "does not want to be named." Although the incumbent has attempted to distance himself from the material, an email from Patterson to reporters suggests Dewhurst was indecisive on the plan -- yet in the loop.

Patrick released a statement saying his opponent lied and then tried to cover it up. "Dewhurst started the day denying any involvement in the release of my medical records. His hapless surrogate, Jerry Patterson, removed all doubt in an afternoon email misfire where he clearly stated that it was Dewhurst's idea," the statement reads.

The Dewhurst campaign asked Patterson to stop the document dump, though Patterson says the medical narrative demonstrates a condition beyond "mild depression." Explaining in an email, he wrote: "This is classic Dan Patrick. It's not the mental illness, it's the lying."

Jones claimed Dewhurst is "attacking Patrick's fitness to serve because he's outflanked on policy issues from the right." He predicted the document release will end up hurting Dewhurst and generating sympathy for Patrick.

"Most voters will feel this level of personal attack is below the belt," Jones said. "The Dewhurst campaign seems to be obsessed with what Dan Patrick did in the 1980s. While this may plant a seed of doubt within the minds of some voters, there is no evidence the issue has surfaced in this current era and this makes it appear Dewhurst has gone off the rails in his attacks."

Those attacks, launched in a media blitz, have hinged on the lying theme and have ranged from accusing Patrick of changing his name to hide business failures -- a claim the Austin-American Statesmen has labeled as "false" -- to using a photograph of a shirtless Patrick. The photo came from a charity event in which Patrick was literally auctioning "the shirt off his back," to raise funds for hearing aids and wheelchairs for disabled Texas children. While Dewhurst apologized to the organization, the ad continued and was not immediately pulled.

Another ad spoofs "Let it Go," from the Disney movie "Frozen" -- an ad Slate dubbed "the strangest attack ad of the year."

Campaign spokesman Andrew Barlow said the ads are not random attacks, but verified through public records and demonstrate "what he's about."

"Unfortunately those things which should be private have been made public and those things which should be public remain private," said Barlow, referring to tax records which Patrick chose not to release.

Patrick, in response, created his own parody and released documents relating to his past businesses and a letter from his doctor. He has called his opponent "cheesy," saying he was lying not only about ad content but his own record. He also has charged his opponent with "passing an expansion of in-state tuition and free health care to illegal immigrants" -- the latter, a claim PolitiFact labels as false.

According to the Dewhurst campaign, the ads are working with internal polls showing the incumbent gaining ground. Barlow says the decision is between "steak and sizzle."

"Lieutenant Governor Dewhurst has cut taxes 54 times and brought people on different sides to work together," Barlow said. "Dan Patrick is the sizzle. He wants to be the star of the show."

Early voting began on Monday and runs through Friday. The run-off election is May 27. The winner will face San Antonio state Sen. Leticia Van de Putte.