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Showing papers in "British Journal of Psychiatry in 1943"



Journal ArticleDOI
TL;DR: Clinical observation shows no appreciable deterioration in personality or intelligence as a result of continued therapy in chronic psychotics treated with electrically induced convulsions repeated at intervals.
Abstract: Chronic psychotics whose behaviour endangered their health, constituted a serious nursing problem, or whose mental state was one of misery were treated with electrically induced convulsions repeated at intervals, with the object of maintaining the improvement achieved after an initial course of treatment or of cutting short a particular phase of illness. The patients included 37 chronic schizophrenics, 8 involutional and senile melancholias, 6 manic-depressives, 3 periodic catatonics and 2 mental defectives. All cases responded favourably except 11 of the schizophrenic group. In some cases treatment has been in progress for over two years. Clinical observation shows no appreciable deterioration in personality or intelligence as a result of continued therapy. The results are discussed and an attempt made to correlate them with theories of convulsion therapy.

33 citations




Journal ArticleDOI
TL;DR: It has been proved that “puerperal insanity” as a clinical entity does not exist, and that every reaction type defined in clinical psychiatry may occur in the puerperium.
Abstract: Twenty-one cases of psychotic reactions following childbirth have been studied and a further case-material of 232 cases has been surveyed. In accordance with recent authors' findings, it has been proved that “puerperal insanity” as a clinical entity does not exist, and that every reaction type defined in clinical psychiatry may occur in the puerperium. Various factors contributing to the origin of psychotic reactions following childbirth have been isolated: hereditary loading, predisposing personality trends, environmental and sociological conditions, psychological experiences arising from childbirth, and physical complications of the puerperium. It could be, demonstrated that the latter factor, which in the past has been regarded as the most important, plays only a minor role, and operates as a precipitating agent only in co-operation with other intrinsic and extrinsic factors. In more than half of the case-material the reaction type was typical of one of the affective psychoses, and in this group the constitutional make-up, as illustrated by heredity and pre-psychotic personality features, was found to be particularly important, though even here it did not operate without additional precipitating conditions. In a proportion of the affective psychotic reaction the clinical picture was coloured by features of the organic reaction type. In a considerable proportion of the melancholic reactions paranoid features were prominent, the delusional ideas being of the katathymic type, connected with the psychological implications of childbirth. Such paranoid features were found not before the fourth decade, and in some cases the melancholic reaction merged into a chronic paranoid condition. The comparatively small number of typically schizophrenic reactions can be partly attributed to the low marriage rate and parity of schizophrenics and schizoid personalities. The wide variety of psychogenic factors based on environmental and sociological conditions has been demonstrated and analysed. Certain mechanisms which have received little attention hitherto have been pointed out. The administration of convulsion therapy has been advocated, and encouraging results from intensive vitamin treatment have been reported. A plea for preventive measures, including psychotherapy,in the ante-natal period, has been made.

20 citations


Journal ArticleDOI
TL;DR: It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention, andPerseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items.
Abstract: A tentative battery of 25 short tests for the measurement of senescence is described ( cf. Table I). The scale is the result of the application of nearly 80 tests to senile patients in three London hospitals. It was administered in full to 38 patients in all, and the present findings refer to a group of 20 less seriously demented ones, with an age range of 68 to 83. The tests are classified into three groups according to the degree of difficulty experienced by the seniles (Table II). The divisions were made on the basis of a number of criteria which emerged during the working up of the results, and are only pointers to the kind of functions involved. Briefly, the most difficult tests were those in which subjects were required to break away from old mental habits and adapt to unfamiliar situations, tests of recent memory (logical), of judgment, planning, and reasoning, or embodying difficult or lengthy instructions. Less difficulty was found with such tests as rote memory, fluency of associations, simple arithmetic, and vocabulary. Performance seemed to be least affected on tests of visual recognition, old mental habits, and simple motor tasks. It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention. Perseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items. There is a loss of steadiness and speed on the motor side. The disturbing effect of tests with a time element on the slower acting senile is noted. The present mental status of the patients is estimated on eleven tests which are scored on the (outmoded) mental age method (Table I): the average of these is between M.A. 10 and 11. This figure is compared with previous reports on the decline of intelligence. An estimate of the former mental status of each patient is made by means of efficiency quotients on part of the “Bellevue” scale. These relate each score to the average level for the peak age-group of 20 to 24 years (Table III). The use of the vocabulary score as an index of former level is discussed. A comparison of score variation within individuals with variation between individuals shows a ratio of the former to the latter of approximately 85 per cent. Variability of scores within individuals increases with age inside the patient group, also with lower intelligence. A shortened version of the scale, which takes about 40 minutes, is indicated (Table I).

19 citations


Journal ArticleDOI
TL;DR: Fugue has been used for a variety of different symptoms, some of which have little in common; the psychiatrist using the term has to define what kind of fugue he means if he wishes to avoid misunderstanding and confusion as mentioned in this paper.
Abstract: The range of psycho-pathological conditions for which the term “fugue” has been used has increased considerably and is still increasing. Originally the term was chosen to denote transitory abnormal behaviour characterized by aimless wandering and more or less marked alteration of consciousness, usually but not necessarily followed by amnesia. At present it is used for a variety of different symptoms, some of which have little in common; the psychiatrist using the term has to define what kind of fugue he means if he wishes to avoid misunderstanding and confusion. The reasons for the great popularity of the term are manifold. It is short, handy, vague, and has even a distinguished foreign flavour. But there are other reasons apart from those virtues. When the psychological mechanisms underlying abnormal behaviour were first studied two were regarded as responsible for the origin of fugues: dissociation and escape. From that time dates the tendency to describe as fugue nearly every condition of transitory alteration of consciousness which can be understood as the result of those mechanisms. Thus a remarkable change of conception has taken place; while the term “fugue” originally described a certain type of abnormal behaviour characterized by running away and wandering under a strong impulse and associated with clouding or narrowing of consciousness, it later came to be used, in addition, as the description of various results of the psychological mechanism of escape, without regard for the resulting behaviour. Obviously the fact that fugue means escape invited that change of conception. Considering the great number of neurotic and psychotic symptoms in the origin of which the two mechanisms mentioned above are supposed to play a part, there are hardly any limits to the use of the term. It is not intended to survey the whole literature on what has been called fugues; a few instances from current text-books and recent articles will demonstrate for how many conditions the term has been used in recent years.

17 citations



Journal ArticleDOI
TL;DR: A method for the administration of electrically-induced convulsions has been described, especially with reference to speed and safety, and factors influencing prognosis have been outlined, particularly the question of chronicity.
Abstract: 1 1 A method for the administration of electrically-induced convulsions has been described, especially with reference to speed and safety 2 2 The results in 100 depressive psychoses have been examined and classified 3 3 The relation of this therapy to age and blood pressure has been discussed 4 4 Factors influencing prognosis have been outlined, particularly the question of chronicity 5 5 The relapse-rate and failures have been considered 6 6 A physically resistant type has been noted 7 7 Recent theories of the modus operandi have been examined, with references to some physiological changes 8 8 A precis of the known histological changes is appended

12 citations


Journal ArticleDOI
TL;DR: In this article, the authors compared seven hundred Progressive Matrices records from neurotic military patients with controls and found that the neurotics as a group had significantly lower scores than the control group.
Abstract: 1. 1. Seven hundred Progressive Matrices records from neurotic military patients were compared with controls. It was found that the neurotics as a group had significantly lower scores. Subjects at higher intellectual levels seem to take written tests better than the low-grade subjects, who often need to be re-tested individually. 2. 2. When the records were divided into “straight” and “uneven,” the latter preponderated. The control group showed an even higher percentage of “uneven” records, so that mere unevenness between the five sets is no criterion of neurosis. There was no significant difference in percentage of uneven records between different score levels in either control or neurotic groups, nor did the two groups differ significantly in amount of reversals. The neurotics showed a tendency to reversals of scores earlier in the test, partly because of their lower scores. In both groups there were significantly more reversals between sets C and D. 3. 3. An analysis of the time factor in the neurotic group, who were tested without time-limits, showed a very low positive correlation between time and score, with no significant differences between “straight” and “uneven” records, but with a slight tendency for time and score to vary directly in the latter, there being more variation in Grade I scores. The Median Time over the whole group was 43 minutes, with a P.E. of 27 minutes. Since times do not alter significantly with increasing scores time-per-item decreases as score-level rises, i.e., quickness and ability are positively correlated. Time and age showed a very low positive correlation, with a slight tendency in the “uneven” group for times to increase with age and for scores over 30 to show more variation. 4. 4. The neurotic group showed a lower median age and wider range than the control group. The correlation between age and score is almost nil . The percentage of “uneven” records does not differ significantly from chance (equal) expectations at different ages in either the control or the neurotic groups, though the former shows a sigificant difference between two age groups, i.e. 21–25 and 26–30, the latter ages giving lower scores. There is a very slight tendency in the neurotic group for scores to decline with age, from 20 to 45. 5. 5. Attitudes of neurotic subjects to the test are on the whole good, only 5 per cent. of a sample (2,500) of records showing really negative attitudes. These are analysed into various categories. There is no significant difference in age or times taken among this “complaining” group, but the low scorers show poorer attitudes towards the test. The need for good testing conditions is emphasized. 6. 6. The current method of assessing unreliability of scores on the Matrix Test is mentioned, with further suggestions incorporating a comparison of individual records, with an over-all order of difficulty of the 60 items on the test and an index of efficiency by the use of a time-score index. A combination of methods gives the best assessments. 7. 7. 2,790 Matrix (control) records were analysed for frequency of wrong choices. It is shown that these follow the progression of the test, i.e. broadly from perceptual to conceptual. There is a tendency for a particular wrong approach to persist amongst low-scorers through several items. Types of errors in each of the five sets are mentioned. 8. 8. A comparison is made between 650 Shipley and Matrix records showing a normal curve of grade-displacements between the tests. The majority of these displacements are of one grade only. 9. 9. The use of a vocabulary score in estimating mental deterioration is mentioned, and the danger of making facile inferences from discrepancy scores (vocabulary scores minus scores on other tests) is emphasized. There is a need for information about the performance of subjects over as wide an age range as possible on the more reputable tests now in use.

12 citations


Journal ArticleDOI
TL;DR: For many years the need has been felt for a means of measuring in a reasonably accurate manner the amount of deterioration present in mental patients as discussed by the authors, and the old criterion of saying that a patient is well because he is capable of working well in the laundry or garden or doing skilful work in the handicrafts department, combined with giving an impression of recovery to the doctors and relatives, is not accurate enough for modern standards.
Abstract: For many years the need has been felt for a means of measuring in a reasonably accurate manner the amount of deterioration present in mental patients. The old criterion of saying that a patient is well because he is capable of working well in the laundry or garden or doing skilful work in the handicrafts department, combined with giving an impression of recovery to the doctors and relatives, is not accurate enough for modern standards.

Journal ArticleDOI
TL;DR: The hypothesis is offered that grouping cases of depression according to their pre-psychotic personality will yield more valuable prognostic criteria than the more usual system of drawing distinction between the involutional cases and the manic and melancholic phases of manic-depressive psychosis.
Abstract: 1. The development of electric convulsion therapy is discussed in relation to its application to states of so-called endogenous psychotic depression. 2. Results obtained by some of those who have treated similar cases by pharmacological convulsion methods are summarized for the sake of comparison. 3. The hypothesis is offered that grouping cases of depression according to their pre-psychotic personality will yield more valuable prognostic criteria than the more usual system of drawing distinction between the involutional cases and the manic and melancholic phases of manic-depressive psychosis. 4. A total of 92 female and 58 male cases of psychotic depression were treated during the period November, 1940, to October, 1942. Of these, 117 (78 per cent.) were discharged recovered and continue to remain in home surroundings. Six (4·0 per cent.) were discharged improved, 15 (10 per cent.) remain in hospital, and 12 (8 per cent.) were discharged but later relapsed and were readmitted to hospital. 5. The number of convulsions required for sustained remission of symptoms has been found to average 17, irrespective of the ages of patients at the time of treatment, and of the duration of their illness. 6. The recoverability of patients was found to be unaffected by duration of illness providing that it did not exceed three years. 7. A social workers' follow-up of the cases discharged from hospital shows that of 85 patients who have been in home surroundings for more than six months 63 are known to be normal and usefully employed, only 5 of those remaining at home have failed to maintain normality by ordinary social standards, 9 have had to be readmitted to hospital, and the end-result of 8 could not be determined. Less than six months have elapsed since the remaining 32 “recoveries” left hospital, and they therefore have not been followed up, but it is known that of these three have already relapsed.


Journal ArticleDOI
TL;DR: The paper I am about to read is one of the many imperfections of the paper as discussed by the authors, and I have not had the time that I would have wished to spend upon its preparation, nor the opportunity to make myself more than superficially conversant with the increasing literature, and trust that you will excuse such imperfections as will appear.
Abstract: May I apologize in advance for the many deficiencies of the paper I am about to read. I have not had the time that I would have wished to spend upon its preparation, nor the opportunity to make myself more than superficially conversant with the increasing literature, and I trust that you will excuse such imperfections as will appear.

Journal ArticleDOI
TL;DR: A case has been described in which gross emaciation gave place to pathological obesity in less than 18 months, and it has been suggested that an original hypofunction of the pituitary became one of pathological hyperactivity.
Abstract: 1. 1. A case, diagnosed as anorexia nervosa, has been described in which gross emaciation gave place to pathological obesity in less than 18 months. 2. 2. The significance of this change has been discussed, and it has been suggested that an original hypofunction of the pituitary became one of pathological hyperactivity. 3. 3. Various endocrine features have been described, and the designation “cerebral” pituitary cachexia has been proposed for anorexia nervosa. 4. 4. Appropriate lines of treatment have been mentioned.





Journal ArticleDOI
TL;DR: Using the 1937 revision of the Stanford-Binet Scale, the test records of 100 schizophrenic patients, when compared with those of 100 non-psychotic subjects matched for mental age, reveal a marked abnormality of pattern that is found to be both reliable and consistent throughout the scale.
Abstract: Using the 1937 revision of the Stanford-Binet Scale, the test records of 100 schizophrenic patients, when compared with those of 100 non-psychotic subjects matched for mental age, reveal a marked abnormality of pattern. This abnormality of pattern is found to be both reliable and consistent throughout the scale. A method for quickly detecting its presence in an individual test performance has been devised. The magnitude of the measurement of this pattern is found to increase with age, and an adjustment of pattern score based on 463 non-psychotics of various ages has been made. Statistically significant differences in average pattern score (adjusted for age) between schizophrenic and non-psychotic subjects are reported. Recovered schizophrenics and neurotics do not display a similar abnormality of pattern, while other groups of abnormal subjects are found to have abnormal patterns of varying degrees. The general nature of this abnormality is described.

Journal ArticleDOI
TL;DR: The conclusion is reached that the recovery was not due to focal cerebral injury, but to the combined operation of physical and psychological factors which are discussed.
Abstract: Summary Five cases of suicidal head injury are reported. Two endogenous and one reactive depression recovered mentally as the result of severe injury to the frontal lobes in two, to the left temporal lobe in one case. One psychopathic reaction with a laceration of the posterior temporal lobe showed no change. One recurrent endogenous depression was not influenced by a mild concussion. Comparing these cases with two cases found in the literature, the conclusion is reached that the recovery was not due to focal cerebral injury, but to the combined operation of physical and psychological factors which are discussed.




Journal ArticleDOI
TL;DR: If attention is paid to finer variations of the results, changes in the cell and protein content of the cerebrospinal fluid will be found in a surprisingly great number of “non-organic” psychiatric cases.
Abstract: A modified Takata reaction, together with the usual routine tests carried out on cerebro-spinal fluid, has been applied to the cerebrospinal fluids of organic and non-organic neurological and psychiatric cases. The results of the gross organic neurological group confirmed previous observations on the value of the Takata reaction on cerebrospinal fluid. In “organic” psychoses the modified Takata reaction is often weak positive in a number of cases, together with a slight Nonne and/or Pandy reaction. The tests have also been used on nearly 80 cases of “non-organic” psychoses. if attention is paid to finer variations of the results, changes in the cell and protein content of the cerebrospinal fluid will be found in a surprisingly great number of “non-organic” psychiatric cases. These changes appeared to be most outspoken in the group of “schizophrenia.” It appears to be characterized by a weak (trace to weak positive) Takata reaction, with the other tests negative or doubtful, aud an average cell count of 5/3

Journal ArticleDOI
TL;DR: A case of torulosis of the nervous system was reported in the St Pancras Hospital Mental Observation Unit, London, UK, in March, 1939 as discussed by the authors, which was only the third recorded case in British medical history and the first one to have come under mental hospital supervision.
Abstract: In March, 1939. there was admitted under my care at the St. Pancras Hospital Mental Observation Unit a case of torulosis of the nervous system. This is a very rare disease in this country and the present case is only the third recorded in British medical history (Greenfield et al., 1938; Smith and Crawford, 1930), and the first one to have come under mental hospital supervision. Although such a rarity here, torulosis is more common in the United States, and cases have been reported from nearly every part of the world.

Journal ArticleDOI
TL;DR: Schrijver-Bernhard's toe-flexor and a toe-fanning phenomenon have been examined, and compared with other reflexes of the so-called “pyramidal type” and with the usual “psychomotor” symptoms occurring in catatonics.
Abstract: 1. 1. Schrijver-Bernhard's toe-flexor and a toe-fanning phenomenon have been examined, and compared with other reflexes of the so-called “pyramidal type” and with the usual “psychomotor” symptoms occurring in catatonics. The examinations have been carried out on 75 normal persons and 82 mainly catatonic schizophrenics, the rest consisting of frank uncomplicated depressive states and a few organic psychotic and neurological cases; altogether 200 subjects have been examined. The observations of previous authors dealing with the frequency of the Schrijver-Bernhard reflex have been confirmed. 2. 2. The toe-fanning phenomenon is probably indicative of a cortical, the Schrijver-Bernhard reflex of subcortical extrapyramidal dysfunction. Both signs occur very often together with symptoms of muscular hypertension, but they are not necessarily dependent on them. 3. 3. It is possible under certain conditions to “provoke” toe-flexor and toe-fanning responses in normal persons. 4. 4. The two phenomena described occur at least as frequently as the psychomotor symptoms usually found in catatonic schizophrenics, and they may therefore be of some diagnostic value. 5. 5. The phenomena described may have a preponderance on the left side of the body. The possible significance of this has been discussed.