1954_sandison_1511_1.pdf

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LSD Noo48 (§l102a)
M 328o6 anxiety
M 398
psychotherapy
J,,DoAo
X 380 psychoneuroses
M 500 therapeutic effect
SANDISON, RoAo_ SPENCER_ AOMo_ WHITELAW_
(Powick Mental Hospital_ Worcestershire)
The therapeutic value of
/Y__erIc
acid diethvlamide in mental il_eSSo
J omento Sci o_lOQ_91(1954) o
4
o
PROBLE_
This preliminary paper describes the results obtained from the
use
of LeD
in }6 psychoneurotic patients over a period of one year°
__
Obsessional reactions (6 ,_asee)_ classical obsessional neurosis (3)9 tense
depressive
reactions in young patxen,_s
_ older depressive patients (2)_
older
depressive patients with epilepsy (1)_ anxiety neurosis with great mental tension
(12) _ psychopathic personality with depressive features (2)_ conversion hysteria
(4),
homosexuality
(l)_
schi_,oid
personality
(l) o
_METHOD
= DOSAGE_
After hespltali_ati_n the patient was given simple psychotherapy
under
pentothal to introduce him to the id_ of drug=assisted psyohotherapyo Dur_
the ensuing week9 he received LeD on two or three occasionso The initial dose was
usually 25/_g; at
subsequent
_reatments the dose was gradually increased until an
adequate reaction was obtainedo Thereafter the drug was continued at approximately
weekly intervalso After 2 to 4 weeks the nature of any particular patlent_s reaction
to
LeD
became apparent and a de,_islon could then be made whether it was advisable
for the patient to remain in hospital for the rest of the treatment or whether he
could continue as an out=p_£tiento In the latter caee_ it was often desirable for the
patient to re_in in hospital for the night following each subsequent treatment°
One
patient took LeD at home but the nature of his reaction was first determined in
hos_italo
In one case
a
dose of 400/_g LeD was administered°
RF_ULTS8
The
authors
review the
ebjective
and
subjective
experiences under LSD_ the
toxic effects_ the _uifestaticns
of the patient°s unconscious_ the hallucinatory
experiences_
identification phenomena_ projection phenomena_ the
zeliving
of repressed
personal memories_ the appearance of impersonal
unconsclo_
images_
depersonalization,
and the
detachment of
the conscious
self o
Patients who
have
completed treatment
;>
Patients still
under
treatment
z
Obsessional Reactions
..
6
2
9.5
Classical Obsessional
Neurosis ..
....
3 2
40
Tense depressive
reactions
in young patients
.. 4 2
5
Older
depressive patients
2 2
7-5
Older depressive patients
withcpilepsy
.. 1 1
6
Anxiety
Neurosis
with
great mcntal
tension
.. 12 2
11.5
Psychopathic personality
with depressive features
2 1
2
Conversion
hysteria
.. 4 1
9
Homosexuality
..
1 1
3
Schizoid
Personality"
.. 1
Total
....
36
14
10.4
o
3
2
z
1
34
2
17.5
1
3
1
1
2
5
1
3
6
13.6
1
12
1
16
1
6
i
1
6
1
1
3"6
_r
1
2
2
5
11
18.6
12
23
(The figures in
it_lie_
indicate the avonumber of treatments
the particular
groups
ofpatients
received0)
Of three classical obsessional neurotics_ two recovered after an average of
40 treatments° In view of the notoriously poor prognosis of this condition
it
is
considered that LeD would represent
only in this type of neurosiso
a major therapeutic
advance
if it were effective
J,_'
!
The reSpo_e Of conversion hysterics was not
satisfactory_
but as the three patients
studied weretreated
early in the series the amount of treatment given may have been
<nsufficient0 0nly one patient refused treatment and in this case refusal to continue
was after only one treatment o
.Relationship of duration of illness and number of treatments req_d
Althou@h the figures are too small for statistical analysis 9 there appeared to be
no relationship between the duration of the illness and the numbe r of treatments req_e_a
Patients who had been ill for up to lO years required only a am_ll number of treatments°
Relationship
of duration
of illness
and results
of treatment
The study showed that unlike other treatments LSD was almost as effective in l_tSo
who had been ill for up to lO years9 as it was in more recent cases°
Previous
treatment
20 patients had previously received a considerable amount of treatment of various
kinds before being given LSDo It is thought reasonable to suppose that all of these
would at best have been left with chronic neurotic disabilities had they not received
LSD therapy° Of these 20 patients 14 recovered_ 3 showed moderate improvement_
not improved and in one it was too early to assess results° Limited experience
that pre=frental leucotomy and recent ECT rendered treatment more difficult°
_Rehabilitation
About one-half of the cases required
establishment of a new set of conditioned
extensive rehabilitation
social responses°
involving
the
2 were
suggested
S,_m-_.
of c_inica! impressions
ry
When used as an adjunct to skilled psychotheraDyo
L_D was
of
the greatest value
in the obsessional and anxiety groups accompanied by mental tensiono
used only by experienced psychotherapists. _
their assistant_o
Treatment should be
continued for
some
considerable time before deciding that it is
of
no value in a_y
particular
case o
Unless contraindications (eogo the threat of psychosis) _re present_
one
should
perse_ere for at least 6 weeks and for 6 to 8 treatments before stopping° Many patso
only started to produce material of value after 4 to 5 treatmentso In _ome cases it
may be necessary to continue treatment for 6 to
12
monthso
The practice
of
.LSD therapy
Details
are given of in=patient and
out=patient
treatment_ the professional team,
medical visitso the role of
nursing
staff_ the environment_ group t_herapy_ individual
work by the patients_ and instructions to the nursing staff (preparation of the pato_
administration of the drug_ management
of
the patient under treatment_ after=care_
and out=pat ients)
o
COMMEN______TT_paper confirms the findings
of
FREDERKING (LSD 38) that LSD can be used
The
therapeutically
in mental disease o For detailed information the original paper
should
be consulted o
(Valeur th@rapeutique du LSD dans des affections
psychiques)
Rapport pr@liminaire sur des r@sultats obtenus par le traitement au LSD chez
36 malades atteints de psychcn@vroses ou d_affections s_milaireso 20 de cos cas ont
4t4 r@fractaires _ d°autres traitements ant@rieurso D4but du traitement avec 25 _
puis augmentation graduelle des doses jusqu_ l_obtention d'une r4action ad@quateo
La dose efflcace est administr4e ensuite _ des inter#alles d_une semaineo Chez 14
malades_ tous les symptSmes sont supprim@s (apr_s 1%4 traitements envo)_ chez un
il y a am41ioration nette (_ traitements)_ chez 6 am@lioration mod@r@e (2 traite=
ments)_ et 2 malades restent non-influenc4s (5 traitements eVo)o ll malades_ chez
lesquels le traitement n_est pas one@re termin4_ sont am@lior4s (1826 traitements
enVo)o Dans un cas (6 traitements)_ l_effet ne peut pas encore @tre 4valu6o Un
malade a refus4_ aprBs la premiere administration_
de continuer le traitemento
NK/
ro s/bh
754

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