Open main menu
Home
Random
Recent changes
Special pages
Community portal
Preferences
About Wikipedia
Disclaimers
Incubator escapee wiki
Search
User menu
Talk
Dark mode
Contributions
Create account
Log in
Editing
Psychosurgery
(section)
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
==Medical uses== All the forms of psychosurgery in use today (or used in recent years) target the [[limbic system]], which involves structures such as the [[amygdala]], [[hippocampus]], certain [[thalamus|thalamic]] and [[hypothalamic]] nuclei, [[prefrontal cortex|prefrontal]] and [[orbitofrontal cortex]], and [[cingulate cortex|cingulate gyrus]]βall connected by fibre pathways and thought to play a part in the regulation of emotion.<ref name="CRAG">Clinical resource and audit group 1996 ''Neurosurgery for mental disorder''. Edinburgh: Scottish Office</ref> There is no international consensus on the best target site.<ref name="CRAG"/> '''Anterior cingulotomy''' was first used by [[Hugh Cairns (surgeon)|Hugh Cairns]] in the UK, and developed in the US by H.T. Ballantine Jr.<ref name="Heller"/> In recent decades it has been the most commonly used psychosurgical procedure in the US.<ref name="CRAG"/> The target site is the anterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region.<ref name="CRAG"/> '''Anterior capsulotomy''' was developed in Sweden, where it became the most frequently used procedure. It is also used in Scotland and Canada. The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei by inducing a lesion in the anterior limb of [[internal capsule]].<ref name="CRAG"/><ref>{{cite journal|pmc=3221188 | pmid=22135450 | doi=10.4103/0019-5545.86823 | volume=53 | issue=3 | title=Anterior capsulotomy for refractory OCD: First case as per the core group guidelines | author=Doshi PK | journal=Indian J Psychiatry | pages=270β73| year=2011 | doi-access=free }}</ref> '''Subcaudate tractotomy''' was the most commonly used form of psychosurgery in the UK from the 1960s to the 1990s. It targets the lower medial quadrant of the frontal lobes, severing connections between the limbic system and supra-orbital part of the frontal lobe.<ref name="CRAG"/> '''Limbic leucotomy''' is a combination of subcaudate tractotomy and anterior cingulotomy. It was used at [[Atkinson Morley Hospital]] London in the 1990s<ref name="CRAG"/> and also at [[Massachusetts General Hospital]].<ref>{{Cite journal | doi = 10.4088/JCP.v62n1202 | last1 = Price | first1 = B.H. | last2 = Baral | year = 2001 | first2 = I | last3 = Cosgrove | first3 = GR | last4 = Rauch | first4 = SL | last5 = Nierenberg | first5 = AA | last6 = Jenike | first6 = MA | last7 = Cassem | first7 = EH | title = Improvement in severe self-mutilation following limbic leucotomy: a series of five consecutive cases | journal = Journal of Clinical Psychiatry | volume = 62 | issue = 12| pages = 925β32 | pmid = 11780871 }}</ref> '''[[Amygdalotomy]]''', which targets the [[amygdala]], was developed as a treatment for aggression by Hideki Narabayashi in 1961 and is still used occasionally, for example at the [[Medical College of Georgia]].<ref>{{Cite journal | last1 = Fountas | first1 = K.N. | last2 = Smith | first2 = J.R. | last3 = Lee | first3 = G.P. | year = 2007 | title = Bilateral stereotactic amygdalotomy for self-mutilation disorder: a case report and review of the literature | journal = Stereotactic and Functional Neurosurgery | volume = 85 | issue = 2β3| pages = 121β28 | pmid = 17228178 | doi = 10.1159/000098527 | s2cid = 71754991 }}</ref> There is debate about whether [[deep brain stimulation]] (DBS) should be classed as a form of psychosurgery.<ref>{{Cite journal | doi = 10.1007/s12376-009-0031-7 | last1 = Johnson | first1 = J. | year = 2009 | title = A dark history: memories of lobotomy in the new era of psychosurgery | journal = Medicine Studies | volume = 1 | issue = 4| pages = 367β78 | s2cid = 144488587 }}</ref> ===Effectiveness=== Success rates for anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy in treating depression and OCD have been reported as between 25 and 70 percent.<ref name="Mashour"/> The quality of outcome data is poor and the Royal College of Psychiatrists in their 2000 report concluded that there were no simple answers to the question of modern psychosurgery's clinical effectiveness; studies suggested improvements in symptoms following surgery but it was impossible to establish the extent to which other factors contributed to this improvement.<ref name="RCPsy"/> Research into the effects of psychosurgery has not been able to overcome a number of methodological problems, including the problems associated with non-standardised diagnoses and outcome measurements, the small numbers treated at any one centre, and [[Publication bias|positive publication bias]]. Controlled studies are very few in number and there have been no placebo-controlled studies. There are no systematic reviews or meta-analyses.<ref name="Mashour"/><ref name="Christmas">{{cite journal | author = Christmas D | year = 2004 | title = Neurosurgery for mental disorder | journal = Advances in Psychiatric Treatment | volume = 10 | issue = 3| pages = 189β99 | doi=10.1192/apt.10.3.189| pmid = 15286074 |display-authors=etal| doi-access = free }}</ref> Modern techniques have greatly reduced the risks of psychosurgery, although risks of adverse effects still remain. Whilst the risk of death or vascular injury has become extremely small, there remains a risk of seizures, fatigue, and personality changes following operation.<ref name="RCPsy"/> A 2012 follow-up study of eight depressed patients who underwent anterior capsulotomy in Vancouver, Canada, classified five of them as responders at two to three years after surgery. Results on neuropsychological testing were unchanged or improved, although there were isolated deficits and one patient was left with long-term frontal psychobehavioral changes and fatigue. One patient, aged 75, was left mute and [[Hypokinesia|akinetic]] for a month following surgery and then developed [[dementia]].<ref name="Hurwitz"/>
Edit summary
(Briefly describe your changes)
By publishing changes, you agree to the
Terms of Use
, and you irrevocably agree to release your contribution under the
CC BY-SA 4.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)