Prefrontal Leucotomy in Chronic Psychosis

Rosie, John M (1948) Prefrontal Leucotomy in Chronic Psychosis. PhD thesis, University of Glasgow.

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(1) The results of prefrontal leucotomy are reported in 68 cases of chronic mental illness which had failed to respond to all other methods of treatment. The patients are still resident in a mental hospital after a postoperative period ranging from one to 4 years. 44 patients improved in varying degree and 24 are considered to he unimproved. (2) The results are analysed in terms of age, sex, duration of the illness, diagnostic classification and the operative technique employed. The form taken hy amelioration in the various illnesses is described and examples of the postoperative state are given. (3) Post-operative signs occurring in all leucotomlsed patients in hospital at the time of the survey are listed. Other early effects of leucotomy include favourable results in 2 cases of obsessional neurosis outwith the present series. The main post-operative signs are euphoria, an elevation of mood to a lesser degree and inertia. These are signs of frontal lobe deficit and their recurrence in relation to improvement in the 68 patients is charted, and their effect in modifying the psychosis described. No relationship is found between premorbid and postoperative personality traits. (4) After-treatmentis described and the value of postoperative electroplexy and of re-operation is discussed. (5) Relapse occurred transiently in 16 and permanently in 12 patients. Its theoretical aspects are discussed. (6) Changes in body-weight following leucotomy are described. No correlation is found between increased weight and improvement of mental symptoms. (7) Two factors in the pre-operative state thought to influence the prognosis are examined in relation to post-operative improvement. Those cases which improved after leucotomy had in aggregate a greater degree of mental tension than those not improving. No such prognostic significance could be attached to the other factor, the degree of break with reality. (8) Theories of the operation are examined in the light of the results. It seems most likely that the operation acts by superimposing a modified frontal lobe syndrome on the psychosis. The importance of the position of the cut is suggested. No relationship is found between orbital area isolation and post-operative changes in the emotional sphere. (9) The lack of finality in the reported results is mentioned. They are compared with the results published by others. The significance of the result "worse" is discussed. It is concluded that affective and obsessional illnesses respond well to leucotomy. The results in schizophrenia are less satisfactory, hut in this illness the greatest response is found in the catatonic and paranoid types, the least in the hebephrenic variety. Leucotomy acts by the removal of mental tension and where this is marked there is still hope of improvement, even if the patient is considered deteriorated. It is further concluded, that while duration is less and tension greater where the response to the operation is good, there is no common factor in those patients who improve or fail to improve after leucotomy. The results in individual cases of chronic mental illness are unpredictable before operation, but the value of this method of treatment in such cases is fully confirmed.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Neurosciences, Psychobiology
Date of Award: 1948
Depositing User: Enlighten Team
Unique ID: glathesis:1948-79678
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 04 Mar 2020 15:40
Last Modified: 04 Mar 2020 15:40

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