Psychosurgery

from Wikipedia, the free encyclopedia

Under psychosurgery refers surgery on the brain to treat severe mental disorders (eg. As schizophrenia , severe OCD ). But also with severe courses of other serious neurological diseases such as B. Parkinson's disease , Tourette's syndrome or epilepsy , human experiments were used in the past.

Irreversible procedures

Interventions that can no longer be reversed include stereotactic operations such as cingulotomy , anterior capsulotomy , subcaudal tractotomy, and limbic leukotomy.

One of the oldest and most famous procedures is the lobotomy , a radical double-sided incision in the frontal medulla that separates the connections between the frontal lobe and thalamus. The operation was first performed by the Portuguese doctor António Caetano de Abreu Freire Egas Moniz in 1935; In 1949 he received the Nobel Prize for it. The intervention should have a calming effect on schizophrenic, severely depressed and aggressive patients, which is, however, controversial today. At the same time, serious side effects were often associated with the procedure, such as the loss of feelings of sadness or joy and a strong emotional flattening.

The fact that the lobotomy was still used can be explained by the state of knowledge at the time about mental disorders, the previously prevailing image of the mentally ill in society and the lack of alternative treatment methods such as neuroleptics. In the United States in the 1950s and 1960s, for example, thousands of people underwent a lobotomy, even if it was only behavioral. In addition, operations on the brain have sometimes been misused to prevent deviant social behavior by interfering with the brain. A well-known case is e.g. B. that Rosemary Kennedy's . The far-reaching side effects as well as the mentioned cases of abuse of this therapy method meant that it hardly played a role at least since the development of modern psychotropic drugs and that "psychosurgical" procedures suffer from an ambivalent reputation to this day.

The irreversible procedures also include psychosurgical operations on the tonsil nucleus , in which the brain tissue is destroyed by an inserted probe using cold, heat or chemical substances. After amygdala operations, the main complaints were serious side effects: the operated patients become more passive, motor impairment, they lose control over their reactions, spontaneity and creativity are restricted.

Reversible procedure

A reversible, i.e. still quite young, surgical method is deep brain stimulation , which is currently mainly used in patients with severe organic or neuropsychiatric diseases such as Parkinson's disease , Tourette's , obsessive-compulsive disorder , epilepsy and the like. a. is used occasionally. This procedure is also called "brain pacemaker" because deep brain stimulation involves the insertion of two electrodes into the brain, via which current is then passed into the affected areas of the brain by pulse generators (pacemakers) implanted in the patient's chest.

In the meantime, possible psychological side effects have also been reported for this procedure, whereby the spectrum should primarily include minor cognitive deterioration, depression and (hypo-) mania. But personality changes have also been documented.

Web links

Individual evidence

  1. ↑ GA Mashour, EE Walker, RL Martuza: Psychosurgery: past, present and future . In: Brain Research Review , 48 (3), 2005, pp. 409-18, doi : 10.1016 / j.brainresrev.2004.09.002 , PMID 15914249 .
  2. ^ Clinical resource and audit group: Neurosurgery for mental disorder . Edinburgh: Scottish Office, 1996.
  3. ^ BH Price, I. Baral, GR Cosgrove, SL Rauch, AA Kartenem, MA Jenike, EH Cassem: Improvement in severe self-mutilation following limbic leucotomy: a series of five consecutive cases . In: Journal of Clinical Psychiatry 62 (12), 2001, pp. 925-32, doi : 10.4088 / JCP.v62n1202 , PMID 11780871
  4. ↑ KN Fountas, JR Smith, GP Lee: Bilateral stereotactic amygdalotomy for self-mutilation disorder: a case report and review of the literature . In: Stereotactic and Functional Neurosurgery 85 (2-3), 2007, pp. 121-8, doi : 10.1159 / 000098527 , PMID 17228178 .
  5. ↑ ES Valenstein: The psychosurgery debate . Freeman & Co., San Francisco, 1980.
  6. ^ Burton Feldman: The Nobel prize: a history of genius, controversy, and prestige . Arcade Publishing, 2001, p. 271.
  7. ^ JW Renfrew: Aggression and its causes. A Biopsychosocial Approach. New York, Oxford University Press 1991. p. 74.
  8. ↑ Alan W. Scheflin and Edward M. Opton, Jr .: The Mind manipulator. New York, Paddington Press 1978. p. 277.
  9. ↑ a b Sabine Müller, Markus Christen: Possible personality changes through deep brain stimulation in Parkinson's patients . Nervenheilkunde 29 (11), 2010, pp. 779–783, (free download) ( Memento of the original dated February 22, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.schattauer.de
  10. ↑ TE Schläpfer, BH Bewernick: . Deep Brain Stimulation for Psychiatric Disorders - State of the Art Advances and technical standards in neurosurgery 34, PMID 19368080
  11. ↑ M. Synofzyk, TE Schlaepfer: Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes . J. Biotechnol. 3 (12), 2008, pp. 1511-1520, PMID 19072907
  12. ↑ Brain pacemaker: rest at the push of a button. - Focus Online , February 19, 2008 (accessed May 27, 2012)