The British Journal of Psychiatry
A Comparative Review of Patients with Obsessional Neurosis and with Depression Treated by Psychosurgery


All patients with primary obsessional illnesses who underwent operation at least three years previously attended for a detailed review and a relative also came to give additional information. These 24 obsessional patients were compared to 24 patients with primary depressive illnesses, matched for sex and age, who also had psychosurgical operations at least three years before, and who also brought a close relative.

Only two patients in each diagnostic group reported no improvement of any kind in the three years since operation, but more definite improvement (I and II) occurred in 67 per cent of the obsessionals and 71 per cent of the depressed patients. In this series no patient reported having become worse since operation.

The backgrounds of the two groups were quite closely similar, except for a higher incidence of disturbed relationships with parents during childhood, especially the father, among the obsessionals, and there were a larger number of depressed patients reporting the death of one or other parent before the patient was 16 years old. In addition, there was evidence of more psychiatric illness among the close relatives of the obsessionals than was the case with the depressive group, but one quarter of the latter reported the loss of either a parent or sibling by suicide. However, these background factors could not be related to prognosis after operation.

It was found that obsessionals who did poorly tended to have illnesses of an earlier onset (mean 22 years) compared to those who did well (33 years), and their illnesses tended to have begun suddenly. In the case of the depressed group the age of onset showed no relationship to outcome, and there was a tendency for illnesses of gradual onset to have a better prognosis. For all patients an onset in pregnancy or the puerperium was associated with a particularly good response. There was evidence to suggest that in general the presence of prominent depression improved the prognosis.

Psychological tests given to the patients at the time of the review discriminated well between those of good outcome and those whose response was poor, but there was less differentiation between the two diagnostic groups.