Depressive Psychosis in the Obsessional Neurotic

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Abstract
The case notes of 398 cases of depressive psychosis admitted to the Professorial Unit of the Maudsley Hospital were studied. Fifty-two cases, on account of exhibiting frank predepressive obsessions were categorized as obsessional neurotics. Comparing the 52 obsessional neurotics with the 346 other depressives, it was found that the obsessional neurotic group had more obsessional personalities in their parents and siblings, a greater incidence of obsessions in their previous depressive attacks, a younger age at onset of the present depressive attack, a greater incidence of delusion-like ideas of Cancer, Bowel and Throat Blockage, and Poverty, a greater incidence of Depersonalization, and a lower rate of attempted suicide. These were no other differences. A second comparison was made between the 39 obsessional neurotics who retained their obsessions during the depression and the 85 other depressives who gained obsessions during the depression not having exhibited them previously. In this comparison the only differences were that the obsessional neurotics had more obsessional personalities in their siblings, a greater incidence of obsessions in their previous depressive attacks, and a younger age of onset of the present depressive attack. There were no other differences. It was concluded that the pre-existing obsessional neurosis per se was responsible for the younger age of onset of the depression and for the greater incidence of obsessions in previous and present depressive attacks, as compared with other depressives. On the other hand, the greater incidence of Depersonalization and the lower rate of attempted suicide in the obsessional neurotics was due to their having obsessions in their depression three times as often as other depressives and not to the presence of the obsessional neurosis per se.

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