PRELIMINARY REPORT ON THE AMYGDALOIDECTOMY ON THE PSYCHOTIC PATIENTS, WITH INTERPRETATION OF ORAL-EMOTIONAL MANIFESTATION IN SCHIZOPHRENICS

Abstract

The symptoms caused by the destruction of amygdaloid complex in man are: intensification of the anger impulse, changefulness and infantization of emotion and behavior, and increase of friendliness in the emotional aspect; polyphrasia, hyperkinesis, acceleration of psychomotor activity, phagomanic and heterophagous tendency, and want for water, and in two cases such abnormal oral behavior as spitting, and the arcentuation of the sexual impulse in behavioral aspect. In three cases erroneous recognition both of persons and objects nas observed. As these symptoms were entirely absent prior to the operation, being evidently independent from and unrelated to the schizophrenic symptoms, it may rightly be interpreted as the symptoms directly caused by the surgical attack on the amygdaloid complex. These symptoms, of course, varied according to the poatoperative course and circumstances, also never uniform in all the five cases. However, we shall outline below the course of the changes in symptoms for convenience's sake Immediately after the operation the patients under dim consciousness would like to try pulling the bandage off or rolling back and forth on the bed throwing up their four limbs so violently that in same cases it was necessary to tie up the patients to their beds. The dimness of consciousness gets reduced rather rapidly. resuming normality within 3 days at the latest. The first symptoms to be noticed after the operation are polyphrasia and hyperkinesis, the patients are extremely hyperactive violently resisting any effort to stop them. They are talkative, their speech suggests mostly a disconnected, illogicol trend of thought pretty characteristic of schizophrenia. Sometimes they complain about their bodily discomfort such as headache. As in Case 4, the patients sometimes present rather manifest schizophrenic taints than prior to the operation. But in this stage food intake is not yet the major subject of talk, the appetite is still weak. It is about this time that the outrageous tendency and emotional and behavioral changeablenesa gets more pronounced, the patients grow extremely susceptive of stimulation. They fall in rage by trifle chances, very often getting nearly delirous. Gradually they resume a more composed state of mind, though still there persist changeableness of mood and tendency to burstout into anger, while speech and behavior of the patients remain childish even then, they act all like spoilt children. In this stage the patients grow more controllable, more capable to be diverted from anger through effort to calm down or fulfillment of desire. From the 3 rd to 4th day asking for refreshments, cigarettes and water becomes marked, they ask for such things untiringly. They never cease asking by every chance to perceive them until they succeed However, what is interesting about it is that they ask nothing but such luxuries as cigarettes and refreshments, the kind that will not likely be able to fill an empty stomach. The amount that they actually “eat” is never large; especially in the later stage they happen to forget asking or when ignored, change the object required in contrast to the eagerness at the starts, an expression of increased “demand impulse” rather than increased “eating impulse”. Especially an interesting Instance is seen in the request for cigarettes in Case 3, as it represents really not the desire for smoking but just to possess a cigrette. Provided that the doctor had given him what he asked for, he would have gone onward asking for one cigarette after another without smoking at all. Heterophagia tends to appear a trifle later than phagomania, is a transient phenomenon and always never marked. Among our cases there occurred only a few cases of it always of short duration. Accentuation of sexual impulse, again in existence and never intense in power, was seen in the middle of the second week. The patient seemed to enjoy the verbal expression of love rather than actual satisfaction. From the end of the first week to the beginning of the second week, the anger impulse gradually weakened as was hardly noticeable in the third week, but the infantization and the friendly attitude succeeding it remained still marked, the former lasting for more than a month after the operation and the latter even for several months more. Regardless of discontended or cheerful mood, they were quite childish in those emotional expressions not unlike children in cross mood or spoilt ones. As the oral-behavioral phenomena gradually disappeared in the end of the second week or in the middle of the third at the latest, the symptoms still discernible a month after the operation were the infantization of action and emotion, the unusually increased friendliness. These were soon replaced by the schizophrenic symptoms, which have had once disappeared in the postoperative period, 3–4 months later there remained fugitive remnants of friendliness and polyphrasia. The manifold schizophrenic symptoms prevalent prior to the operation got covered up for a while by such symptoms inter-pretable as the direct effect of the operation, excepting an occasional, transient disturbance in thinking of schizophrenic nature. Immediately after the operation, the auditory hallucinations were reduced from systematic ones to simple elementary sounds, the patients behaved little attentive to them. However there started now the real schizophrenic symptoms gradually to reappear roughly parallel with fading of the direct effect of the operation. One condition evidently different from that prior to the operation was that so-called “rapport” was gained, in most cases the patients, got free from autistic trend, came to answer readily. They also looked much more gentle and friendly and were now willing to tell others of his hallucination and delusion without shunning. Of course we cannot evaluate the effect of the operation too hastily, on the contrary, observation for a longer period and reliable data will be necessary before drawing any conclusion. Table 1 shows the above symptomatologic course. The symptoms seem to come less serious in the cases (Case 1 and 2) in which the amygdaloid nuclei were operated unilaterally with certain time interval in between, compared with the simultaneously operated bilateral cases. Thereby it is well noticeable that only moderate symptoms were observed by the initial unilateral operation. While it must be admitted that Cases 1 and 2 are cases which had already undergone the bilateral frontal lobotomy, yet it is evident that such symptoms as were mentioned above appear solely and markedly following destruction of the bilateral amygdaloid nuclei. The fact that in two of the cases there come severe vomiting and abdominal pain, presumably telling a profound influence of amygdaloid function upon gastrointestinal motility.