THE PSYCHOPATHOLOGY OF ANANCASTIC ENDOGENOUS DEPRESSION

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Abstract
From a sample of 1,005 patients admitted to the Psychiatric Hospital in Aarhus for the first time during the period 1950-1959 and diagnosed as suffering from manic-depressive psychosis or endogenous depression (affective psychoses), a subsample of 104 manic-depressive patients with anancastic symptoms in the history was selected. The 104 probands were individually matched with 104 non-anancastic probands with affective psychoses. The study was designed as a follow-up study, and the patients who were still living were seen personally. In the search for factors which could be used to distinguish affective psychoses with anancastic symptoms from affective psychoses without these traits, the incidence of a number of psychopathological features was evaluated based on the case histories and the information given by the patients at the follow-up. There was no difference as far as atypical, schizophrenia-like symptoms were concerned between the anancastic probands and the controls. Manic and hypomanic features were more frequent among the controls, corresponding to a greater number of bipolar psychoses among them. At the same time, the controls showed a significant preponderance of decidedly psychotic symptoms such as disturbances of consciousness, delusions and delusion-like ideas and hallucinations. Furthermore, retardation was more frequent among the controls. There was no difference in the suicidal behaviour of the two groups. Symptoms which were more often met among the anancastic depressives were: anxiety, agitation, diurnal variation of mood and early awakening. Seasonal variation in symptomatology was also more frequent among the anancastic probands. The same held true for depersonalization. The anancastic probands showed a significant preponderance of anancastic premorbid personality features. A positive correlation was found between the number of anancastic personality features and the following symptoms: agitation, anxiety, diurnal fluctuation, seasonal variation, hypochondriacal attitude and depersonalization. On the other hand, objective retardation or flight of ideas showed a significant negative correlation. The pattern of the anancastic symptoms was rather uniform; aggressive obsessions, mostly in the form of suicidal and homicidal obsessions, were present in more than two thirds of the cases. The anancastic depressions were often less severe than non-anancastic depressions in that the latter were more often complicated by decidedly psychotic symptoms. It is possible to interpret the symptomatology of anancastic depressions as a pathoplastic influence of the anancastic personality, but it cannot be excluded that some of the symptoms like anxiety and agitation are linked to the presence of anancastic symptoms as such.

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