Psychiatric disorders after surgery for duodenal ulcer

Abstract

LondonSUMMARY A prospective trial was conducted to determine the relationship between personality type and the results of surgery for peptic ulcer. Previous investigations had suggested that patients with an obsessional personality fared less well than those who were not obsessional. However, although there was a high incidence of psychiatric disorders in these surgical patients no significant difference was found between the two groups. It was concluded that classifying patients as obsessional and non-obsessional did not have any bearing on the outcome of operation.The psychosomatic theory of the aetiology of duodenal ulcer probably stems from the observations of Beaumont (1833) who studied the gastric mucosa through a gunshot wound fistula in his patient Alexis St. John. The marked changes in the vascularity and secretion of the stomach found in response to induced changes in mood provided direct evidence that an association existed. Attempts to extend these observations to the aetiology of peptic ulcer, however, have met with little success (Roth, 1955;Kessel and Munro, 1964). Although no evidence has been found to support a psychosomatic cause for duodenal ulcer the relationship between psychological factors and the results of surgery show some interdependence (Pascal, Thoroughman, Jarvis, and Jenkins, 1966;Glen and Cox, 1968) and this may have a bearing on selecting suitable cases for operation. Sinclair-Gieben, Clark, and Dean (1962), in a retrospective study, found that patients with an obsessional personality were more liable to psychiatric breakdown if their ulcer symptoms were relieved by operation. This finding was so remarkable that a prospective study was begun in 1962. Sufficient time has now elapsed to assess the results. MethodsA series of 100 patients admitted to hospital for elective surgery for duodenal ulcer were examined by a psychiatrist. An objective rating scale based on the Minnesota multiphasic personality inventory was used, principally to determine aspects of mood, and personality was determined by specific questions (Sinclair-Gieben et al, 1962) modelled on Schneider's (1958) concept of anencastic personality. On this basis the patients were allocated either to an 'obsessional' or 'nonobsessional' group. Where there was doubt the patient was regarded as non-obsessional. These ratings, together with the comments of the psychiatrist, were not seen by the surgeon performing the operation, and were filed away until the final assessment some years later.The operations performed were vagotomy with gastroenterostomy, either ante-colic or retrocolic, in all but two cases where a pyloroplasty was perform-d. An attempt was made to see these patients in 1967, an average of four to five years after operation. The results of surgery were then examined in relation to the psychological grading. A note was made of any treat-