History of Psychosurgery: Psychiatrist’s Perspective.

History of Psychosurgery: Psychiatrist’s Perspective.

Filed under: Depression Treatment

World Neurosurg. 2013 Feb 15;
Lapidus KA, Kopell BH, Ben-Haim S, Rezai AR, Goodman WK

Interest in using neuromodulation to treat psychiatric disorders is rapidly increasing. The development of novel tools and techniques, such as Deep Brain Stimulation (DBS), increases precision and minimizes risk. This article reviews the history of psychosurgical interventions and recent developments of DBS to provide a framework for understanding current options and future goals. We begin by discussing early approaches to psychosurgery, focusing on the widespread used of lobotomy and the subsequent backlash from the public and professionals in the field. Next, we discuss the development of stereotaxis. This technique allows for more targeted, precise interventions that produce discrete subcortical lesions. We focus on four stereotactic procedures that were developed using this technique: cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy. We subsequently review contemporary theory and approaches with relevance to psychosurgery. We discuss the systems and neurocircuitry that are thought to be involved in psychiatric illness and provide targets for intervention. This discussion includes presentation of basal ganglia thalamocortical pathophysiology including cortico-striato-thalamo-cortical (CSTC) loops. We focus the discussion on two psychiatric disorders that have been targets of neurosurgical interventions: Obsessive-Complusive Disorder (OCD) and mood disorders such as Major Depressive Disorder (MDD). Evidence from studies of DBS in psychiatric disorders, including efficacy and tolerability, is reviewed. Finally, we look to the future, exploring the possibilities for these approaches to increase understanding, transform societal views of mental illness, and improve treatment.
HubMed – depression


Psychometric properties of the Quick Inventory of Depressive Symptomatology (QIDS-SR) in UK primary care.

Filed under: Depression Treatment

J Psychiatr Res. 2013 Feb 15;
Cameron IM, Crawford JR, Cardy AH, du Toit SW, Lawton K, Hay S, Mitchell K, Sharma S, Shivaprasad S, Winning S, Reid IC

It is widely believed that severity of depressive disorder should guide treatment selection and many guidelines emphasise this factor. The Quick Inventory of Depressive Symptomatology (QID-SR(16)) is a self-complete measure of depression severity which includes all DSM-IV criterion symptoms for major depressive disorder. The object of this study was to assess the psychometric properties of the QIDS-SR(16) in a primary care sample. Adult primary care patients completed the QIDS-SR(16) and were assessed by a psychiatrist (blind to QIDS-SR(16)) with the 17-item Hamilton Rating Scale for Depression (GRID-HAMD). Internal consistency, homogeneity and convergent and discriminant validity of the QIDS-SR(16) were assessed. Severity cut-off scores for QIDS-SR(16) were assessed for convergence with HRSD-17 cut-offs. Published methods for converting scores to HRSD-17 were also assessed. Two hundred and eighty-six patients participated: mean age = 49.5 (s.d. = 13.8), 68% female, mean HRSD-17 = 12.6 (s.d. = 7.6). The QIDS-SR(16) exhibited acceptable internal consistency (Cronbach’s alpha = 0.86), a robust factor structure indicating one underlying dimension and correlated highly with the HRSD-17 (r = 0.79) but differed significantly in how it categorised the severity of depression relative to the HRSD-17 (Wilcoxon Signed Rank Test p < 0.001). Using published methods to convert QIDS-SR(16) scores to HRSD-17 scores did not result in alignment of severity categorisation. In conclusion, psychometric properties of the QIDS-SR(16) were found to be strong in terms of internal consistency, factor structure and convergent and discriminant validity. Using conventional scoring and conversion methods the scale was found not to concur with the HRSD-17 in categorising the severity of depressive symptoms. HubMed – depression


Chronic stressors and trauma: prospective influences on the course of bipolar disorder.

Filed under: Depression Treatment

Psychol Med. 2013 Feb 18; 1-10
Gershon A, Johnson SL, Miller I

BACKGROUND: Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. Method One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). RESULTS: Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. CONCLUSIONS: Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.
HubMed – depression



Depression treatment options and results – Aradical new brain operation, a procedure called Deep Brain Stimulation, is being used on patients suffering severe depression. The procedure has been performed for the first time in Australia at the Royal Melbourne Hospital. Associate Professor Richard Bittar, Neurosurgeon, Royal Melbourne Hospital, describes the procedure and its almost immediate effects. Dr. Richard Bittar, Precision Neurosurgery Director MBBS (Honours), PhD, FRACS Dr. Richard Bittar is a highly qualified Australian neurosurgeon and researcher. Dr. Bittar is a visiting neurosurgeon at Royal Melbourne Hospital, Frankston Hospital, and numerous Private Hospitals in Melbourne. He is also Director of Precision Neurosurgery. Deep brain stimulation (DBS) works by targeting one of several areas in the brain that are part of the movement disorder pathway. By placing a fine wire (electrode) very precisely within the desired area, we are able to introduce a small amount of electrical current to these areas, which causes deactivation of the nerve cells. This electrode is connected to a battery which is implanted under the skin, allowing a small pulse of electricity to be delivered 24 hours a day. The most commonly targeted regions are the subthalamic nucleus (STN), thalamus (Vim), pallidum (GPi), and pedunculopontine nucleus (PPN) in Parkinson’s disease, the thalamus (Vim) for essential tremor and multiple sclerosis tremor, and the pallidum (GPi) in dystonia. Precision Neurosurgery is a superspecialty


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