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The authors investigated some social, psychological, clinical features in 72 patients suffering of neuroses with an early and late onset of the disease. Statistically important differences between the groups were observed. These data should be considered in treatment strategy, determination of the prognosis of the disease, tactics of subsequent outpatient therapy.
The authors give an account in the effect of seven weeks of comprehensive regime therapy and psychotherapy of neuroses under conditions of partial hospitalization. They processed data from 390 patients who participated in 1977-1986 in a complete therapeutic immediately after treatment. substantial symptomatic improvement occurred in 65%, when those with slight improvement were added the percentage was 90%. As regards views, 81% reported a substantial gain and as regards change of attitudes and behaviour 60%. A general substantial improvement after therapy is reported by 82% patients. Catamnestic evaluation of the achieved effect by the patients six months after termination of treatment (200 patients returned filled in questionnaires) confirms substantial symptomatic improvement in 70%, as regards views in 80%, in change of attitudes and behaviour in 64%. The data provide evidence of the stability of the achieved effect. After termination of treatment the consumption of psychopharmaceutical drugs declines markedly.
A cross-sectional investigation on a day chosen at random i autumn 1987 in the Hospital for Neuroses, Montebello, Elsinore, revealed that a total of 25% of the female patients treated on that date had previously been the victims of incest (8.7%) or sexual abuse (17.3%). Of these, the great majority, 19 out of 23 (82%) had been abused prior to the age of 18 years. One out of 15 male patients (7%) had been the victim of previous sexual abuse. Approximately one third of the sexually abused women had been abused by more than one person. The incident had been reported to the police on one occasion only. In addition, previous incest/sexual abuse was presumed where further 10% of the female patients were concerned, on the basis of the opinions formed by the therapists from the clinical pictures and the case histories. In approximately half of the cases, the secrecy concerning the abuse was broken in the course of the psychotherapeutic process and it is concluded that frankness knowledge and courage on the part of the therapist are essential in order to establish sufficiently differentiated psychotherapeutic treatment and that increased knowledge about the problem in society will presumably exert a prophylactic effect.
By contact microscopy the state and reactivity of the capillary bed (capillaries of the cheek mucosa) were studied in neurotic patients with different levels of arterial pressure (AP). It has been shown that at constant AP capillariscopic parameters (diameter, length and number of capillaries in the visual field) are relatively stable. Neuroses with hypertension are characterized by uneven (more expressed in arterioles) contraction of the capillaries, accelerated development and greater duration of reactions to the mental stress and applications of adrenaline and noradrenaline solutions in comparison with healthy persons. In hypotension, uniform capillaries contraction and slower development of the above reactions are observed.
The shapes of the slow brain potentials--conditioned negative wave (CNW) and postimperative negative wave (PNW)--were compared in normal and neurotic subjects. Instruction-directed performance was used to investigate the physiological mechanisms of neuroses and to develop the diagnostic psychophysiologic tests with simultaneous recording of the slow potentials. These were evaluated by calculation of asymmetry and power amplification coefficients for CNW and PNW while more and more complicated instructions were given.
The results of clinico-psychological examination of 121 patients have demonstrated that acupuncture is a fairly effective method of treating asthenic states in neurotic patients. Thus, considerable improvement and improvement has been observed in 67% of the patients. The absence of positive effect in the remaining cases is explained by an aggravated history, a stubborn course of the disease, and depletion of the functional activity of the sympathoadrenal system (SAS) and the adrenal cortex. Normalization of EEG rhythm is effected through activation of the synchronizing and inactivation of the desynchronizing cerebral systems; the positive dynamics of the structure of nocturnal sleep is reflected in an increased duration of slow sleep and rapid sleep which were initially reduced, in more regular alternation of the cycles and phases of sleep, and in a shorter period of falling asleep. Biochemical examinations have revealed activation of the mediatory component of the SAS and elevation of the function of the adrenal cortex, while baroalgesimetric studies have shown that acupuncture is characterized by antinociceptive and activizing effects. On the whole the efficacy of acupuncture in controlling asthenic conditions related to neuroses is due to its integral action.
Having outlined the limits of drug-therapy in neuroses, where it may support psychotherapy, a treatment the use of which is still questioned by some, the authors review the rare publications involving the indications of Carpipramine in neurotic syndroms. Active upon symptom patterns consisting essentially of asthenia, inhibition and psychomotor impairment, raising the level of activity, stimulating enthusiasm and relational activity, Carpipramine would appear to represent a new advance in the treatment of some neurotic syndroms, partially encompassing the border-line indications of anti-depressants and those of certain disinhibitory neuroleptic agents.
A study covering 100 sinistral and 100 dextral neurotic children revealed a higher percentage of persons with manifestations of motor disinhibition, phobias and anxiety among sinistral children. It was also in this group that a considerable number of children presented at the beginning of schooling such phenomena as "mirror" writing and attempts of reading and counting from right to left. Elements of "mirror" thinking seemed to explain difficulties in learning writing and reading observed in such children. The authors discuss the questions of prophylactic measures in sinistral children with neuroses.
In modelling of neuroses, successive stages of development of this pathology were observed in dogs. The first stage is characterized by circular disturbances of conditioned activity, vegetative shifts of compensatory character and intensification of individual characteristics of behaviour. At the second stage, parallel with sharp disturbances of conditioned reflexes and with vegetative dystonia, a distortion of emotional reactions was observed in dogs. It is essential that resumption of neurotization episodes in experiments on dogs with the second stage of disease promoted a development of depressive-like states. Diazepam corrected the behavioural and vegetative shifts at the first stage of neurosis. Non-typical antidepressants eliminated the manifestation of symptoms complex of the disease, especially at prolonged treatment.
Following some introductory remarks on the importance of multicausal factors in the genesis and development of neurotic disorders it is especially the part played by early-childhood cerebral lesions that is underscored by the author. The importance of this lesion to the development of neuroses in adults continues to be an open question. Within the framework of an attempt made with a view to finding an answer to this question the author presents the results of an analysis of 300 case histories of patients of the neurosis ward. After a description of an analysis of 22 patients diagnosed as having "neurosis", who had suffered from an early-childhood cerebral lesion, and of a comparison with a control group of anxiety-neurosis patients certain characteristics of these patients and of the clinical course of their disease are discussed. On the basis of this analysis there is then formulated a hypothetical model of the development of neurotic disturbances in the course of the lives of some persons with early-childhood cerebral lesions.
In conditions of overloaded function of short-term memory, studied by the method of delayed reactions, with a prolonged deficit of time allotted for realization of the function, the animals exhibit substantial disturbances of higher nervous activity which by their etiological character belong to the group of informational neuroses. Appearance of the neurosis is preceded by a number of complex behavioral and vegetative changes reflecting activation of powerful compensatory mechanisms of the brain activity, aimed at elimating the time deficit and other neurotizing factors of the surroundings. Experimental neurosis caused by overloading the function of short-term memory is characterized by a severe course and is attended with motor and somatic disturbances as well as by memory and emotional disorders.
We think that we have collected a certain amount of arguments in support of the following hypothesis: Without assuming if it is in itself the cause of neuroses, the way of being and of thinking in this world, characteristic of our times' positivistic technico-industrial culture seems to promote a more or less artificial and unconscious anti-anxiety behaviour leading to the psychosomatic syndromes. This way of being in the world and of thinking it is symptomatic of a discrepancy between the exogen (primacy of assimilation) and the endogen (primacy of accommodation) assimilation/accommodation balance. The non-decoupling of the exogen and endogen accommodation leads to a rigid content of concepts and limits the mind process to consider only the materially possible, leading to a regressive causality. Its' ultimate term is the object in which the essence includes the existence, the "causa sui" that is none other than the patient's body. Inability to take into account what is structurally possible makes it difficult to approach the notions of chance and of great numbers, proceeding on to apprehend the time in a way akin to Aristoteles', where the future is reduced to chance. This type of thinking limits the world's understanding to what is materially possible. Outside this, just everything is possible, including the possible the occult sciences account for.
A comparative clinico-statistical study of 149 neurotic patients revealed the distinctive characteristics of the clinical time-course of neuroses with marked hypochondriac disturbances. These were expressed in the specific premorbid features, "a reactive form" of neurosis, the presence of paroxysmal psychovegetative disorders, the symptoms pathognomonic for a given form of neurosis, and the characterological reactions in the initial period. In patients without hypochondriac emotions, the initial period was determined by astheno-depressive reactions. In the subsequent stages of the disease this difference became less prominent and was expressed only in the predominance in patients with hypochondriac disturbances of such features as egocentrism, reticence, weakness, fatigability, and importunity.
Using an adapted psychologic technique, the authors considered the predominant types of therapeutic behaviour of 70 psychotherapists from the USSR and CSSR who employ methods of group psychotherapy in treating neuroses. The frequency of optimal variants of the therapeutic behaviour resorted to by psychotherapists in difficult situations arising in the course of group psychotherapy was established. Characteristic features of the therapeutic tactics used by psychotherapists from both countries are shown.
Ultrastructure of neurones and synapses of the cortical associative area of dogs has been studied under conditions of experimental neuroses caused by prolonged informational loads with constant time deficit and high motivational signals significance. Analysis of subcellular reorganization of a number of neuronal and synaptic organelles showed the degenerative changes of afferent conducting systems in various neuropil parts leading to the falling out of definite neuronal groups from stable functional connections and to the disturbance of intracortical interrelations. In the cortex simultaneously with destructive processes, are developing intracellular compensatory-adaptive reactions.
This paper emphasizes the importance of understanding and treating the aged with neuroses and character disorders. Although they are often neglected by mental health workers, the aged with these emotional problems form a far larger group than the psychotic aged who receive a greater share of attention. Stereotyped attitudes and commonly accepted myths regarding the aged encourage an attitude of therapeutic nihilism and pessimism. The unconscious motivation for ignoring the obvious distress of older people is discussed. Certain specific myths, such as the "rigidity" of the aged and the tendency to "wastebasket" and to view all pathology as organic or caused by aging alone, are discussed. The fear of the devouring older person is also explored, as well as the myth of "family rejection." A number of clinical examples are given of the types of emotional problems frequently seen among the noninstitutionalized older population. Each case is described from the standpoint of dynamic understanding and management. A trial of observation and psychotherapy is recommended in all situations, since even "organic" signs may be reversed. Generalizations concerning the aged as a group are avoided in the belief that they lead to further stereotyping and the discouragement of scientific investigation. Individual assessment and understanding are emphasized. The persistence of unconscious attitudes, fantasies, and wishes from childhood is pointed out, but it is emphasized that they may not always carry the same value and meaning throughout life. Certain patients achieve insight through treatment, along with a greater capacity to enjoy life than they had before. Others are comforted by the relationship with the therapist for both its "real" and unconscious meanings. Some require assistance in accepting and tolerating more regressive behavior, while others need help in accepting and assimilating their changing feelings about their goals, objects, and sexuality in old age. Reminiscences are emphasized as important sources of elevating self-esteem. Concerns about death and common countertransference problems in work with the aged are examined. The need to be flexible but not to "lean over backward" is emphasized. Patients understand a genuine offer of involvement and concern as the most precious gift.
Three groups of patients with neuroses (30 patients as a total) were examined in the process of group psychotherapy. The examinations revealed a close interconnection between some personality peculiarities on the one hand, difficulties in social functioning, disturbances in the somatic and emotional spheres, adequacy of understanding the disease cause, compensation and decompensation by the patients, level of the motivation for the treatment, and time course of all these factors in the process of the group psychotherapy on the other. A comparative analysis of the groups has confirmed the hypothesis that the efficacy of the treatment by the group psychotherapy method depends on the level of the socio-psychological development of the patients constituting one or another group.
The authors have found that disturbances of general sensitivity are characteristic of not only patients with hysterical neurosis, but also of patients with neurasthenia. The clinical structure and the time course of those disturbances in both groups of the patients were found to be rather close. In general, they differ substantially from the sensitivity disturbances in neuroses described earlier. The leading mechanism of the development of those sensitivity disturbances consists in an impairment of the function of the limbico-reticular complex structures.