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Introduction: The use of surgery for treatment of psychiatric conditions is a well-established strategy, especially in severe and resistant obsessive-compulsive disorder. Attractive anatomical and functional targets for stereotactic surgery are reported in some studies. Surgery for treatment of psychiatric conditions in our nation and Arab world is obscured and hidden because of several social and cultural limitations, which should be overcome. We report here the first psychiatric neurosurgery in our nation and how we overcome such community limitation. This the first report of postoperative tremor. Case Presentation: Young patient presented with severe and persistent obsessive-compulsive disorder resistant to all non-surgical modalities for several years. Stereotactic ablation surgery was done under local anaesthesia. Marked improvement in our obsessive-compulsive disorder patient after psychiatric neurosurgery with self-limited tremor was not reported before in the literature. The medications were the same before and immediate after surgery and this is not a drug-induced tremor. Postoperative YBOCS showed 90% of improvement. Conclusion: Surgery-induced tremor could be a self-limited side effect after surgery in obsessive-compulsive disorder. Safety and efficacy should be promoted in our nation and Arab world. Society and cultural limitations should be overcome by further research studies, intervention, and activism in the field of mental health systems in our nation and Arab countries to improve awareness. [ABSTRACT FROM AUTHOR]

Background: In the early 20th century, psychosurgery had gained worldwide popularity for treating mentally ill persons, especially in western countries. We attempt to chronicle its journey in the Mysore Government Mental Hospital (MGMH), now the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. Methods: Archived case records and registers of patients admitted from 1939 to 1947 were reviewed to identify those who had undergone psychosurgery. Case records of the identified patients were assessed for clinical information, including the details of psychosurgery. Results: Among the patients, 107 had undergone psychosurgery, primarily leucotomy. Schizophrenia (51.5%) was the most common diagnosis in them, and 33.7% of all patients were reported to have improved. Yet, inconsistencies were found about the presence and degree of improvement. Possible side effects were not consistently documented. Conclusion: Psychosurgery was adopted at the MGMH very soon following its introduction in the western world. However, ambiguity about its benefits and risks was noted in the current study. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a frequent symptom of major depressive disorder (MDD) that is associated with poor outcomes and treatment resistance. While most studies on RNT have focused on structural and functional characteristics of gray matter, this study aimed to examine the association between white matter (WM) tracts and interindividual variability in RNT. A probabilistic tractography approach was used to characterize differences in the size and anatomical trajectory of WM fibers traversing psychosurgery targets historically useful in the treatment of MDD (anterior capsulotomy, anterior cingulotomy, and subcaudate tractotomy) in patients with MDD and low (n = 53) or high (n = 52) RNT, and healthy control subjects (n = 54). MDD samples were propensity matched on depression and anxiety severity and demographics. WM tracts traversing left hemisphere targets and reaching the ventral anterior body of the corpus callosum (thus extending to contralateral regions) were larger in the high-RNT MDD group compared with low-RNT (effect size D = 0.27, p =.042) and healthy control (D = 0.23, p =.02) groups. MDD was associated with greater size of tracts that converge onto the right medial orbitofrontal cortex regardless of RNT intensity. Other RNT-nonspecific findings in MDD involved tracts reaching the left primary motor and right primary somatosensory cortices. This study provides the first evidence to our knowledge that WM connectivity patterns, which could become targets of intervention, differ between high- and low-RNT participants with MDD. These WM differences extend to circuits that are not specific to RNT, possibly subserving reward mechanisms and psychomotor activity. [ABSTRACT FROM AUTHOR]

History has conflated the legacies of José Manuel Rodríguez Delgado and Walter Freeman, midcentury proponents of somatic therapies for neuropsychiatric conditions. Both gained notoriety: Delgado after he appeared on the front page of the New York Times having used his stimoceiver to stop a charging bull in Spain; Freeman as the proponent of lobotomy. Both were the object of critique by the antipsychiatry movement and those who felt that their methods and objectives posed a threat to personal liberty. Using archival sources, we demonstrate that this conflation is a misrepresentation of the historical record and that their methods, objectives, ethics, and philosophical commitments differed widely. Accurate knowledge about historical antecedents is a predicate for ethical analysis and becomes especially relevant information as neuroscience develops circuit-based treatments for conditions such as Parkinson disease, depression, and brain injury. Part of that corrective is to counter the conflation of Delgado's and Freeman's life and work. Appreciating their distinctive legacies can help guide neuropsychiatric research done today that might yet haunt future generations. [ABSTRACT FROM AUTHOR]

Background: This retrospective study aimed to compare preferential manual bronchoplasty (PMB) and mechanical stapler closure (MSC) of the bronchial stump after 2–3 cm single‐port (SP) video‐assisted thoracoscopic surgery (VATS) lobectomy in patients with pathological T1 (pT1) stage lung cancer. Methods: Between January 2019 and March 2022, patients with pulmonary neoplasms who underwent 2–3 cm SP VATS lobectomy were retrospectively screened. After propensity‐matched analysis, we compared perioperative outcomes and analyzed the safety and feasibility of PMB and MSC of the bronchial stump while performing VATS lobectomy. Results: In this study, 280 and 832 patients were enrolled in the PMB and MSC groups, respectively. Propensity score matching produced 280 pairs. The operation time was shorter in the PMB group, whereas the average number of lymph nodes dissected was higher in the PMB group. The conversion rate was significantly lower in the PMB group. The following were similar between the PMB and MSC groups, respectively: average blood loss volume, postoperative hospital stay, and chest tube removal time. Postoperatively, the incidence of atelectasis was significantly higher in the MSC group. As per subgroup analyses, PMB was associated with a shorter operation time in left and right upper lobectomies. Particularly in left upper lobectomy, PMB had more lymph node dissections and less conversion to open and postoperative atelectasis. Conclusions: In comparison with MSC of the bronchial stump, PMB showed better safety and feasibility in 2–3 cm SP VATS left and right superior lobectomies in patients with pT1 stage lung cancer. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) is a relatively dated treatment procedure that emerged in the late 1980s. Nonetheless, numerous studies are being carried out to examine its influence on the human brain and develop new treatment indications. This systematic review aims to summarize the current state of knowledge referring to DBS, investigate novel insights into its indications, and discuss the technical aspects and rationale behind DBS application. In particular, we sought to subject to scrutiny the application of DBS specifically in anorexia nervosa (AN), various addiction types, depression, and obsessive--compulsive disorders (OCDs). The method is supposed to offer promising results, especially in pharmacologically resistant forms of the upper-mentioned psychiatric disorders. Moreover, further insight has been provided into the historical notions of the method and differences in the surgical approach in specific disease entities. Furthermore, we mark the possible influence of comorbidities on treatment results. Our review consists of articles and studies found on PubMed, Google Scholar, Cochrane, and Scopus, which were then analyzed with scrutiny in the identification process, including the most resourceful ones. After methodological quality and risk of bias assessment, a total of 53 studies were included. To this date, DBS's usefulness in the treatment of AN, OCDs, depression, and addictions has been proven, despite an ongoing debate concerning the technical aspects and parameters when applying DBS. To the best of our knowledge, we have not found any paper that would recapitulate the current state of DBS in the context of psychiatric disorders with an addition of technical insights. [ABSTRACT FROM AUTHOR]

Purpose: The cingulate gyrus is a potential surgical area to treat tumours, psychiatric diseases, intractable pain and vascular malformations. The aim of the study was to define the topographic anatomy and arterial supply of the cingulate gyrus located on the medial surface of the cerebral hemisphere. Methods: We studied thirty-six hemispheres, each hemisected in the midsagittal plane. The vertical thickness of the cingulate gyrus was measured at the anterior commissure (AC), posterior commissure (PC), and genu levels of the corpus callosum. The branches of the anterior and posterior cerebral arteries supplying each zone were noted separately. The arterial pathways were transformed to digital data in AutoCAD to identify the condensation and reduction areas. Results: The mean AC-PC distance was 27.17 ± 1.63 mm. The thinnest region was the genu level of the corpus callosum (10.29 mm). The superior internal parietal artery (SIPA), inferior internal parietal artery (IIPA) and pericallosal artery (PrCA) supplied all zones of the cingulate gyrus. The anterior zone received the greatest supply. The arterial condensation and reduction areas on both sides of cingulate gyrus and its x, y, and z coordinates specified. Conclusions: The target cingulotomy (TC) area was determined for anterior cingulotomy. The properties of the TC area are that the thinnest region of the cingulate gyrus is supplied relatively less than other areas and is close to the anterior cingulotomy areas in the literature. The arterial reduction area (ARA) was found to be suitable for corpus callosotomy in terms of avoiding haemorrhage. [ABSTRACT FROM AUTHOR]

Background: Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment‐resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. Methods: Eight patients with severe, chronic, treatment‐resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6‐month after surgery. Findings: Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. Interpretation: These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions. Highlights: Although body mass index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of continuous DBS stimulation either to the nucleus accumbens or subcallosal cingulateAn increase in BMI was related to a decrease in depressive symptoms and an improvement in memory functioningThese preliminary findings suggest that DBS is not associated with any cognitive deterioration in people with AN [ABSTRACT FROM AUTHOR]

Stereoelectroencephalography (sEEG) is an increasingly popular surgical technique used clinically to study neural circuits involved in medication-refractory epilepsy, and it is concomitantly used in the scientific investigation of neural circuitry underlying behavior. Using PRISMA guidelines, the U.S. National Library of Medicine at the National Institutes of Health PubMed database was queried for investigational or therapeutic applications of sEEG in human subjects. Abstracts were analyzed independently by 2 authors for inclusion or exclusion. The study search identified 752 articles, and after exclusion criteria were applied, 8 studies were selected for in-depth review. Among those 8 studies, 122 patients were included, with indications ranging from schizophrenia to Parkinson disease. All the included studies were single-institution case series representing level IV scientific evidence. sEEG is an important method in epilepsy surgery that could be applied to other neurologic and psychiatric diseases. Information from these studies could provide additional pathophysiologic information and lead to further development and refinement of neuromodulation therapies for such conditions. [ABSTRACT FROM AUTHOR]

Long has the standard of care for substance use disorder (SUD) been pharmacotherapy, psychotherapy, or rehabilitation with varying success. Deep brain stimulation (DBS) may have a beneficial reduction in the addiction-reward pathway. Recent studies have found reduced relapse and improvements in quality of life following DBS stimulation of the nucleus accumbens. We aim to identify positive outcomes and adverse effects to assess the viability of DBS as a treatment of addiction. A PubMed search following PRISMA guidelines was conducted to identify the entirety of reports reporting DBS as a treatment for SUD. Outcomes were extracted from the literature to be summarized, and a review of the quality of publications was also performed. From 2305 publications, 14 studies were found to fit the inclusion criteria published between 2007 and 2019. All studies targeted the nucleus accumbens (NAc) and remission rates at 6 months, 1 year, 2 years, and more than 6 years were 61% (20/33), 53% (17/32), 43% (14/30), and 50% (3/6), respectively. Not all studies detailed the stimulation settings or coordinates. The most common adverse effect across studies was a weight change of at least 2 kg. DBS shows potential as a long-term treatment of SUD in refractory patients. Further studies with controlled double-blind paradigms are needed for evaluation of the efficacy and safety of this treatment. Future studies should also investigate other brain regions for stimulation and optimal device stimulation parameters. [ABSTRACT FROM AUTHOR]

Rolf Hassler is one of the most renowned German specialists in psychiatry, neurology and neuroanatomy. Hassler's career exemplifies medicine as scientific endeavor. Relaying on an expertise in neuroanatomy gained at Oscar and Cecile Vogt's Kaiser Wilhelm Institute, especially regarding the structure of the thalamus, Hassler enabled Freiburg University's neurosurgery clinic the invention of stereotactic "stepped leucotomy" and established thalamotomy internationally in a leading way. While directing the Neuroanatomical/Neurobiological department of the Max Planck Institute for Brain Research from 1959 until 1982, Hassler continued to study the effects of stimulation and targeted subcortical electrocoagulation in the cat brain. The Freiburg trained neurosurgeon Gert Dieckmann helped Hassler to apply the newly gained knowledge for the stereotactic therapy of torticollis, tics and obsessions and compulsions. The use however of thalamotomy also as a surgical therapy for aggressiveness in children, mainly during the late 1960s and early 1970s, is starting to provoke public criticism. Contrary however to the accusation of a medicine shaped by Nazi ideology into a "science without humanity", Hasslers career reveals a problematic intrinsic to medicine: the together of "art of healing and science". [ABSTRACT FROM AUTHOR]

Background: Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response. Methods: We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies. Results: After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry. Limitations: The included studies were few and highly varied, spanning 2 decades. Conclusion: Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed. Registration: www.crd.york.ac.uk/prospero/display_record.php?RecordID=131151. [ABSTRACT FROM AUTHOR]

Stereotactic ablation (cingulotomy) and subcallosal cingulate deep brain stimulation (SCC DBS) of different regions of the cingulum bundle (CB) have been successfully used to treat psychiatric disorders, such as depression and bipolar disorder. They are hypothesized to work by disrupting white matter pathways involved in the clinical manifestation of these disorders. This study aims to compare the connectivity of different CB subregions using tractography to evaluate stereotactic targets for the treatment of mood disorders. Fourteen healthy volunteers underwent 3T-MR imaging followed by connectivity analysis using probabilistic tractography. Twenty-one anatomic regions of interest were defined for each subject: 10 CB subregions (including the classical cingulotomy and SCC DBS targets) and 11 cortical/subcortical structures implicated in mood disorders. Connectivity results were compared using Friedman and Bonferroni-corrected post-hoc Wilcoxon tests. CB connectivity showed a high degree of regional specificity. Both of the traditional stereotactic targets had widespread connectivity with discrete topology. The cingulotomy target connected primarily to the dorsomedial frontal, dorsal anterior cingulate, and posterior cingulate cortices, whereas the SCC DBS target connected mostly to the subgenual anterior cingulate and medial/central orbitofrontal cortices. However, a region of the rostral dorsal CB, lying between these surgical targets, encompassed statistically equivalent connections to all five cortical regions. The CB is associated with brain structures involved in affective disorders, and the rostral dorsal CB demonstrates connectivity that is comparable to the combined connectivity of cingulotomy and SCC DBS neurosurgical interventions. The rostral dorsal CB represents a surgical target worthy of clinical exploration for mood disorders. [ABSTRACT FROM AUTHOR]

With the publication in Chile of Law N° 20.968 that typifies the crime of torture and other cruel, inhuman and degrading treatment, the health system of people with mental disabilities is endowed with suitable legal instruments to understand that it is definitely proscribed as a treatments in mental health care centers, the use of electroshock and psychosurgery, for being acts that affect the moral integrity in the way described in the crime of torture or any of its residual figures, all those administrative norms that regulated such practices. [ABSTRACT FROM AUTHOR]

The practice of surgical intervention for the treatment of psychiatric disorders has a rich and fascinating history. Arguably dating back to more than 7 millennia ago, neurosurgery for psychiatric disease is shrouded in stigma, being widely portrayed in the media (almost invariably negatively). The first such procedure to be performed in modern history was conducted by the Swiss psychiatrist Gottlieb Burckhardt in 1882. The landscape of neurosurgery for psychiatric conditions has shifted constantly since, guided by new developments in neuroscience and surgical technology. In this article, we outline the salient events in the story of this field. [ABSTRACT FROM AUTHOR]

Objective Caudate nucleus has been discussed as a target for new treatments of neurologic and psychiatric diseases but the connectivity remains unclear for both microsurgical procedures and stereotactic interventions despite the basic neuroanatomical knowledge. We aim to reveal the anatomic features of the caudate nucleus in psychiatric diseases using fiber dissection technique. Material and Methods Four brain specimens (8 Hemispheres) were frozen for 15 days at -16 °C according to Klingler's Technique. The freezing process facilitates the dissection of the fiber tracts. After completion of the freezing process, all of the hemispheres were dissected and the dissections were stepwise performed from lateral to medial, under x6 to x40 magnification using a surgical microscope, two and three-dimensional anatomic pictures were obtained. Results Stepwise microsurgical fiber dissection of the caudate nucleus and adjacent areas were dissected. The cortical areas communicating with and overlying the caudate nucleus are reviewed. Frontocaudate connection fibers and temporocaudate fibers were intense and the microsurgical anatomy of the area were revealed. Two and three dimetional pictures were taken step by step. Conclusion Psychosurgery has been used primarily in treatment of depression when medical treatments were not adequate. Deep brain stimulation of caudate nucleus is not a standard method in clinical practice. Deep brain stimulation of caudate nucleus is not a standard method in clinical practice but it could be an alternate treatment for Parkinson's disease, obsessive compulsive disorder and major depression. [ABSTRACT FROM AUTHOR]

Addiction is a major public-health crisis associated with significant disability and mortality. Although various pharmacological and behavioral treatments are currently available, the clinical efficacy of these treatments is limited. Given this situation, there is a growing interest in finding an effective neurosurgical treatment for addiction. First, we discuss the use of ablative surgery in treating addiction. We focus on the rise and fall of nucleus accumbens ablation for addiction in China. Subsequently, we review recent studies that have explored the efficacy and safety of deep-brain-stimulation treatment for addiction. We conclude that neurosurgical procedures, particularly deep-brain stimulation, have a potentially valuable role in the management of otherwise intractable addictive disorders. Larger well-controlled clinical trials, however, are needed to assess clinical efficacy and safety. We end by discussing several key issues involved in this clinical field and identifying some areas of progress. [ABSTRACT FROM AUTHOR]

Pioneered in 1936 by Portuguese neurologist and politician Egas Moniz, lobotomy was a definitive lesional surgery on the brain, which consisted of splitting the white fibers in the frontal lobes. Sixteen years later, the first antipsychotic medication appeared at Sainte-Anne Mental Hospital in Paris, drastically reducing the number of surgical lobotomies in France and worldwide. Lobotomy has been one of the most criticized medical procedures in history, with thousands of patients lobotomized around the world and causing serious consequences to their personalities and intellectual function. In the 1940s, the French language was widely used as an alternative language in medical studies, the reason we decided to focus a francophone review on this subject. We conducted the first francophone review of the reported data for the period from 1935 to 1985. Moreover, for a clearer understanding of the background of the time, we also studied the social historical environment. A total of 1340 cases of lobotomized patients were identified through a review of 29 studies. The indications had varied and were not limited to mental illness. Lobotomy was also performed in some rare cases on patients with peptic ulcers or ulcerative colitis to stop gastrointestinal hemorrhage. The lobotomy techniques were numerous, varying from classic lobotomy to the transorbital injection of radioactive iridium 194. We have discussed the psychiatric, societal, and media contexts that led to the emergence of lobotomy. Our aim was to highlight this period in the history of medicine and place the medical practice into perspective. [ABSTRACT FROM AUTHOR]

Following the rise and fall of lobotomy, a majority of U.S. states took legislative aim at psychosurgical procedures. This article canvasses, organizes, and analyzes the existing body of United States statutes and regulations mentioning psychosurgery. Many states regulate psychosurgery without defining the term; existing definitions are imprecise, but many would arguably apply to contemporary procedures like deep brain stimulation. Common to many states are restrictions on surrogate consent to psychosurgery, codifications of patients' consent or refusal rights, and situation-specific bans on the practice targeting certain contexts of vulnerability. Many states have only a handful of scattered laws bearing on psychosurgery, but a few have wide-ranging and well-integrated regulatory regimes. In reviewing these laws we perceive much room for harmonization and modernization. Greater consistency in protecting vulnerable persons from troubling uses of psychosurgery is achievable even alongside an effort to remove undue legal obstacles impeding patient access to potentially therapeutic procedures. Our hope in surveying current psychosurgery law is to inaugurate a conversation on how best to shape its future. [ABSTRACT FROM AUTHOR]

Background: Radiation-induced brain edema (RIBE) is a serious complication of radiation therapy. It may result in dramatic clinico-radiological deterioration. At present, there are no definite guidelines for management of the complication. Corticosteroids are the usual first line of treatment, which frequently fails to provide long-term efficacy in view of its adverse complication profile. Bevacizumab has been reported to show improvement in cases of steroid-resistant radiation injury. The objective of this study is to evaluate the role of Bevacizumab in post-radiosurgery RIBE.Material and Methods: Since 2012, 189 out of 1241 patients who underwent radiosurgery at our institution developed post-radiosurgery RIBE, 17 of which did not respond to high-dose corticosteroids. We systematically reviewed these 17 patients of various intracranial pathologies with clinic-radiological evidence of RIBE following gamma knife radiosurgery (GKRS). All patients received protocol-based Bevacizumab therapy. The peer-reviewed literature was evaluated.Results: 82 percent of the patients showed improvement after starting Bevacizumab. The majority began to improve after the third cycle started improvement after the third cycle of Bevacizumab. Clinical improvement preceded radiological improvement by an average of eight weeks. The first dose was 5 mg/kg followed by 7.5-10 mg/kg at with two-week intervals. Bevacizumab needs to be administered for an average of seven cycles (range 5-27, median 7) for best response. Steroid therapy could be tapered in most patients by the first follow-up. One patient did not respond to Bevacizumab and needed surgical decompression for palliative care. One noncompliant patient died due to radiation injury.Conclusion: Bevacizumab is a effective and safe for treatment of RIBE after GKRS. A protocol-based dose schedule in addition to frequent clinical and radiological evaluations are required. Bevacizumab should be considered as an early treatment option for RIBE. [ABSTRACT FROM AUTHOR]

Thinking about the chronology of the introduction of leucotomy in Germany sheds new light on the hypothesis of a special 'radical' approach of German psychiatry to the treatment of the mentally ill during the period of National Socialism. Moreover, it offers new insights into the transnational and interdisciplinary conditions of the introduction of leucotomy in early divided post-war Germany. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of compliance with anti‐epileptic medication regimens. We reasoned that widespread clinical benefits could be gained if the psychiatric comorbidities among these patients were reduced. In this study, we assessed the utility of anterior capsulotomy in managing medication‐refractory comorbid psychotic symptoms and aggression in patients with epilepsy. Methods: In this retrospective case series, we evaluated the clinical outcomes of 13 epilepsy patients with severe psychiatric comorbidities who had received bilateral anterior capsulotomy. Clinical outcome assessments were performed at 1 week, 6 months, 1 year, and several years after surgery focusing on: (a) severity of psychotic symptoms, as assessed by the 18‐item Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale; (b) severity of impulsivity and aggression, measured by the Barratt Impulsiveness Scale‐11 and the Buss‐Perry Aggression Scale; and (c) social function and quality of life, assessed by the Social Disability Screening Scale and the Quality of Life in Epilepsy. Results: After anterior capsulotomy, patients displayed significant improvements of psychotic symptoms, as well as of impulsivity and aggression, along with improvements of social function and quality of life. The clinical benefits to patients were evident within 6 months after surgery and remained stable or continued to improve at a much slower rate thereafter. Furthermore, after anterior capsulotomy all patients complied with epilepsy interventions that they did not comply with prior to surgery. No significant side effects or complications occurred during the study. Conclusion: Anterior capsulotomy seems to be a safe and effective treatment for epilepsy patients with otherwise intractable comorbid psychotic symptoms and aggression. Moreover, this neurosurgical treatment may improve the patients' social function, quality of life, and compliance with anti‐epilepsy medication regimens. [ABSTRACT FROM AUTHOR]

Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process.The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder.Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients (n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 (n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder (n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes.A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity.Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. [ABSTRACT FROM AUTHOR]

The 2019 Latest Advances in Psychiatry Symposium was held in March at the Royal College of Physicians, London, with the theme 'Mental health after Brexit: from psychosis to borderline personality disorders'. Here, Felix David covers highlights on the opioid overdose crisis, severe personality disorder, neurosurgery for severe mental illness, generalised anxiety disorder and burnout in medical staff. [ABSTRACT FROM AUTHOR]

Despite advancements in pharmacotherapeutic and behavioral interventions, a substantial proportion of patients with obsessive-compulsive disorder (OCD) continue to have disabling and treatment-refractory illness. Neurosurgical interventions, including ablative procedures and deep brain stimulation (DBS), have emerged as potential treatment options in this population. We review the recent literature on contemporary surgical options for OCD, focusing on clinical aspects such as patient selection, presurgical assessment, and safety and effectiveness of these procedures. Given the invasiveness and limited evidence, these procedures have been performed in carefully selected patients with severe, chronic, and treatment-refractory illness. Along with informed consent, an independent review by a multidisciplinary team is mandated in many centers. Both ablative procedures and DBS have been found to be helpful in around half the patients, with improvement observed months after the procedure. Various targets have been proposed for either procedure, based on the dominant corticostriatal model of OCD. There is no strong evidence to recommend one procedure over the other. Hence, the choice of procedure is often based on the factors such as affordability, expertise, and reversibility of adverse effects. Surgery is not recommended as a standalone treatment but should be provided as part of a comprehensive package including medications and psychotherapeutic interventions. Available evidence suggest that the benefits of the procedure outweigh the risks in a treatment-refractory population. Advances in neurosurgical techniques and increasing knowledge of neurobiology are likely to bring about further progress in the efficacy, safety, and acceptability of the procedures. [ABSTRACT FROM AUTHOR]

Neurosurgery for psychiatric disorders (NPD) has been practiced for >80 years. However, the interests have waxed and waned, from 1000s of surgeries in 1940-1950s to handful of surgery in 60-80s. This changed with the application of deep brain stimulation surgery, a surgery, considered to be "reversible" there has been a resurgence in interest. The Indian society for stereotactic and functional neurosurgery (ISSFN) and the world society for stereotactic and functional neurosurgery took the note of the past experiences and decided to form the guidelines for NPD. In 2011, an international task force was formed to develop the guidelines, which got published in 2013. In 2018, eminent psychiatrists from India, functional neurosurgeon representing The Neuromodulation Society and ISSFN came-together to deliberate on the current status, need, and legal aspects of NPD. In May 2018, Mental Health Act also came in to force in India, which had laid down the requirements to be fulfilled for NPD. In light of this after taking inputs from all stakeholders and review of the literature, the group has proposed the guidelines for NPD that can help to steer these surgery and its progress in India. [ABSTRACT FROM AUTHOR]

Aim: Lung cancer has become a global health problem today. Both patients and physicians prefer oncologic treatment approaches rather than surgery in T3 and T4 lung cancers in the geriatric age group. The objective of this study was to assess the long-term survival outcomes of patients aged 70 years and older, who underwent chest wall resection due to non-small cell lung cancer, and the prognostic factors affecting morbidity. Methods: Eighteen patients, who underwent chest wall resection due to non-small cell lung cancer, were assessed retrospectively. Results: A total of 18 patients (16 male and 2 female) with a mean age of 74.28±3.81 years were included in the study The most common surgery was right upper lobectomy (55.6%, n=10). Complications were detected in nine patients (50%). The most common complication was arrhythmia. Mortality was detected in four patients (22%). The mean two-year and five-year survival rates were 77.9% and 41.4%, respectively. Lymph node status, adjuvant treatment and tumor stage were prognostic factors affecting survival (p=0.001). Conclusion: Age should not be the only criterion for surgery. Appropriately selected patients should be offered anatomical resection. Long-term survival can be achieved in these patients. [ABSTRACT FROM AUTHOR]

Background The habenula is a small, mostly underrated structure in the pineal region. Multidisciplinary findings demonstrate an underlying complex connectivity of the habenula with the rest of the brain, subserving its major role in normal behavior and the pathophysiology of depression. These findings suggest the potential application of “habenular psychosurgery” in the treatment of mental disorders. Objective/Hypothesis The remission of two patients with treatment-resistant major depression treated with deep brain stimulation of the habenula supported the hypothesis that the habenula is an effective target for deep brain stimulation and initiated a surge of basic science research. This review aims to assess the viability of the deep brain stimulation of the habenula as a treatment option for treatment resistant depression. Methods PubMed and the Cochrane Library databases were searched with no chronological restrictions for the identification of relevant articles. Results The results of this review are presented in a narrative form describing the functional neuroanatomy of the human habenula, its implications in major depression, findings of electrode implantation of this region and findings of deep brain stimulation of the habenula for the treatment of depression. Conclusion Data assessing the hypothesis are scarce. Nonetheless, findings highlight the major role of the habenula in normal, as well as in pathological brain function, particularly in depression disorders. Moreover, findings of studies utilizing electrode implantation in the region of the habenula underscore our growing realization that research in neuroscience and deep brain stimulation complement each other in a reciprocal relationship; they are as self-reliant, as much as they depend on each other. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. [ABSTRACT FROM AUTHOR]

Objective: Psychosurgery is rarely discussed and is a form of last method of psychiatric intervention. It is timely to review the indications and components of psychiatric assessments for psychosurgery for aggression in intellectual disability in the literature. Methods: Articles were searched in the MEDLINE database using these search terms: "Aggression; challenging behaviour; mental retardation, intellectual disability; psychosurgery; stereotactic surgery; surgical intervention". Results: Twelve case series and case reports were found. Refractory aggression in intellectual disability warranting psychosurgery includes the following elements: severity, long duration of symptoms, failures of multiple treatments, and profound impairment of functioning/quality of life. Progressive neurological disorders have to be ruled out. Informed consent from guardians and ethical approval are also essential for psychosurgery. Several tools have been employed to measure variables such as intelligence, aggression, and adaptive functioning. Conclusions: A set of inclusion and exclusion criteria is proposed based on the findings. Protocol for referral and assessment in the local setting is also recommended. With careful patient selection, psychosurgery is a feasible treatment option. [ABSTRACT FROM AUTHOR]

Objective: Deep brain stimulation can be of benefit in carefully selected patients with severe intractable obsessive-compulsive disorder. The aim of this paper is to describe the outcomes of the first seven deep brain stimulation procedures for obsessive-compulsive disorder undertaken at the Neuropsychiatry Unit, Royal Melbourne Hospital. The primary objective was to assess the response to deep brain stimulation treatment utilising the Yale-Brown Obsessive Compulsive Scale as a measure of symptom severity. Secondary objectives include assessment of depression and anxiety, as well as socio-occupational functioning. Methods: Patients with severe obsessive-compulsive disorder were referred by their treating psychiatrist for assessment of their suitability for deep brain stimulation. Following successful application to the Psychosurgery Review Board, patients proceeded to have deep brain stimulation electrodes implanted in either bilateral nucleus accumbens or bed nucleus of stria terminalis. Clinical assessment and symptom rating scales were undertaken pre- and post-operatively at 6- to 8-week intervals. Rating scales used included the Yale-Brown Obsessive Compulsive Scale, Obsessive Compulsive Inventory, Depression Anxiety Stress Scale and Social and Occupational Functioning Assessment Scale. Results: Seven patients referred from four states across Australia underwent deep brain stimulation surgery and were followed for a mean of 31 months (range, 8–54 months). The sample included four females and three males, with a mean age of 46 years (range, 37–59 years) and mean duration of obsessive-compulsive disorder of 25 years (range, 15–38 years) at the time of surgery. The time from first assessment to surgery was on average 18 months. All patients showed improvement on symptom severity rating scales. Three patients showed a full response, defined as greater than 35% improvement in Yale-Brown Obsessive Compulsive Scale score, with the remaining showing responses between 7% and 20%. Conclusion: Deep brain stimulation was an effective treatment for obsessive-compulsive disorder in these highly selected patients. The extent of the response to deep brain stimulation varied between patients, as well as during the course of treatment for each patient. The results of this series are comparable with the literature, as well as having similar efficacy to ablative psychosurgery techniques such as capsulotomy and cingulotomy. Deep brain stimulation provides advantages over lesional psychosurgery but is more expensive and requires significant multidisciplinary input at all stages, pre- and post-operatively, ideally within a specialised tertiary clinical and/or academic centre. Ongoing research is required to better understand the neurobiological basis for obsessive-compulsive disorder and how this can be manipulated with deep brain stimulation to further improve the efficacy of this emerging treatment. [ABSTRACT FROM AUTHOR]

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as nonresponder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested. [ABSTRACT FROM AUTHOR]

The article discusses characteristics, clinical presentation, and treatment options for refractory obsessive-compulsive disorder (OCD). Topics explored include the comorbidities of OCD such as anxiety disorders and depression, the cognitive-behavior therapy (CBT) strategies recommended for individuals with OCD, and the effectiveness demonstrated by deep brain stimulation in refractory OCD particularly in terms of symptom reduction.

Very little has been published on the rise and fall of psychosurgery in Australia. In the mid-twentieth century, Western Australia was the largest but most sparsely-populated of the six Australian States, and its local psychiatry practice was, as one commentator put it, ‘backward’. Nonetheless, electroconvulsive therapy was introduced in 1945, and leucotomy in 1947. This paper will explore the introduction of leucotomy to Western Australia in the context of wider national and international trends in psychiatry, and posit some reasons for its decline and abandonment in the 1970s. It will present a narrative reconstruction of the local introduction and practice of leucotomy, using retrieved, reconstructed and previously unpublished data. [ABSTRACT FROM AUTHOR]

Nach Ende des Zweiten Weltkrieges kam die in Europa seit 1936 eingeführte Leukotomie auch in den westdeutschen Besatzungszonen und der frühen Bundesrepublik zur Anwendung. Unter der Indikation „Schizophrenie“, „Depression“, „Zwangserkrankung“, aber auch „Psychopathie“ wurden Kranke in auswärtige neurochirurgische Abteilungen oder aber in solche überwiesen, die innerhalb der psychiatrischen Kliniken und Nervenkliniken etabliert wurden. Auf der Grundlage von Tagungsberichten, damaligen Fallberichten, Dissertationen sowie Stichproben von Krankenakten wird die Anwendung der Leukotomie in der frühen Bundesrepublik bis in die 1950er Jahre dargestellt. Deutlich wird, wie die Einführung der Leukotomie in der westdeutschen Nachkriegspsychiatrie von der amerikanischen Psychiatrie und Neurochirurgie unterstützt wurde. [ABSTRACT FROM AUTHOR]

This article is based on a comparative thematic analysis of two novels that explore the experiences of institutional psychiatric care. Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest is a classic of modern U.S. literature. It is argued here that Kesey’s representation of the “psychiatric patient” as rebel was not only a reflection of some the changing societal attitudes in postwar America, but it also helped to shape them. The challenge to the asylum system was thus cast in terms of questions of the civil rights of a marginalized group. The main themes of the novel reflect those of protesters against the abuses of the asylum system—the poor physical conditions, the social isolation of the patients, poor physical care and abuse, and the use of ECT and psychosurgery. The rebellious spirit of Kesey’s work is contrasted with a recent novel—Nathan Filer’s 2012 award-winning The Shock of the Fall. In Filer’s work, the optimism and challenge to authority has dissipated to be replaced by a resigned fatalism reflecting the current crisis in mental health services. [ABSTRACT FROM AUTHOR]

In Poland, there were 176 cases of prefrontal leucotomy performed by Moniz’s method between 1947 and 1951. There were also several cases in which alternative psychosurgical techniques were used: prefrontal topectomy by Bilikiewicz and colleagues, and prefrontal topischemia by Ziemnowicz. This article analyses the following: publications by Choróbski, who performed lobotomy in Poland, and by Korzeniowski, who assessed its short-term results; a report by Bornsztajn, who reviewed general results of the method; and clinical research by Broszkiewicz and by Konieczyńska, who assessed Polish patients in terms of long-term results of lobotomy. Negative clinical evaluation of lobotomy led to its abandonment in Poland, a decision strengthened by a regulation that forbade lobotomy in the USSR and impacted Polish psychiatry. [ABSTRACT FROM AUTHOR]

Period of Custodial Care Only: The magnificent "Institute of Mental Health" has its history almost from 1795 when the East India company appointed Surgeon Valentine Conolly to be in charge of a "House for accommodating persons of unsound mind." After a few transitions, backed by a government order for the construction of a lunatic asylum in a 66 1/2 acre site, the asylum started functioning from 1871. The period of about six decades from its inception could be referred to as "the period of custodial care." However, the quality of care for the general medical problems gradually improved with the creation of separate facilities for some common ailments and also one for seriously ill. Separate wards were also conceptualized for criminal patients and female inmates. Towards Modern Comprehensive Patient Care: Thanks to Government sanctions, the staff strength gradually increased with regularization of bed strength to 1800, and by 1948-1957, the hospital had 14 medical officers and a host of other staff. The period from 1939 to 1948 witnessed the introduction of electroconvulsive therapy and insulin coma therapy including the modified one and also insulin histamine therapy. During the prephenothiazine era, the drugs used were barbiturates, paraldehyde, opiates, and Rauwolfia serpentina, which were discontinued after the use of Chlorpromazine from 1954. Psychosurgery was also undertaken in selected cases from 1948, but the procedure went out of vogue soon due to the quality of outcome being poor and development of complications. Rehabilitation of patients got a fillip with the introduction of occupation therapy in 1949 and industrial therapy center in 1970. Extension of psychiatric services to general hospitals began from 1949. Advances in Academic Spheres And Research Activities: Regular training was imparted to paramedical and undergraduate medical students from 1948. The institute had the privilege of hosting the Annual National Conference of Indian Psychiatric Society - 1957. The institute also spearheaded in several pioneering researches such as insulin coma therapy, syphilis, and Alzheimer's dementia, to name a few. The pivotal role played by the State Psychiatric Institutes in patient care, training, and research, should speak for adequate empowerment of these government institutes. [ABSTRACT FROM AUTHOR]

Abstract: Scholars have offered various critiques of Alberto Giubilini and Francesca Minerva's controversial article, ‘After‐birth abortion: Why should the baby live?’ My book The Ethics of Abortion: Women's Rights, Human Life, and the Question of Justice presents four such critiques. First, Giubilini and Minerva argue from the deeply controversial to the even more controversial. Second, they presuppose a false view of personal identity called body‐self dualism. Third, their view cannot secure human equality. And fourth, their account of harm cannot account for harm found in some cases of murder. In the article, ‘Pro‐life arguments against infanticide and why they are not convincing’, J. Räsänen examines and finds wanting these four critiques. This essay responds to Räsänen's defense of infanticide and argues that his responses to the four objections fail. [ABSTRACT FROM AUTHOR]

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. [ABSTRACT FROM PUBLISHER]

Background: No effective treatment for tardive dystonia (TD) has been well established. Deep brain stimulation (DBS) can ameliorate motor manifestations in primary dystonia, and may also be an effective approach for TD.Objectives: This study aimed to illuminate the long-term efficacy and safety of subthalamic nucleus (STN)-DBS in treating TD.Methods: Ten patients with refractory TD underwent STN-DBS therapy and were assessed by the Burke-Fahn-Marsden dystonia rating scale (BFMDRS), Abnormal Involuntary Movement Scale (AIMS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and the Short Form (36) Health Survey (SF-36) at four time points: pre-operation, 1 week post-operation, 6 months post-operation, and at a final long-term postsurgical follow-up time point.Results: The mean follow-up time was 65.6 ± 30.4 months (range, 12-105 months). At the first follow-up, BFMDRS motor and disability scores had improved by 55.9± 28.3% and 62.6± 32.0%, respectively, while AIMS scores improved by 53.3± 26.7%. At the second follow-up, BFMDRS motor and disability scores improved further, by 87.3± 17.0% and 84.3% ± 22.9%, respectively, while AIMS scores improved by 88.4 ± 16.1%. At the last follow-up, this benefit was sustained and had plateaued. Quality of life was improved significantly at the long-term follow-up, and the HAMA and HAMD scores displayed a significant reduction that persisted after the first follow-up.Conclusion: STN-DBS may be an effective and acceptable procedure for TD, leading to persistent and significant improvement in both movement and psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this retrospective study were to analyze the short-term and long-term effects and complications of stereotactic anterior capsulotomy for patients with refractory obsessive-compulsive disorder (OCD). The advantages and disadvantages of stereotactic anterior capsulotomy have been discussed. Materials and Methods: Between October 2007 and June 2010, 37 patients with OCD underwent anterior capsulotomy in West China Hospital of Sichuan University or Mian Yang Central Hospital. The clinical effects were evaluated by an independent psychiatrist preoperatively and after 1 week, and after 1, 3, 6, 12, 36, and 60 months postoperatively. The main parameters were evaluated by scores on the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression scale (HAMD), and Hamilton anxiety scale (HAMA). 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and diffusion tensor imaging (DTI) were performed preoperatively and at 3 and 6 months postoperatively. Results: On comparing the scores obtained at various time points, the effects of anterior capsulotomy were as follows: The Y-BOCS score of the 37 patients decreased in the fifth year postoperatively (P < 0.05); 27 (73.0%) patients exhibited significant improvement (>50% decrease in the Y-BOCS score); 6 (16.2%) patients exhibited partial improvement (20-50% decrease in the Y-BOCS score); and, 4 (10.8%) patients exhibited no evident improvement (<20% decrease in the Y-BOCS score). Moreover, depression and anxiety improved among all the patients (P < 0.05). FDG-PET showed that the glucose metabolic rate had decreased in bilateral frontal cerebral lobe and basal ganglia. DTI showed that the transverse fibers in bilateral anterior limb of the internal capsule were disconnected. Conclusion: Using MRI guidance, stereotactic treatment of refractory OCD via bilateral anterior internal capsulotomy significantly improved several OCD symptoms such as compulsive behavior, depression, and anxiety. In addition, the assessment of the effects and complications of this treatment was most accurate at 6 months postoperatively. [ABSTRACT FROM AUTHOR]

Thermal dose and absorbed radiation dose have historically been difficult to compare because different biological mechanisms are at work. Thermal dose denatures proteins and the radiation dose causes DNA damage in order to achieve ablation. The purpose of this paper is to use the proportion of cell survival as a potential common unit by which to measure the biological effect of each procedure. Survival curves for both thermal and radiation doses have been extracted from previously published data for three different cell types. Fits of these curves were used to convert both thermal and radiation dose into the same quantified biological effect: fraction of surviving cells. They have also been used to generate and compare survival profiles from the only indication for which clinical data are available for both focused ultrasound (FUS) thermal ablation and radiation ablation: essential tremor thalamotomy. All cell types could be fitted with coefficients of determination greater than 0.992. As an illustration, survival profiles of clinical thalamotomies performed by radiosurgery and FUS are plotted on a same graph for the same metric: fraction of surviving cells. FUS and Gamma Knife have the potential to be used in combination to deliver a more effective treatment (for example, FUS may be used to debulk the main tumour mass, and radiation to treat the surrounding tumour bed). In this case, a model which compares thermal and radiation treatments is valuable in order to adjust the dose between the two. [ABSTRACT FROM PUBLISHER]

This article examines how lobotomy came to be banned in the Soviet Union in 1950. The author finds that Soviet psychiatrists viewed lobotomy as a treatment of “last resort,” and justified its use on the grounds that it helped make patients more manageable in hospitals and allowed some to return to work. Lobotomy was challenged by psychiatrists who saw mental illness as a “whole body” process and believed that injuries caused by lobotomy were therefore more significant than changes to behavior. Between 1947 and 1949, these theoretical and ethical debates within Soviet psychiatry became politicized. Psychiatrists competing for institutional control attacked their rivals’ ideas using slogans drawn from Communist Party ideological campaigns. Party authorities intervened in psychiatry in 1949 and 1950, persecutingjewish psychiatrists and demanding adherence to Ivan Pavlov’s theories. Psychiatrists’ existing conflict over lobotomy was adopted as part of the party’s own campaign against harmful Western influence in Soviet society. [ABSTRACT FROM AUTHOR]

Psychosurgery, the neurosurgical treatment for psychiatric disorders, has a long and controversial history. The review introduces the birth of psychosurgery, the rise and fall of the frontal lobotomy and the transition to the modern era of psychosurgery, due to the development of the stereotactic instruments, and the different psychosurgical procedures. Today, recent advances in neuromodulation may provide an opportunity for psychosurgery to become a more attractive option for the treatment of psychiatric diseases. Current states in China and prospects of psychosurgery are also discussed. [ABSTRACT FROM AUTHOR]

Gracias a los avances técnicos en técnicas neuroquirúrgicas, y debido a que el diagnóstico y la clasificación de las enfermedades psiquiátricas han evolucionado significativamente a lo largo de las últimas décadas, se están desarrollando tratamientos a nivel experimental para aquellos pacientes resistentes al manejo conservador.La anorexia nerviosa es una enfermedad de prevalencia creciente, con la tasa de mortalidad más elevada dentro de los trastornos psiquiátricos, y con aproximadamente un 20% de pacientes que presentan una evolución tórpida. Para estos pacientes que no responden a manejo conservador, la estimulación cerebral profunda ha surgido como una alternativa terapéutica, si bien la literatura especializada al respecto es escasa.A continuación presentamos una revisión de la fisiopatología de la anorexia nerviosa, así como de los distintos tratamientos neuroquirúrgicos realizados a lo largo de la historia. Se detalla la perspectiva de tratamiento quirúrgico actual, así como los aspectos éticos que se han de considerar en relación con el surgimiento de estas nuevas terapias. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) has emerged as an established effective and safe treatment option for a small subset of patients with severe Tourette syndrome (TS) refractory to psychological and pharmacological treatments. Several targets have been implicated in the study of the effects of DBS on TS symptomatology. The targets applied for DBS in TS include the thalamus, the globus pallidus internus, the internal capsule/nucleus accumbens, the globus pallidus externus and the subthalamic nucleus. In the majority of studies there has been a significant clinical benefit on tics. Nevertheless, the best target has not been defined yet. Up until now, only five double blind randomized controlled trials have been carried out worldwide for a total of 32 patients. Thus, the new recommendations for DBS in TS emphasize the importance of standardized recordings of all pre-, intra-, and postoperative data to optimize the registration of patients so that results can be compared. Recent reports have shown that standard continuous DBS for TS patients may not be the most optimal paradigms to pursue. Adaptive stimulation and the use of human-computer interfaces might in the future optimize the results of DBS in TS because of the paroxysmal nature of the disease. [ABSTRACT FROM AUTHOR]