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[Dynamics and outcome of obsessive neuroses with onset in childhood and adolescence in the light of follow-up studies].

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.

Adolescent↗

[Psychosurgery today (author's transl)].

After discussion of the historical and neurophysiological bases of psychosurgery a report on personal experience in different indications is given. Finally, the present degree of informedness of doctors and the media on psychosurgery is discussed.

Aggression↗

An uncontrolled trial of clomipramine (Anafranil) in the treatment of phobic and obsessional states in general practice.

A small, open, multicentre trial of clomipramine (Anafranil, Geigy Pharmaceuticals) in the management of phobic and obsessional states was performed in general practice. New rating devices were used. Twenty-seven patient suffering from a variety of phobias and obsessions were treated with doses of clomipramine up to a maximum of 225 ng daily for six weeks. In phobic subjects best results were obtained in social phobias, agoraphobia and diffuse phobic anxiety, situational anxiety, interference, avoidance and autonomic effects all responding. An improvement of between 33% and 47% was seen in obsessional symptoms.

Adult↗

The measurement of obsessionality: first validation studies of the Lynfield obsessional/compulsive questionnaires.

The difficulties encountered in attempts at the rating and quantification of obsessional behaviour are outlined and some of the reasons for such difficulties are mentioned. The development of the Lynfield Obsessional-Compulsive Questionnaire from the Leyton Obsessional Inventory is discussed together with the advantages and disadvantages attendant upon its administration. The author concludes that the Lynfield Obsessional-Compulsive Questionnaire promises well as a measure for assessing change and that, following further validity and reliability tests, it may be used in multicentre trials of treatment procedures.

Evaluation Studies as Topic↗

Clomipramine (Anafranil) in depressive patients with obsessive neurosis.

The authors express the view that, clinically, clomipramine (Anafranil, Geigy Pharmaceuticals) seems to be the treatment of choice for obsessive-compulsive illness. Clomipramine possesses a specific anti-obsessional property which is distinct from its antidepressant property. The optimal therapeutic dose from this study appears to be in the range of 175 mg to 225 mg a day. Minor reversible adverse reaction gradually decreases with the increase of duration of treatment.

Adult↗

Treatment of obsessive-compulsive neurosis with clomipramine (Anafranil).

An uncontrolled clinical study was carried out to evaluate the therapeutic efficacy of clomipramine (Anafranil, Geigy Pharmacueticals) in a group of twenty obsessive-compulsive neurotic patients. Clomipramine proved to be extremely useful in alleviating obsessive-compulsive neurosis as well as phobia. This finding was not secondary to the improvement in anxiety or depression which occurred, as the degree of improvement in obsessive symptoms far exceeded the improvement in the other symptoms.

Adult↗

Use of neurosurgery for psychological disorder in British Isles during 1974--6.

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.

Brain↗

The Hopkins Symptom Checklist (HSCL)--factors derived from the HSCL-90.

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.

Adolescent↗

The Minnesota Multiphasic Personality Inventory in predicting response to pharmacotherapy of neurotic outpatients.

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.

Adjustment Disorders↗

On the psychology of the aging woman. Depression in late mid-life: change or repetition? Another chance for working through.

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...

Adaptation, Psychological↗

Cerebral lateralization and personality style.

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.

Adult↗