Medical and general reports and accounts for the year ended 31st December, 1943 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1944?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1943 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    time lag between the solution of the difficulty in the patient’s mind and his recovery from anxiety symp¬ toms. This “ basic anxiety reaction ”, presumably the result of habit formation in a predisposed individual can be greatly reduced by the modified insulin therapy introduced into this country by Sargent. After a preliftiinary examination of the urine and blood sugar to exclude disorders of carbohydrate metabolism, the patient is given 10 units of insulin on a fasting stomach at 7 a.m. The dose is increased daily by 10 units until a hypoglycsemic reaction occurs, usually taking the form of profuse sweating or drowsiness. The average dose required for this purpose is 40-50 units. The hypoglycsemia is interrupted at 10 a.m. with a glucose drink followed by a high carbohydrate breakfast. 60 grs. of sodium chloride are also given fn the form of enteric coated capsules to counteract the loss through sweating. Further glucose is administered during the afternoon to eliminate the risk of a delayed reaction. The rationale of the treatment is still on a highly speculative basis. The suggestion of a specific effect upon the anxiety reaction, rather than a mere improvement in nutrition, gains support from the fact that as the patient becomes clinically.less anxious so his tolerance for insulin decreases. The maximum dosage has thus gradually to be decreased or coma is likely to occur. The treatment is given on 6 days in the week and may be kept up for several weeks. There is usually a striking gain in weight, up to 6 lbs. per week has been recorded. Electric Shock Therapy The depressed patient is more or less completely unable to benefit from extensive psychotherapeutic procedures. Anything save the most superficial analysis tends to render him more depressed and he is incapable of making the effort of constructive synthesis. In the past, therefore, his treatment necessarily consisted of rest, diversion and daily reassurance in the well justified hope that time would bring about the restoration of normal mood. In most cases this took place within a few months. Some cases, however, tended to drag on for years. Now the depressive illness can, in the majority of cases, be cut short by the use of electric shock therapy. There has been much discussion of the advantages and disadvantages of the method. The results obtained at the Cassel Hospital are to be published elsewhere. It is, therefore, sufficient to state here that of a series of 71 cases so treated, a recovery rate of 77 per cent, was obtained with an average duration of stay in hospital of 13 weeks. Before the introduction of shock therapy, U group of 75 cases, much more carefully selected for favour¬ able prognosis, gave a recovery rate of 53 per cent, with an average duration in hospital of 26 weeks. For conditions other than mild depressive psychosis the treatment in a limited series has given very poor results. In our hands it has proved almost useless for affective neuroses, conversion hysteria and obsessional neurosis. Others (e.g., Mayer-Gross— personal communication) have recorded good results in some long standing cases of conversion hysteria. In this hospital we cannot give an adequate account of its value in the treatment of schizophrenic disorders for which it was originally introduced. Prefrontal Leucotomy . There remain a small number of cases of chronic affective disorder which fail to respond adequately to any of the methods of treatment already described. Some are examples of depressive psychosis which relapse repeatedly after shock therapy, others fall into the category of chronic affective neurosis and fail to respond to psychotherapy, modified insulin therapy or shock therapy. In such cases where the degree of disability precludes a working adjustment to life, the operation of pre-frontal leucotomy has proved beneficial. The present is not the place to describe the technique by which the pre-frontal association fibres are severed. The result, however, in a successful case, is the almost complete cessation of anxiety. The immediate result may appear disastrous. One of our patients, an anxiety ridden bank manager of 38, the severity of whose symptoms rendered him totally unable to carry on his work, was transformed from a meticulous obsessional individual to a slovenly, careless, dirty patient who was quite capable of using his wash basin for defeca¬ tion. A three months regime of re-education helped to restore him almost to normal. He returned easily to his work and maintained his former intellectual level. When seen after 12 months, he lacked some insight into his former condition, his affect was a trifle shallow and when asked if he worried about his work he replied “ Good God, no ! Why should I ? ” Our series of these cases is too small to permit further comment. It is not a pro¬ cedure we would care to sanction at the present time except as a last resort and then only after very careful consideration, full presentation of the facts to a responsible relative and, preferably a second psychia¬ tric opinion. COMCLUSION The methods .of treatment at present in use at the Cassel Hospital have been reviewed in the light both of classical psychotherapy and of modern physical techniques. It is suggested that the introduction of the new affords in this instance no grounds for the super cession of the old.