Show simple item record

dc.contributor.authorMcIntyre, William Morisonen
dc.date.accessioned2019-02-15T14:36:14Z
dc.date.available2019-02-15T14:36:14Z
dc.date.issued1937en
dc.identifier.urihttp://hdl.handle.net/1842/35251
dc.description.abstracten
dc.description.abstractThis thesis is concerned with the occurrence of acute psychotic reactions in adolescents and young adults. The study of the causation, the symptoms, and the course of these reactions, furnishes a series of problems of importance and interest. The thesis depends on the examination of the psychoses as reactions brought on by an interplay of the social environment and the individual endowment.en
dc.description.abstractThe fundamental problem that is discussed is the problem of prognosis. The question that we will address ourselves to is the question of what the prognosis depends on in these reactions. There are various subsidiary questions, each in itself a method of approach to the main problem. For example, the factors which conduce to a recovery are fully discussed and the factors which constitute a basis of malignancy in the reactions are considered. The problems are approached by an examination of the evidence manifested in the endowment of character and personality, in the environmental circumstances, and in the psychotic reaction itself. The points suggestive of the reaction being of a more easily recoverable nature are evaluated along with those which might indicate that the final and satisfactory social adjustment is more difficult of achievement.en
dc.description.abstractThe problem of the relation to prognosis of the character and personality, the environmental circumstances, and the psychiatric symptomatology may be approached in many ways. What are the best methods of approach? In what way, for example, should the pre -psychotic personality be assessed? To what extent in the majority of cases is it possible to arrive at a satisfactory estimate of the type of pre- psychotic personality or the adequacy of the pre -psychotic character? To what extent is it the case that the better the pre -psychotic adjustment, the better the prognosis? Can the pre-psychotic history be regarded as a reliable guide to prognosis? To what extent can mental illness or eccentricity in the parents or ancestry be taken as a guide to the unsoundness of the individual endowment?en
dc.description.abstractThe study of the environmental circumstances similarly raises many points. Can abnormality in the reactions of the parents be considered also in this connection? Can the reactions in some such cases indicate an understandable reaction in the circumstances, or is the parental abnormality more suggestive of the likelihood of a bad endowment in the offspring and of the probability that an illness occurring in early life is likely to be malignant in proportion to the eccentricity of the parents? If patients come from a part of the country where there is a greater tendency to psychotic reactions, is it likely that the majority will not recover on account of their coming from a bad stock, or is it likely that the factors that in other people would 'lead to adolescent emotional difficulties of a minor nature, lead, in such people, to a frank psychotic reaction and that this reaction is therefore a temporary upset. In the case of patients who have espoused strange beliefs, or have been interested in strange sects, can it be assumed that there has been an insidious tendency to abnormal thinking indicative of a progressively asocial type of reaction? Or does the fact that a patient has for long been involved in, say, spiritualistic beliefs indicate that the psychosis is not so bad as it looks, that the patient is not so ill, having regard to his usual standard of mental health, and that as he has been associated with others in the abnormal trend of beliefs, so he may be influenced by others towards a recovery?en
dc.description.abstractWith regard to the study of the patient in the psychosis, there are also many factors to consider. Is an acute onset always of good prognosis, or sufficiently so to serve as a useful guide? If regression is not a true indication of a bad prognosis, is it any guide at all? How should a stupor reaction be assessed in terms of prognosis? Is apparent absence of affect a bad sign? Is preservation of affect always a good sign? Can the extent to which affect is present always be assessed with any degree of confidence? Can any of the features of the psychosis be regarded with any degree of confidence as of good or bad prognosis? Is the acute recoverable schizophrenia of young people a true condition?en
dc.description.abstractDo cases of chronic depression occur, beginning in youth? Is it legitimate to divide all cases of psychosis occurring before the age of thirty between the manic depressive group and the schizophrenic group? Is it to be recommended that these names should carry as much prognostic significance as they are accustomed being acceded? Is it possible to continue the use of these terms without such impli- cations having regard to the tenacity with which the diagnosis and course have clung together in spite of all efforts at separation?en
dc.description.abstractIt is generally appreciated that a prognostic classification has more disadvantages and advantages and that diagnosis by outcome is wholly unsatisfact- ory. The disadvantages of a prognostic classification have been a constant subject of dissension for the past thirty years, and diagnosis by outcome has been held up to ridicule. At the same time the present methods are but modifications of the methods of classifying by prognosis and diagnosing by outcome. The current practice is somewhat as follows:en
dc.description.abstractIf the examiner's bias is in favour of basing a prognosis on the features of the psychosis, he first assesses the relative prominence of manic - depressive and schizophrenic features and then makes a diagnosis which bears great prognostic significance since the manic depressive elements are equivalent to the more favourable prognostic signs and the schizophrenic to the less favourable. If the manic depressive patient recovers and the schizophrenic patient dements, then the diagnosis is supported by the course. If, on the other hand, the manic depressive patient proceeds to dementia, the diagnosis requires to be changed although the schizophrenic patient may be allowed to recover without the necessity of change of diagnosis.en
dc.description.abstractIf the examiner's bias is in favour of basing prognosis mainly on the pre -psychotic history, he first arrives at an estimate of the comparative adequacy of the adaptation, assesses the prognosis on this estimate, and calls the patient "manicdepressive" or "schizophrenic" according to the prognosis already arrived at.en
dc.description.abstractThere is sufficient truth in this account of present methods of diagnosis and prognosis to make it clear that the criticisms of the more rigid type of prognostic classification have not had the desired effect.en
dc.description.abstractIf the term "schizophrenia" is to be robbed of much of its prognostic importance, then an assessment of the prognosis on the basis of the psychosis, or the pre -psychosis, being so much schizophrenic and so much manic -depressive psychosis will no longer be valid. Are the essentially schizophrenic and the essentially malignant the same? If not, then the term "schizophrenia" can embrace recoverable conditions. How wide should the net be cast? Are all cases of malignant psychosis occurring in young people cases of schizophrenia? If so, is it reasonable to hammer away at the necessity of separating diagnosis from prognosis? If cases other than schizophrenia occur in youth and run a malignant course, can the division remain, or must a new search be made for the essential and fundamental characters of the psychosis?en
dc.description.abstractIf there is so much misgiving with regard to diagnosis, is prognosis in a better position? Are the prognostic principles of the past thirty years justified? Is a prognosis based on the psyd2 osis and the pre -psychotic history sufficiently accurate to permit us to be satisfied with the present methods, or are such studies as the present merely indicative of an awareness of the limitation of present methods and of an admission that the secant of reversibility in the psychoses must await the development of psycho pathology, or of the methods of psychometry, biophysics and biochemistry?en
dc.description.abstractIn the present contribution, the psychosis is considered in relation to the life situation. This relationship is studied with a view to finding indications of importance for prognosis. It should be made clear that in the selection of case material, the less malignant rather than the more malignant have been chosen. The approach to the study of the prognosis can be made in two ways. One way is to attempt to establish the essential signs of malignancy, to search for what are assumed to be the essentially malignant features, and to assess the prognosis on their relative prominence. This is best done in association with a report of cases which are running a chronic course. In the present contribution, the other method is chosen; namely, an attempt is made to estimate the value of what may be considered to be favourable signs in the pre -psychotic history, the onset of illness, and the features of the psychosis. Reports are given of groups of cases where such favourable signs can be noted. By means of brief historical surveys, the development of the present -day methods of approach to the problem of prognosis is studied. It is hoped that if this thesis were read by anyone unfamiliar with twentieth century methods in psychiatry, it would prove sufficiently comprehensive for the value of the approach to mental illness in terms of the life situation and the psychobiological reaction to be appreciated. If present -day methods have their limitations, it is surely because the deeper implications in the psychobiological approach have yet to be realised.en
dc.description.abstractIt is my belief that an examination of the psychosis in its relation to the environmental circumstances and the development of the individual from childhood is as important in the study of mental illness as i8 the examination of the symptoms and physical signs in relation to gross pathology in the study of physical diseases. On this basis an attempt is made to indicate the possibilities of prognostic forecasts.en
dc.description.abstractAn examination of the psychosis in relation to the development of the individual in early childhood may prove' more analogous to the study of sickness in relation to the finer pathology of disease, and may reveal methods of surer guidance in prognosis. This thesis is not concerned with any such study.en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2019 Block 22en
dc.relation.isreferencedbyen
dc.titleA contribution to the study of psychoses in young people with special reference to prognosisen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


Files in this item

This item appears in the following Collection(s)

Show simple item record