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Obsessional Illness in Mental Hospital Patients

University of Glasgow

ABSTRACT

The natural history of obsessional illness has been studied in 89 mental hospital in-patients. Diagnostically 37 were classified as obsessive-compulsive neurosis, 16 as phobic-ruminative, 14 were doubtfully schizophrenic, 10 showed depressive features and 12 were otherwise atypical.

The incidence was 0.9 per cent. of all admissions. The celibacy rate was 51 per cent., the fertility rate 1.1 per cent. Social class and intelligence were higher than in control groups of hysterics and anxiety states.

Childhood symptoms were seen in 36 per cent., precipitants of the illness were important in 69 per cent. Pregnancy was a common precipitant. The illness began early (mean 24.7 years) but admission was delayed (mean age 36.l years). The majority (54 per cent.) showed a constant course; only 13 per cent. a definitely phasic one.

Sixty-four cases, 18 of whom were leucotomized, were followed up for an average of 5.9years. Of those not leucotomized 39 per cent. were improved; and 66 per cent. were working. Of those leucotomized, 55 per cent. were improved and 72 per cent. working. In the typical obsessive-compulsive cases only one of the 16 not leucotomized was improved, compared with seven of the 13 leucotomized.

Spontaneous improvement was significantly associated with atypicality, absence of motor symptoms, absence of childhood symptoms, and a short duration prior to admission. It was concluded that chronicity and presence of motor symptoms were not contra-indications for leucotomy and that many of the current recommendations for leucotomy are indicators of spontaneous remission.

Spontaneous recovery in severe obsessional illness is rare, improvement common, and disablement only occurs in a minority.