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PubMed1976

Psychosurgery: some current observations.

The term "psychosurgery" encompasses a wide variety of different neurosurgical procedures applied in the treatment of behavioral and psychiatric disorders. Arguments about the effectiveness and ethicality of psychosurgery are often based on studies using outdated procedures or inappropriate patient populations. The debate over psychosurgery is also obscured by the frequent confusion between its use in classical psychiatric syndromes and in such controversial areas as aggression or violent behavior associated with temporal lobe epilepsy. The author believes that such factors need to be clarified so that practitioners can choose a personal position based on sound medical fact.

Ethics, Medical↗

PubMed1978

Psychosurgery and the Porteus Maze Tests: review and reanalysis of data.

Because of current interest in assessing psychosurgery outcome, a reanalysis of Porteus maze test findings was done. The maze tests are generally considered to measure foresight and judgment. Review of the literature relating to the effects of practice on the test shows average gains of 1.25 years on the second application of the test and an additional gain of 0.70 years on the third application. Much of the early psychosurgery research did not take practice effects into account. Reanalysis of data shows that the magnitude of changes in maze performance depends on the site of surgery and length of time between surgery and testing. The more posterior the frontal lobe surgery, the shorter the postoperative interval, the greater the loss in maze test ability. Losses following relatively posterior frontal lobe surgery are probably permanent.

Frontal Lobe↗

PubMed1979

Psychosurgery on sex offenders and sexual "deviants" in West Germany.

About 70 men have undergone a stereotaxic hypothalamotomy in West Germany for sexual behaviors. In most cases the nucleus ventromedialis (Cajal) has been unilaterally destroyed. The question of whether this kind of psychosurgery shoudl be legally controlled is being discussed by both scientists and the public in West Germany. The justification for this psychosurgery is taken from a theoretical basis which is at least questionable and which stems from a biologically truncated and therefore limited perspective on human sexuality. An inspection of the published reports shows that the indication for surgery was based on questionable scientific and clinical grounds and practically excluded psychotherapeutic and sociotherapeutic aspects. In the authors' opinion stereotaxic hypothalamotomy can in no way be regarded as an unquestioned, applicable method of therapy. We consider it essential that this surgery be suspended at least as long as the possible therapeutic effectiveness and the possible adverse side effects remain unclear.

Germany, West↗

PubMed1978

The incidence of psychosurgery in the United States, 1971--1973.

As part of the work of the APA Task Force on Psychosurgery, the author surveyed 1,901 neurosurgeons on how many psychosurgical procedures they performed in 1971, 1972 and 1973. A total of 1.481 questionnaires were returned: 195 neurosurgeons indicated they had performed a total of 476 procedures for intractable pain and 1.039 procedures for psychiatric conditions. Excluding the procedures reported by 4 neurosurgeons who performed more than 20 psychosurgical operations in any one of the three years, the number of psychosurgical operations in 575 for the three years, which the author suggests should allay fears about the abuse of psychosurgery.

Humans↗

PubMed1992

The present status of psychosurgery in Australia and New Zealand.

OBJECTIVES: To assess the extent and nature of psychosurgery currently being performed in Australia and New Zealand, and the present status of legislation regulating its practice. METHODS: Details of current legislation were obtained through inspection of statutes and direct communication with Departments of Health. All full and associate members of the Neurosurgical Society of Australasia were surveyed by postal questionnaire. Ninety-eight neurosurgeons were surveyed, of whom 72 (73%) replied. RESULTS: In the 1980s a mean of nine (SD, 5.9) operations were performed per year; about two were performed per year in the late 1980s. Ninety per cent of these operations were performed at one centre in Sydney. The most common indications were severe and medically intractable depression and obsessive-compulsive disorder. Surgery is now exclusively stereotactic and involves the creation of lesions in the orbitomedial frontal or cingulate tracts or a combination of the two. The nature and type of surgery are comparable to those in other centres in the Western world. Regulatory legislation is in place in most, but not all, States in Australia and in New Zealand. CONCLUSIONS: Further developments of other forms of psychiatric treatments may make psychosurgery, in its present form and at its present level of validation, redundant. If it is to have a resurgence, it would have to be based on a much sounder theoretical premise, and a stronger demonstration of efficacy and predictability of effect.

Adult↗

PubMed1991

Psychosurgery: a retrospective.

Of the 56 patients within the Yakovlev collection who had undergone psychosurgery 11 (20%) improved, 18 (32%) were either worse or without improvement, and 27 (48%) were without any clinical follow-up. Thus, in retrospect, psychosurgery was perhaps not as successful as once envisioned.

Adult↗

PubMed1979

[Psychosurgery today (author's transl)].

After discussion of the historical and neurophysiological bases of psychosurgery a report on personal experience in different indications is given. Finally, the present degree of informedness of doctors and the media on psychosurgery is discussed.

Aggression↗

PubMed1992

Effect of psychotropic drugs on excitatory amino acids in patients undergoing psychosurgery for depression.

Samples of ventricular CSF were taken from 52 consecutive patients admitted for psychosurgery for intractable depression. Concentrations of asparagine, aspartate, glutamine, glutamic acid, and serine were determined. Glutamate and aspartate concentrations, implicated in excitotoxic brain damage, were not affected by various types of psychotropic drug treatment. Serine, a modulator of glutamate responses, was significantly elevated in samples from subjects receiving antidepressants. These subjects responded poorly to the operation. Psychotropic drugs are unlikely to be neurotoxic. Nevertheless, antidepressants may influence excitatory neurotransmission.

Adult↗

PubMed1977

[Psychosurgery in behavior disorders].

The results obtained in a casuistic of 170 patients with mental diseases and behavior disturbances treated by neurosurgical procedures are reported. The authors call attention to the advantages of the atraumatic stereotaxic psychosurgery over the major surgical procedures on the frontal lobes for the treatment of psychoses and intractable psychoneurosis.

Epilepsy, Temporal Lobe↗

PubMed1992

Psychosurgery in the modern era: therapeutic and ethical aspects.

Brain operations for psychiatric illness were in the past the centre of public controversy. Fear of untoward side-effects and an exaggerated use of the procedure including treatment of societal aspects of the disease process caused a virtual cessation of psychosurgical operations. With the introduction of techniques that could accurately lesion specific areas in the brain, especially in the limbic system, psychosurgical procedures were revived. Psychiatric syndromes, such as obsessive-compulsive affective disorders, were shown to have benefited from such intervention, without giving rise to untoward side-effects. Given societal supervision it is appropriate to reconsider the use of psychosurgery in well-defined clinical entities of mental disease that do not respond to alternative therapy.

Behavior Control↗

PubMedDate not supplied

Transsexualism and a new type of psychosurgery.

A discussion of "The Transsexual Wish in a Psychotic Character" by Katherine MacVicar, M.D. Patients in increasing numbers are seeking sex-reassignment surgery. The topic receives coverage in both the lay and professional press; many advocate surgery as the only "cure". Clinical study reveals that these patients have borderline personality organization and are seeking to discard bad and aggressive features and to replace them with a new idealized perfection. Surgical procedures in these cases can usefully be conceptualized as a new type of psychosurgery.

Defense Mechanisms↗

PubMed1975