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Contemporary psychosurgery: indications, outcome and the Irish experience

Published online by Cambridge University Press:  13 June 2014

Miriam O'Doherty
Affiliation:
St Vincent's Hospital, Convent Avenue, Fairview, Dublin 3, Ireland.
Paul K Bridges
Affiliation:
United Medical & Dental Schools, Guy's & St Thomas's Hospitals, St Thomas Street, London SE1 9RT, England.

Abstract

Objectives: To review recent use of psychosurgery in Britain and Ireland; to outline the indications and contraindications; and to summarise the Irish experience of psychosurgery.

Method: The Geoffrey Knight National Unit for Affective Disorders (GKU), now based at the Maudsley Hospital has performed the largest number of psychosurgical operations in the last 30 years. This paper reviews criteria for referral and outcome of stereotactic subcaudate tractotomy at the GKU. The twenty-one referrals from Ireland to the Unit, resulting in eight operations over the fifteen year period 1981-1995, are considered separately.

Results: The efficacy of stereotactic subcaudate tractotomy is of the order of 30-60% and there is a low incidence of long-term adverse effects. The outcome of the eight Irish patients who underwent psychosurgery compare favourably with the overall outcome figures for the Unit.

Conclusions: Stereotactic subcaudate tractotomy remains a treatment of last resort in the rare cases of severely treatment-resistant affective disorders and obsessive compulsive disorders.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 1998

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References

1.Bridges, PK, Bartlett, JR, Hale, AS, Poynton, AM, Malizia, AL, Hodgkiss, AD. Psychosurgery: Stereotactic subcaudate tractotomy, an indispensable treatment. Br J Psychiatry 1994; 165: 599611.CrossRefGoogle ScholarPubMed
2.Bowskill, RJ, Bridges, PK. Treatment resistant affective disorders. Br J of Hosp Med 1997; 57: 171–2.Google ScholarPubMed
3.Poynton, AM. Current State of Psychosurgery. Br J Hosp Med 1993; 50(7): 408411.Google ScholarPubMed
4.Malhi, GS, Bartlett, JR. The new lesion for the psychosurgical operation of stereotactic subcaudate tractotomy. Br J Neurosurg 1998: (in press).Google ScholarPubMed
5.Poynton, AM. Psychosurgery in the eighties: a description of referrals stereotactic tractotomy 1981-1985 and a comparison between operated and non-operated patients. MPhil Thesis, University of London, 1990.Google Scholar
6.Hodgkiss, AD, Malizia, AL, Bartlett, JR., Bridges, PK. Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy. J Neuropsychiatry Clin Neurosci 1995; 7(2): 230–4.Google ScholarPubMed
7.Hale, AS, Proctor, A, Bridges, PK. Clomipramine, tryptophan and lithium in combination for resistant depression: seven case studies. Br J Psychiatry 1987; 151:213–7.CrossRefGoogle ScholarPubMed
8.Mental Health Act 1983. London: Her Majesty's Stationery Office, 1983.Google Scholar
9.Mental Health Act Commission. Fifth Biennial Report 1993. London: Her Majesty's Stationery Office, 1993.Google Scholar
10.Bridges, PK, Goktepe, EO, Maratos, J. A comparative review of patients with obsessional neurosis and with depression treated by psychosurgery. Br J Psychiatry 1973; 123: 663–74.CrossRefGoogle ScholarPubMed
11.Hay, P, Sachdev, P, Cumming, Set al.Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand 1993; 87: 197207.CrossRefGoogle ScholarPubMed
12.Strom-Olsen, R, Carlisle, S. Bi-frontal stereotactic tractotomy; a follow-up study of its effect on 210 patients. Br J Psychiatry 1971; 118: 141–54.CrossRefGoogle ScholarPubMed
13.Lovett, LM, Shaw, DM. Outcome in bipolar affective disorder after stereotactic tractotomy. Br J Psychiatry 1987; 151: 113–6.CrossRefGoogle ScholarPubMed
14.Poynton, AM, Bridges, PK, Bartlett, JR. Psychosurgery in Britain now. Br J Neurosurgery 1988; 2: 297306.CrossRefGoogle ScholarPubMed
15.Lovett, LM, Crimmins, R, Shaw, DM. Outcome in unipolar affective disorder after stereotactic tractotomy. Br J Psychiatry 1989; 155: 547–50.CrossRefGoogle ScholarPubMed
16.Sachdev, P, Smith, JS, Matheson, J. Is Psychosurgery antimanic? Biol Psychiatry 1990; 27: 363–71.CrossRefGoogle ScholarPubMed
17.Kartsounis, LD, Poynton, A, Bridges, PK, Bartlett, JR. Neuropsychological correlates of stereotactic subcaudate tractotomy: a prospective study. Brain 1991; 114: 2657–73.CrossRefGoogle ScholarPubMed
18.Goktepe, EO, Young, LB, Bridges, PK. A further review of the results of stereotactic subcaudate tractotomy. Br J Psychiatry 1975; 126: 270–80.CrossRefGoogle Scholar
19.Curson, DA, Trauer, T, Bridges, PK, Gillman, P. Assessment of outcome after psychosurgery using the present state examination. Br J Psychiatry 1983; 143: 118–23.CrossRefGoogle ScholarPubMed
20.Pippard, J. Rostral leucotomy: a report on 240 cases personally followed-up after one and a half to five years. J Ment Sciences 1955; 101: 756–77.CrossRefGoogle Scholar
21.Sykes, M, Tredgold, R. Restricted orbital undercutting. Br J Psychiatry 1964; 110: 609–40.CrossRefGoogle ScholarPubMed
22.Mitchell-Heggs, N, Kelly, D, Richardson, A. Stereotactic limbic leucotomy a follow-up at 16 months. Br J Psychiatry 1976; 128: 226–40.CrossRefGoogle Scholar
23.Ballantine, H, Bouckoms, J, Thomas, E, Giriunas, I. Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry 1987; 22: 807–19.CrossRefGoogle ScholarPubMed
24.Hussain, E, Freeman, H, Jones, R. A cohort study of psychosurgery cases from a defined population. J Neurol Neurosurg Psychiatry 1988; 51: 345–52.CrossRefGoogle ScholarPubMed
25.Knight, G. Further observations from an experience of 660 cases of stereotactic tractotomy. Postgr Med Journal 1973; 45: 113.CrossRefGoogle Scholar