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Claybury Hospital, Woodford Bridge, Essex
ABSTRACT
The effect of rostral leucotomy on personality in a selected group of 120 non-psychotic patients followed up at home 1
to 5 years after operation is described and compared with the effect of standard leucotomy in Partridge's (1950) series.
One-third of patients still showed a noticeable reduction in "drive", but a few had been more active since operation than they had ever been. Few patients showed much reduction in spontaneity, but there was a tendency for leisure pursuits to be less active.
Nearly half the patients had detectable affective deficit; particularly, they tended to be less concerned for others, more selfish, less sympathetic. They worried less and were more contented. However, the changes were rarely more than slight and in comparatively few was there anything to distress either patient or relatives.
Nearly half the patients were less restrained; this showed chiefly in speech and temper; tactlessness was exceptional and never a problem, indeed the freedom of speech was often welcomed by relatives. The quickly flaring but rapidly subsiding temper was readily accepted by families, who often preferred it to the sulks and grudge-bearing of the past.
Half the patients had some intellectual impairment, but rarely of more than academic interest. Patchy amnesias and defective retention and recall were frequent and have been noticed more by patients who in the past had more than 6 E.C.T. Disturbances of conceptual thinking, present in about a quarter of cases, seem to have no relation to E.C.T., but are a little more marked in G cases than in B, and were not observed in O cases.
There were no active professional people in the series and therefore there is no evidence about the effect of rostral leucotomy in highly skilled and responsible workers. The work adjustment after operation ran closely parallel to the symptomatic relief; it was unusual for any lowering in status at work to be due to the effects of leucotomy. Sixty-seven per cent. of patients were in full employment or keeping house as efficiently as before illness.
Religious attitudes are not directly affected by rostral leucotomy.
There is little change in sexual adjustment except as a result of relief of illness.
Ratings for personality changes are significantly correlated with ratings for symptomatic relief. Both are considered to be related to the extent of the leucotomy lesion.
Personality deficits were more marked in 10 patients (9 per cent.). There is some evidence that where changes are marked the operative lesion has been more extensive than it should be, either because it was misplaced or because of post-operative haemorrhage or venous thrombosis; in 2 cases the marked personality changes may be related to post-operative epilepsy.
All but one of 13 other patients who later had unilateral or bilateral standard leucotomy suffered an increased personality deficit and in 7 cases the losses were more severe than in any case in the rostral series.
Personality deficits are negligible after 95 per cent. of rostral leucotomies which have given good symptomatic relief, compared with only 44 per cent. of standard leucotomies. Positively undesirable changes were present in only 2 of 114 cases, compared with 29 per cent. of standard leucotomies.
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