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Psychosurgery in Britain now.

A Poynton1, P K Bridges, J R Bartlett

  • 1Geoffrey Knight Unit for Affective Disorders, Brook General Hospital, London, United Kingdom.

British Journal of Neurosurgery
|January 1, 1988
PubMed
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Psychosurgery use in Britain declined but remains a viable option for severe, treatment-resistant depression and obsessions. Modern techniques offer precise lesioning with minimal side effects, aiding patient recovery and social function.

Area of Science:

  • Neurosurgery
  • Psychiatry
  • Medical Ethics

Background:

  • Psychosurgical operations in Britain decreased significantly from 1979-1986.
  • This decline is attributed to advancements in psychotropic medication and legal oversight via the Mental Health Act (1983).

Purpose of the Study:

  • To evaluate the current role and efficacy of psychosurgery for specific psychiatric conditions.
  • To assess the impact of modern techniques and legal frameworks on psychosurgery practice.

Main Methods:

  • Review of historical trends in psychosurgery procedures.
  • Analysis of patient outcomes and side effects at the Geoffrey Knight Unit.
  • Discussion of patient selection criteria and surgical techniques, including stereotactic methods.

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Main Results:

  • Psychosurgery is no longer indicated for schizophrenia following the advent of phenothiazines.
  • For severe endogenous depression and obsessional illnesses unresponsive to other treatments, psychosurgery can be effective, with over half of patients showing significant improvement in social function.
  • Stereotactic techniques minimize side effects and reduce epileptic risk to 2-3%.

Conclusions:

  • Psychosurgery remains a valuable treatment for a small, carefully selected group of patients with severe psychiatric disorders.
  • Neuropsychiatric evaluations show no adverse cognitive effects, and personality often recovers post-operation.
  • Collaborative evaluation by psychiatrists and neurosurgeons is crucial for optimal patient selection and outcomes.