Psychiatry 2008 - September 2008 - (Page 32)

from treatment-resistant depression who had not responded to trials of pharmacotherapy, psychotherapy, and electroconvulsive therapy, and were implanted with bilateral DBS electrodes in the nucleus accumbens.36 Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Lastly, in a third target area, in the largest study of DBS in MDD reported to date, 15 chronically depressed patients underwent bilateral DBS implantation in the ventral internal capsule/ventral striatum (VC/VS). Responses were seen in 7/15 (47%) at six months, 5/11 (45.5%) at 12 months, and 8/15 (53.3%) at last follow-up. This was accompanied by long-term improvements in depression severity, functioning, quality of life, and shortterm memory. Safety outcomes were good with no hemorrhages, infections, or neurological deficits reported.37 REFERENCES 1. Shorter E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York, NY: John Wiley and Sons, Inc., 1997:239–287. Kopell BH, Greenberg B, Rezai AR. Deep brain stimulation for psychiatric disorders. J Clin Neurophysiol. 2004;21(1):51–67. Kramer M., The 1951 survey of the use of psychosurgery. In: Mettler FA, Overholster W (eds). Proceedings of the Third Research Conference on Psychosurgery. Washington, DC: United States Government Printing Office, 1954(USPHS publication 221):159–168. Nuttin B, Gybels J, Cosyns P, et al. Deep brain stimulation for psychiatric disorders. Neurosurg Clin N Am. 2003;14(2):xv–xvi. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. [see comment][erratum appears in Arch Gen Psychiatry. 2005;62(7):709 Note: Merikangas, Kathleen R [added]]. Arch Gen Psychiatry 2005;62(6):617–627. Eisen JL, Goodman WK, Keller MB, et al. Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. J Clin Psychiatry. 1999;60(5):346–351. Saxena S, Rauch S. Functional neuroimaging and the neuroanatomy of obsessivecompulsive disorder. Psychiatr Clin North Am. 2000;3(23):563–589. Grados MA, Riddle MA, Samuels JF, et al.The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biologic Psychiatry. 2001;50(8):559–565. Murphy ML, Pichichero ME. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A 10. 2. 11. 3. 12. 13. 4. 14. 5. 15. 16. 6. CONCLUSIONS From this overview of surgical procedures and DBS techniques for OCD and treatment-resistant depression, it is clear that although much remains unknown about the underlying neurobiology of these disorders, progress in helping the most severely afflicted is being made. Currently, large scale, multicenter, sham-controlled trials for DBS in major depression are being planned in the US. Thus, it is likely that further progress by means of functional neurosurgery approaches will be made before too long in this field. If this occurs, it will be of great benefit to the many patients suffering with OCD and MDD who have not responded to traditional treatments and remain extremely disabled by their illnesses. 17. 7. 18. 8. 19. 9. 20. streptococcal infection (PANDAS). Arch Pediatr Adolesc Med. 2002;156(4):356–361. Freud S. Two case histories: “Little Hans” and the “Rat Man.” In: Standard Edition of the Complete Works of Sigmund Freud. New York, NY: W.W. Norton & Company Ltd, 1909:pi–vi. Panksepp J. Textbook of Biological Psychiatry. Hoboken, NJ: Wiley-Liss, Inc.,2004. Saxena S, Brody AL, Schwartz JM, Baxter LR. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Supplementum. 1998;35:26–37. Rush AJ. STAR*D: what have we learned? Am J Psychiatry. 2007;164(2):201–204. Vaidya VA, Duman RS. Depresssion—emerging insights from neurobiology. Br Med Bull. 2001;57:61–79. Mayberg HS. Positron emission tomography imaging in depression: a neural systems perspective. Neuroimag Clin North Am. 2003;13(4):805–815. Lipsman N, Neimat JS, Lozano AM. Deep brain stimulation for treatment-refractory obsessivecompulsive disorder: the search for a valid target. Neurosurgery. 2007;61(1):1–11. Jenike MA, Baer L, Ballantine T, et al. Cingulotomy for refractory obsessive-compulsive disorder. A long-term follow-up of 33 patients. [see comment]. Arch Gen Psychiatry. 1991;48(6)548–555. Dougherty DD, Baer L, Cosgrove GR, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessivecompulsive disorder. Am J Psychiatry. 2002;159(2):269–275. Jung HH, Kim CH, Chang JH, et al. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotact Function Neurosurg. 2006;84(4):184–189. Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin North Am. 32 Psychiatry 2008 [SEPTEMBER]

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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