Which neuroses need specialist care?

In order to differentiate the neurotic patient who both needs and responds to psychiatric care from the majority of neurotic patients, who do not need this, carefully matched pairs of neurotic patients being treated at psychiatric and nonpsychiatric clinics in Montreal were followed up for 1 year. Improvement was substantial regardless of treatment, and the psychiatrically treated, on the whole, improved only slightly more than the others. However, one type of patient improved greatly under psychiatric care while improving almost not at all without it--introverts who considered themselves unhealthy but found life manageable, had avoided taking time off work or using anxiolytic drugs and appeared to handle their frustrations without repressing their irritation or losing self-control. It is suggested that it is mainly this type of neurotic that should receive specialist referral.