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Surgery for psychiatric disorders.

G R Cosgrove1

  • 1Harvard Medical School, Massachusetts General Hospital, Boston, MA.

CNS Spectrums
|July 17, 2007
PubMed
Summary
This summary is machine-generated.

For severe psychiatric conditions unresponsive to conventional treatments, psychosurgery offers a potential therapeutic option. This surgical intervention, when performed by expert teams, can provide significant benefits for select patients.

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Area of Science:

  • Neurosurgery
  • Psychiatry
  • Neurology

Background:

  • Psychiatric diseases often require multimodal treatment including psychotherapy, pharmacotherapy, and electroconvulsive therapy.
  • Patients with severe, treatment-refractory psychiatric conditions may be candidates for surgical intervention.
  • Psychosurgery has evolved with modern stereotactic techniques, aiming to improve outcomes and reduce complications.

Purpose of the Study:

  • To review the role of psychosurgery in managing severe psychiatric disorders.
  • To discuss the common psychosurgical procedures and their efficacy.
  • To highlight the importance of a multidisciplinary approach and patient selection.

Main Methods:

  • Review of common psychosurgical procedures: cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy.

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  • Discussion of response rates (35%-65%) for these procedures.
  • Emphasis on modern stereotactic techniques and their impact on complication rates.

    • Main Results:

    • Psychosurgery is effective for treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states.
    • Response rates for current psychosurgical procedures range from 35% to 65%.
    • Stereotactic techniques have improved safety, though optimal procedures remain debated.

    Conclusions:

    • Psychosurgery is a viable therapeutic option for carefully selected patients with disabling psychiatric diseases.
    • It must be integrated into a comprehensive treatment plan with psychiatric rehabilitation.
    • Requires an expert multidisciplinary team including neurologists, neurosurgeons, and psychiatrists.