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Am J Psychiatry 1941;98:132-139.
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The Psychiatric Service of the Massachusetts General Hospital and the Department of Nervous and Mental Diseases, Harvard Medical School.

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1. Fifty-one women, aged 20 to 55, were given a neuropsychiatric examination before major abdominal surgery, with special reference to anxiety concerning the operation, history of former psychiatric difficulties, marital maladjustment and sources of environmental stress.2. Forty patients who had no somatic complications and whose convalescences were uneventful, were reexamined after an interval of from twelve to eighteen months.3. Twenty-five of these patients showed no change in their psychiatric status. Two patients showed relief from former psychiatric complaints.4. Thirteen patients showed a picture of restlessness, sleeplessness, agitation and pre-occupation with depressive thought content beginning from three to four weeks after the operation and lasting more than three months.5. The relative frequency of this postoperative condition was much higher in pelvic operations than in cholecystectomies; it occurred more frequently in persons who had had depressive episodes in their former life.6. The incidence of this condition in our series shows no significant relationship to the presence of preoperative anxiety, to sexual maladjustments or to environmental factors as elicited in the preoperative interview.7. Reliable predictions as to postoperative psychiatric course will be possible only after more detailed studies.

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