Nova iskustva u hirurškom lečenju duševnih bolesnika

Abstract

Modem psycho-surgery is an achievement of today. It started in 1936 when Moniz began applying prefrontal leucotomy, and it is based, apart from empirics, on a better understanding of functional paths in the fronta! cortex and of certain brain ganglia. By a severance of these paths the intellectual functions are freed from emotional factors and in this lies the essence of the surgical operation according to modem interpretation. Opinions on the mechanism of prefrontal leucotomy stil differ considerably.

The essence of this operative method lies in a symmetric, bilateral severing of the paths, by which the impulses travel from the cortex to the thalamus and from the thalamus to the cortex. The severing is performed on a suitable scale and in the optimal zone, generally immediately in front of the frontal homs of the lateral ventricles. Other modifications of this standard form of prefrontai leucotomy show certain deficiencies and some good points.

The effect of prefrontal leucotomy is reflected in a series of psychosomatic phenomena. After leucotomy the majority of the operated patients show a slackening of inner tension; the patient becomes more quiet and less agressive. Prefrontal leucotomy per­ formed lege artis and vvithin the limits of set indications does not lessen reasonable thinking, nor acquired knowledge and basic experience. By removing affective symptoms, leucotomy, as a symptomatic method of treatment, has found a wide application, primarily in the treatment of endogenic psychosis, psychoneurosis and certain other mental disturbances.

The indications for performing prefrontal leucotomy are set by neuro-psychiatrists. They make a judicious selection of cases previously unsuccessfully treated by medicoph^sical methods. On the basis of an accurate diagnosis, the surgeon decides on the most suitable modification of prefrontal leucotomy.

The results obtained by operative treatment, are, taken as a whole, far more favourable and lasting than those obtained by conservative treatment.

At the Neurosurgical Clinic in Belgrade, from September 1947 till September 1952, that is over a period of five years, we performed leucotomy on a series od 339 patients. Among these there were 301 cases of schysophrenia, while the remaining 38 included other diseases (psychneurosis, imbecility, idiocy, hysteria etc.). In the group of schysophrenics there were 183 males (61o/0) and 118 females (39%). Of these there were 119 cases of hebephrenia (39%), 98 of catatonia (37%) and 84 of paranoid state (28%). Most of them were chronic cases which had previously been treated by shocks but without success. Half of the operated patients were in the third decade.

The operative results were assessed by psychiatrists. According to their assessment, in this seires of 301 operated schysophrenics, we had 189 (63%) practically cured and considerably recovered, vvhile in 89 cases (30%) the condition remained unchanged and these were retained at the hospital. There were relapses in 9 cases (3%) and there was an operative mortality of 3% (10 cases).

From what has been said we can see that favourable operative results were obtained in 63% while in 3% of the cases there were relapses. According to this, by means of prefrontal leucotomy aihnost 2/3 of the patients were socially rehabilitated and made fit for life outsidie hospital; of these almost one half were able to retum to their former occupation and norma! life. For yoars before ali of these had been considered as incurable. By the operative treatment of schysophrenics and of the more serious cases of psychoneurosis we are achieving better and more lasting results; this undoubtedly represents not only a great medical success but is likewise of great significance in social and economic respect. In the future we should therefore make the greatest efforts with this goal in view.