Good outcome in a catatonic patient with enlarged ventricles.

In the differential diagnosis of the catatonic syndrome, the demonstration of an intracranial anomaly is often taken as evidence of irreversibility. We present the case of a 27-year-old white female with catatonia who was found to have enlarged ventricles on automatic computerized tomographic axial scan. She had a complete resolution of the catatonia and psychotic symptoms without any change in the size of the ventricles. This resolution occurred when the patient was treated for her ulcerative colitis with colectomy and the steroids she received for the colitis were gradually withdrawn. The discovery of a structural anomaly of the brain per se should not discourage the clinician from identifying and treating all other factors that might contribute to the catatonic syndrome.

Lobotomy in private practice.

In a follow-up of 43 private psychiatric patients referred for open bimedial prefrontal lobotomies between 1948 and 1970, patients were rated by personal interviews and review of medical records for symptom improvement and organic brain syndromes. Initial diagnoses were obsessive-compulsive neurotic (27), hypochondriacal neurotic (five), manic-deprresive (depressed) (one), and schizophrenic (ten). All had been severely impaired by illness intractable to extensive previous treatment. Thirty-five were found to be virtually free of symptoms that prompted operation, six had some improvement, and two were unimproved. Six had moderate to severe organic brain syndromes; three had seizure disorders necessitating treatment; and 17 incurred substantial weight gains. Best results were for hypochondriacal and obsessive-compulsive neurotic patients with phobic symptoms: poorest results were for paranoid schizophrenic subjects. This study was undertaken to provide some increment of data that could aid ongoing efforts to evaluate the consequences of this treatment.