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Report of thirty years evolution of observation princeps of " obsession de négation " which was presented to Société Médico-Psychologique by Raymond Mallet 11 may 1933. Opportunity to show different nosological qualification. Diseases are models chosen by physicians. Choice directed by means for action.
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The basic principle of treatment of phobias and obsessions is exposure of the patient to the evoking stimulus. Utilizing this principle, exposure in vivo seems an effective treatment for many, but not all, obsessional patients. The role of tricyclic drugs is at present being investigated. Nurse therapists have been found to be very competent in delivering treatment. Similar results, using an exposure in vivo model, have been obtained in the managment of phobias. Some reasons why patients do not comply with, or adhere to, treatment recommendations are put foward. Finally, the vexed question of the cost-effectiveness of treatment is considered.
The case represented above reminds the description of Freud concerning the special relationship in obsessive neurosis to the theme of death, i.e. that these patients find a constant preoccupation in reflecting over the duration of life as well as of the possibility of death of those who are in close relationship to them. Furthermore, the world in which our patient lives, has the quality of threatening and rejecting ("Drohung und Abstossung") described by von Gebsattel in his study on the phenomenology of the obsessional.--The young special-school teacher who was 24 years old in the beginning of the therapy, suffered not only from depression, but from obsessions in thinking certain thoughts, and compulsions, mainly controls. The facts in his fate: early death of the mother, sickness of the father, a congenital abnormity of one eye which demanded several operations, and, last not least, school-years passed in a college of Benedictine monchs, created the roots of his neurosis. And when, in the age of 20 years, he fell in love with a girl, he had to discover that she was suffering from Hodgkin disease, which put him in the dilemma whether to stay with her or to seperate. In this situation he asked for therapeutic help which proceedings were reflected in a rich material of dreams.
Eleven consecutive patients with primary obsessive-compulsive syndrome were studied neuropsychologically and the power spectral EEG characteristic of ten of these patients unmedicated, at rest, and during cognitive tasks were analyzed. The finding of predominantly left frontal dysfunction in the obsessional syndrome is discussed in the light of neurophysiological and psychosurgical evidence which suggest that perturbation of the cingulate-orbital frontal connections modulates obsessive-compulsive symptomatology.
Behavior therapy of a young man, suffering from grave obsessive and compulsive troubles is the first example of combined therapy, with individual therapy, family therapy as group therapy. Two steps are find in the cure. There are benefits--trust and hope--due to psychiatric hospitalization and generous and constant affection of the sponse. The sponse was the key of reciprocal inhibition necessary to the control of anxieties due to the treatment. The aim reached was the control of obsessions and compulsions lasting for more than sixteen years.
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A total of 52 patients (28 males and 24 females from 16.5 to 21.5 years of age) observed in childhood because of obsessional neuroses were studied. All the studied cases were divided into 3 groups: patients with obsessional movements and actions, patients with obsessional fears and patients with obsessions of the mixed type. Follow-up studies of the patients demonstrated that the prognosis of obsessional states with an onset in childhood and adolescency should not be based only on the duration of the disease. It depends on the combination of a number of factors: the clinical form of neuroses, type of development, traits of the "basis", stage of psychophysical development, determing evolution of the disease and degree of social adaptation.
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All 44 neurosurgical units in the British Isles replied to a postal questionnaire asking about their use of neurosurgery during 1974--6 for functional mental illness. A total of 431 operations was reported, representing a yearly rate of 3.4 operations per million population aged over 15. The numbers of operations declined from 158 in 1974 to 119 in 1976. Four units did two-thirds of the operations. Stereotactic methods for locating the site for the lesion were used in two-thirds of procedures. Mood disorders, anxiety states, and obsessive-compulsive neurosis were the conditions most commonly treated.
A factor analysis of the 90-item version of the Hopkins Symptom Checklist, performed on the pretreatment self-ratings of nonpsychotic outpatients with symptoms of depression and anxiety, revealed the presence of 8 clinically meaningful factors. These eight orthogonal factors each contained at least 5 items with loadings above 0.40 and explained 4.5% or more of the matrix variance. They were labeled Somatization, Phobic-Anxiety, Retarded Depression, Agitated Depression, Obsessive-Compulsive, Interpersonal Sensitivity, Anger-Hostility and Psychoticism.
The utility of the Minnesota Multiphasic Personality Inventory (MMPI) in predicting treatment response to pharmacotherapy for a group of 54 anxious and 43 depressed outpatients was examined. Discriminant function analyses using the MMPI scales were conducted on groups of improved and unimproved patients. Several significant function, as well as zero-order, differences were found. In general, improved patients scored significantly lower on scales reflecting depression and obsessive-compulsive or schizoid tendencies. They also obtained lower scores on scales measuring interpersonal sensitivity and suggestive of character traits such as low frustration tolerance, impulsivity, and resentment toward authority figures. Additional analyses in which several different profile types were compared for treatment outcome revealed few differences among groups.
A woman of 58 came for psychotherapy for the first time suffering from a depressive reaction precipitated by two mid-life events: the marriage of her daughter and the realization that her own cherished marital dream would never be fulfilled. She had postponed coming to terms with the disappointments of her marriage as long as she had had other objects. When these objects were lost, and the distance she had maintained to handle her feelings was threatened, she sought help. There was suggestive evidence that a collusive marital system had sustained an unsatisfactory relationship for 35 years. Her husband was described as an obsessive-compulsive character. His traits were both needed, feared, and resented by the patient, representing the rejected part of herself and aspects of her hated grandmother. Mrs. A. had character traits and a developmental history which supported a diagnosis of primitive hysterical personality. (This type has been described by Zetzel (1968) as "the so-called good hysteric.") The paucity of object relationships in her life, her poor work habits, her inability to tolerate affects were striking. The patient had identified with a pathological mother in a family dominated by rejecting and depreciating attitudes. The patient's use of the defense mechanisms of splitting, projection, and withdrawal as ways of dealing with ambivalence significantly interfered with her self-object differentiation and her capacity for intense emotional or physical intimacy. She could only love men whom she rescued or protected, a pattern consistent with the fact that she could not relate to equals or superiors. Yet she was unable to draw on a good identification with a nuturing mother, so as to really be able to give. There was too much hurt and uncontrolled anger when she was in the superior position with the kind of man who could not meet her dependency needs. Feeling unprotected, she had married a "strong" man, who she expected would meet her narcissistic and dependency demands. He was inhibited and controlled and could neither need nor be needed by her during his active work life. This led to immediate disappointment of her conflicting conscious and unconscious expectations. She wanted him to be strong and ideal, yet to need her and never oppose her. Hence, there was a failure to establish a mature or satisfying marital relationship. She turned to her children for comfort, particularly her daughter, becoming depressed when her daughter married. She found gratification by staying busy tutoring and teaching underprivileged children. In the course of treatment her depressive symptoms disappeared. She felt hopeful, capable of being believed in, and able to cope as a result of the therapist's functioning as her uncritical ally. After she resumed living with her husband she began to acknowledge an ambivalence toward her cherished, confidante daughter and in some ways reversed her previous splitting of husband and daughter. The mean husband became a kindly saint and the darling daughter became a critical, spiteful queen...
Hysterical and obsessive-compulsive style subjects, as determined by a modified Rorschach test and the Wechslar Adult Intelligence Scale Comprehension subtest, were questioned in a face-to-face format where lateral eye movements were surreptitiously observed. Only right-handed subjects were used. It has been argued that lateral eye movements index immediate hemispheric activation after questions--the first such eye movement being a direction opposite to the putatively activated hemisphere. There was significantly more left-looking among the hysterical subjects than among the obsessive-compulsive style subjects.