Surgery for psychiatric disorders

Abstract

Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. Several double-blind controlled and open trials have been conducted and the response rate is estimated around 54%. Open trials have shown encouraging results with DBS for therapy-refractory depression and case reports have shown potential effects of DBS on addiction. Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research.

Keywords: ALIC; AN; Addiction; Anorexia nervosa; Anterior limb of the internal capsule; Circuits connecting orbitofrontal cortex; DBS; DDS; Deep brain stimulation; Dopamine dysregulation syndrome; GPi; Globus pallidus; HDRS; Hamilton Depression Rating Scale; IPG; ITP; Inferior thalamic peduncle; Internal pulse generator; MDD; Major depressive disorder; Medial prefrontal cortex; NAc; Nucleus accumbens; OCD; OFC; Obsessive-compulsive disorder; Orbitofrontal cortex; PG; Pathologic gambling; Psychosurgery; SCG; STN; Subcallosal cingulate gyrus; Subthalamic nucleus; TRD; TS; Therapy-resistant depression; Tourette syndrome; VC/VS; Ventral capsule/ventral striatum; Y-BOCS; Yale-Brown obsessive-compulsive scale; mPFC.