OBSESSIONAL NEUROTICS: A LONG-TERM FOLLOW-UP.
Ninety-one former in-patients with a diagnosis of phobic and/or obsessional illness (neurosis), admitted to the University Psychiatric Clinic, Oslo, were followed up for 13-20 years after admission. Most of the patients were personally re-examined by the author, usually in the course of visiting their homes. The sample constitutes a small proportion of patients admitted to the hospital, 2.5 per cent. of all patients and 4.3 of the neurotic and psychopathic group. The investigation confirms earlier works, that obsessional traits and obsessional illness are found in significant concentration in the families of obsessionals. The study further seems to support the view that obsessionals have received a strict and puritanical upbringing, with much insistence on rectitude, obedience and cleanliness. Sixty-five (83 per cent.) of the patients suffered from a variety of nervous troubles as children. Most of them had obsessional traits prior to their main illness; 25 (28 per cent.) had none. Half of the sample developed their illness before the age of 20; and nearly one-fifth had obsessional symptoms in childhood. The mean age at first admission was 34 for males and 36 for females, reflecting the long time between the onset of illness and hospitalization. Most of the patients had symptoms other than phobic and obsessional ones at the time of admission. In only a few patients was the clinical picture monosymptomatic; as a rule obsessive thoughts, obsessive acts and phobias are all mixed together. Most of the patients received somatic therapy, particularly E.C.T. At follow-up, six patients were dead, five from somatic diseases, one by suicide. Six patients were found to suffer from psychosis or borderline psychosis. None of these patients were typical obsessionals; their symptomatology might have led one to suspect a psychotic development at an early stage. Roughly three-quarters of the sample were unchanged at time of follow-up, one-quarter being much improved. Obsessive premorbid personality and a severe clinical picture at first admission seemed to give a significantly less favourable prognosis. It is thought that patients with a typical phobic and/or obsessional neurosis have a relatively early onset of symptoms and a poor prognosis with few remissions and few improvements; development into psychosis, alcoholism or drug addiction is rare; and the suicidal risk is small.