Editing Psychosurgery (section)

{{short description|Neurosurgical treatment of mental disorders}}
{{distinguish|psychic surgery}}
{{for|the Tourniquet album|Psycho Surgery}}
{{Infobox interventions
| Name        = Psychosurgery
| Image       =
| Caption     = Picture of James Watts (left) and Walter Freeman performing a [[Leucotomy]].
| ICD10       =
| ICD9        =
| MeshID      = D011612
| OPS301      =
| OtherCodes  =
| HCPCSlevel2 =
}}
'''Psychosurgery''', also called  '''neurosurgery for mental disorder''' ('''NMD'''), is the [[neurosurgery|neurosurgical treatment]] of [[mental disorders]].<ref name="Mashour">{{Cite journal | doi = 10.1016/j.brainresrev.2004.09.002 | last1 = Mashour | first1 = G.A. | last2 = Walker | first2 = E.E. | last3 = Martuza | first3 = R.L. | year = 2005 | title = Psychosurgery: past, present and future | journal = Brain Research Reviews | volume = 48 | issue = 3| pages = 409–18 | pmid=15914249| s2cid = 10303872 }}</ref> Psychosurgery has always been a controversial medical field.<ref name="Mashour"/> The modern [[history of psychosurgery]] begins in the 1880s under the Swiss psychiatrist [[Gottlieb Burckhardt]].<ref name="berrios 1997">{{Cite journal | doi = 10.1177/0957154X9700802905 | last1 = Berrios | first1 = G.E. | year = 1997 | title = The origins of psychosurgery: Shaw, Burckhardt and Moniz | journal = History of Psychiatry | volume = 8 | issue = 29| pages = 61–82 | pmid=11619209| s2cid = 22225524 }}</ref><ref name="shorter 225">{{Cite book| publisher = John Wiley & Sons| isbn = 978-0-471-15749-6| last = Shorter| first = Edward| title = A history of psychiatry: from the era of the asylum to the age of prozac| location = New York| year = 1997| page = [https://archive.org/details/historyofpsychia0000shor/page/225 225]
| url = https://archive.org/details/historyofpsychia0000shor| url-access = registration}}</ref> The first significant foray into psychosurgery in the 20th century was conducted by the Portuguese neurologist [[António Egas Moniz|Egas Moniz]] who, during the mid-1930s, developed the operation known as leucotomy. The practice was enthusiastically taken up in the United States by the [[Neuropsychiatry|neuropsychiatrist]] [[Walter Jackson Freeman II|Walter Freeman]] and the [[Neurosurgery|neurosurgeon]] [[James W. Watts]] who devised what became the standard prefrontal procedure and named their operative technique [[lobotomy]], although the operation was called leucotomy in the United Kingdom.<ref>{{Cite book
| last = Freeman| first = Walter|author2=James W. Watts | title = Psychosurgery| location = Baltimore| year = 1942}}</ref> In spite of the award of the [[Nobel Prize]] to Moniz in 1949, the use of psychosurgery declined during the 1950s. By the 1970s the standard Freeman-Watts type of operation was very rare, but other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is only used in a few centres on small numbers of people with [[Major depressive disorder|depression]] or [[obsessive-compulsive disorder]] (OCD).<ref name="RCPsy">Neurosurgery working group 2000 ''Neurosurgery for mental disorder''. London: Royal College of Psychiatrists</ref>
In some countries it is also used in the treatment of [[schizophrenia]] and other disorders.<ref name="Wall">N. Zamiska 2007 [https://www.wsj.com/articles/SB119393867164279313 In China, brain surgery is pushed on the mentally ill]. ''Wall Street Journal'', 2 November</ref><ref name="ReferenceA">{{Cite journal | last1 = Barcia | first1 = J.A. | year = 2007 | title = Present status of psychosurgery in Spain | url = http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-14732007000400003| journal = Neurocirugía | volume = 18 | issue = 4 | pages = 301–11  | display-authors = etal  | doi = 10.1016/S1130-1473(07)70274-9 | pmid = 17882337 }}</ref>

Psychosurgery is a collaboration between psychiatrists and neurosurgeons. During the operation, which is carried out under a [[general anaesthetic]] and using [[Stereotactic surgery|stereotactic]] methods, a small piece of [[Human brain|brain]] is destroyed or removed. The most common types of psychosurgery in current or recent use are anterior capsulotomy, [[bilateral cingulotomy|cingulotomy]], [[subcaudate tractotomy]] and [[limbic leucotomy]]. Lesions are made by radiation, thermo-coagulation, freezing or cutting.<ref name="Mashour"/> About a third of patients show significant improvement in their symptoms after operation.<ref name="Mashour"/> Advances in surgical technique have greatly reduced the incidence of death and serious damage from psychosurgery; the remaining risks include [[seizures]], incontinence, decreased drive and initiative, weight gain, and [[Cognition|cognitive]] and [[Affect (psychology)|affective]] problems.<ref name="Mashour"/>

Currently, interest in the neurosurgical treatment of mental illness is shifting from [[Ablation|ablative]] psychosurgery (where the aim is to destroy brain tissue) to [[deep brain stimulation]] (DBS) where the aim is to stimulate areas of the brain with implanted [[electrode]]s.<ref name="Sachdev">{{Cite journal | doi = 10.1097/YCO.0b013e32831c8475 | last1 = Sachdev | first1 = P. | last2 = Chen | first2 = X. | year = 2009 | title = Neurosurgical treatment of mood disorders: traditional psychosurgery and the advent of deep brain stimulation | journal = Current Opinion in Psychiatry | volume = 22 | issue = 1| pages = 25–31 | pmid = 19122531 | s2cid = 30892980 }}</ref>