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Stereotactic Limbic Leucotomy—A Follow-up at 16 Months

Published online by Cambridge University Press:  29 January 2018

Nita Mitchell-Heggs ,
Desmond Kelly  and
Alan Richardson
Nita Mitchell-Heggs
Affiliation:
St. George's Hospital Medical School, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20
Desmond Kelly
Affiliation:
St. George's Hospital Medical School, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20
Alan Richardson
Affiliation:
St. George's Hospital Medical School, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20
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Summary

Sixty-six patients were assessed clinically, psychologically and physiologically before operation, at six weeks and at a mean of 16 months following stereotactic limbic leucotomy. Seventy-three per cent were clinically improved at six weeks and 76 per cent at 16 months. In obsessional neurosis, 89 per cent of patients showed definite clinical improvement at 16 months; in chronic anxiety, 66 per cent were improved; in depression, 78 per cent; and in the small number of schizophrenics treated the improvement rate was over 80 per cent. Self-assessment and observer-assessment questionnaires and scales measuring Depression, Anxiety, Neuroticism, Hysterical symptoms and Obsessional symptoms and traits all showed highly significant reductions of mean scores at 16 months. There was no fall-off in intelligence, and adverse effects were minimal. Limbic leucotomy, with its enhanced accuracy and safety, compares very favourably with similarly assessed, more extensive ‘free-hand’ procedures, and in obsessional neurosis and chronic anxiety the results are superior.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 128 , Issue 3 , March 1976 , pp. 226 - 240
Copyright
Copyright © Royal College of Psychiatrists, 1976 

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References

Beck, A., Ward, C., Mendolson, M., Mark, J. & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561—71.Google Scholar
Beech, H. R. (1974) Obsessional States. London: Methuen.Google Scholar
Bridges, P. K. (1972) Psychosurgery today: psychiatric aspects. Proceedings of the Royal Society of Medicine, 65, 40—4.Google ScholarPubMed
Bridges, P. K. Goktepe, E. O. & Maratos, J. (1973) A comparative review of patients with obsessional neurosis and depression treated by psychosurgery. British Journal of Psychiatry, 123, 663—74.Google Scholar
Brodman, K., Deutschenberger, J. & Wolff, H. G. (1956) Manual for the Cornell Medical Index Health Questionnaire. New York: Cornell University Medical College.Google Scholar
Cooper, J. (1970) The Leyton Obsessional Inventory. Psychological Medicine, 1, 48—64.CrossRefGoogle ScholarPubMed
Crisp, A. H. & Kalucy, R. L. (1973) The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa). Postgraduate Medical Journal, 49, 883—93.CrossRefGoogle ScholarPubMed
Crown, S. & Crisp, A. H. (1966) A short clinical diagnostic self-rating scale for psychoneurotic patients. British Journal of Psychiatry, 112, 917—23.CrossRefGoogle Scholar
Evans, P. (1971) Failed leucotomy with misplaced cuts: a clinico-anatomical study of two cases. British Journal of Psychiatry, 118, 165—70.Google Scholar
Eysenck, H. (1959) Manual of the Maudsley Personality Inventory. London.Google Scholar
Freeman, W. (1971) Frontal lobotomy in early schizophrenia: long follow-up in 415 cases. British Journal of Psychiatry, 119, 621—4.CrossRefGoogle ScholarPubMed
Freeman, W. & Watts, J. (1942) Psychosurgery. Springfield, Illinois: Charles C. Thomas.Google Scholar
Hamilton, M. (1959) The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50—9.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278—96.Google Scholar
Jackson, H. (1954) Leucotomy—a recent development. Journal of Mental Science, 100, 62—5.CrossRefGoogle Scholar
Kelly, D. H. W. (1967) The technique of forearm plethysmography for assessing anxiety. Journal of Psychosomatic Research, 10, 373—82.CrossRefGoogle ScholarPubMed
Kelly, D. H. W. (1973) Psychosurgery and the limbic system. Postgraduate Medical Journal, 49, 825—33.Google Scholar
Kelly, D. H. W. (1975) Advances in the neurosurgical treatment of psychiatric disorders. In Recent Advances in Clinical Psychiatry (ed. Granville-Grossman, Kenneth). 2nd edition. London: Churchill Livingstone. In press.Google Scholar
Kelly, D. H. W. & Mitchell-Heggs, N. (1973) Stereotactic limbic leucotomy—a follow-up study of thirty patients. Postgraduate Medical Journal, 49, 865—82.Google Scholar
Kelly, D. H. W., Pik, R. & Chen, C. (1973) A psychological and physiological evaluation of the effects of intravenous diazepam. British Journal of Psychiatry, 122, 419—26.Google Scholar
Kelly, D. H. W., Richardson, A. & Mitchell-Heggs, N. (1973a) Stereotactic limbic leucotomy, neurophysiological aspects and operative technique. British Journal of Psychiatry, 123, 133—40.Google Scholar
Kelly, D. H. W., Richardson, A. Mitchell-Heggs, N., Greenup, J., Chen, C. & Hafner, R. (1973b) Stereotactic limbic leucotomy: a preliminary report on forty patients. British Journal of Psychiatry, 123, 141—8.CrossRefGoogle ScholarPubMed
Kelly, D. H. W., Walter, C., Mitchell-Heggs, N. & Sargant, W. (1972) Modified leucotomy assessed clinically, physiologically and psychologically at six weeks and eighteen months. British Journal of Psychiatry, 120, 19—29.CrossRefGoogle ScholarPubMed
Knight, G. (1964) The orbital cortex as an object in the surgical treatment of mental illness. British Journal of Surgery, 51, 114—24.Google Scholar
Knight, G. (1973) Further observations from an experience of 660 cases of stereotactic tractotomy. Postgraduate Medical Journal, 49, 845—54.CrossRefGoogle ScholarPubMed
Kringlen, E. (1965) Obsessional neurotics—a long-term follow-up. British Journal of Psychiatry, 111, 709—22.CrossRefGoogle Scholar
Laitinen, L. (1972) Stereotactic lesions in the knee of the corpus callosum in the treatment of emotional disorders. Lancet, i, 472—5.Google Scholar
Lewin, W. (1961) Observations on selected leucotomy. Journal of Neurology, Neurosurgery and Psychiatry, 24, 37—44.CrossRefGoogle ScholarPubMed
Marks, I. (1972) Flooding (implosion) and allied treatments. In Learning Theories Application of Principles and Procedures to Psychiatry (ed. Agras, W.). New York: Littlebrown.Google Scholar
McKissock, W. (1959) Discussion on psychosurgery. Proceedings of the Royal Society of Medicine, 52, 206—9.Google ScholarPubMed
Meyer, V., Levy, R. & Schnurer, A. (1974) The behavioural treatment of obsessive-compulsive disorders. In Obsessional States (ed. Beech, H. R.). London: Methuen and co. Ltd.Google Scholar
Morruzi, G. & Magoun, H. (1949) Brain stem reticular formation and activation of the EEG. Electroencephalography and Clinical Neurophysiology, 1, 455—73.Google Scholar
Partridge, M. (1950) Prefrontal Leucotomy. Oxford: Blackwell Scientific Publications.Google Scholar
Pippard, J. (1955) Rostral leucotomy: a report on 240 cases personally followed up after 1f12 to 5 years. Journal of Mental Science, 101, 756—73.Google Scholar
Pollitt, J. (1957) Natural history of obsessional states: a study of 150 cases. British Medical Journal, i, 194—8.Google Scholar
Registrar General (1968) A Glossary of Mental Disorders. Studies on Medical and Population Subjects Number 22. London: H.M.S.O.Google Scholar
Richardson, A. (1973) Stereotactic limbic leucotomy: surgical technique. Postgraduate Medical Journal, 49, 860—4.Google Scholar
Richardson, A. Kelly, D. & Mitchell-Heggs, N. (1976) Lesion site determination in stereotactic leucotomy. In Proceedings of Fourth International Congress of Psychosurgery. In press.Google Scholar
Rigby, B., Clarren, S. & Kelly, D. (1973) A psychological and physiological evaluation of the effects of intravenous clomipramine (Anafranil). Journal of International Medical Research, 1, 308—16.Google Scholar
Robin, A. (1958) A controlled study of the effects of leucotomy. Journal of Neurology, Neurosurgery and Psychiatry, 21, 262—9.Google Scholar
Rollin, H. (1974) The Mental Health Act, 1959. British Journal of Hospital Medicine, 12, 272—7.Google Scholar
Routtenberg, A. (1968) The two-arousal hypothesis: reticular formation and limbic system. Psychological Review, 75 (1).Google Scholar
Schurr, P. (1969) Leucotomy. British Journal of Hospital Medicine, 2, 1712—5.Google Scholar
Schurr, P. (1973) Psychosurgery. British Journal of Hospital Medicine, 10, 53—60.Google Scholar
Ström-Olsen, R. & Carlisle, S. (1971) Bi-frontal stereotactic tractotomy: a follow-up study of its effects in 210 patients. British Journal of Psychiatry, 118, 141—54.Google Scholar
Sykes, M. & Tredgold, R. (1964) Restricted orbital undercutting: a study of its effects on 350 patients over the ten years 1951—60. British Journal of Psychiatry, 110, 609—40.Google Scholar
Tan, E., Marks, I. & Marset, P. (1971) Bimedial leucotomy in obsessive-compulsive neurosis: a controlled serial enquiry. British Journal of Psychiatry, 118, 155—64.Google Scholar
Taylor, J. (1953) A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology, 48, 285—90.CrossRefGoogle ScholarPubMed
Torrey, E. & Peterson, M. (1974) Schizophrenia and the limbic system. Lancet, ii, 942—6.Google Scholar
Walter, C., Mitchell-Heggs, N. & Sargant, W. (1972) Modified narcosis, ECT and antidepressant drugs: a review of technique and immediate outcome. British Journal of Psychiatry, 120, 651—62.Google Scholar
Wechsler, D. (1955) Manual for the Wechsler Adult Intelligence Scale. New York.Google Scholar
Wolpe, J. (1973) The Practice of Behavior Therapy. New York: Pergamon Press.Google Scholar
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