Psychosurgery

Main components of psychosurgery

1. Prefrontal lobotomy
2. Stereotactic psychosurgery
3. Deep brain stimulation

Prefrontal lobotomy

Procedure involving selective destruction of fibres in the frontal lobe.

This is an area that is involved in impulse control and mood regulation its purpose was to alleviate some of the severe symptoms of mental illness however initially it was performed on patients with affective disorders and found to be ineffective especially on those with schizophrenia.

 

Prefrontal leucotomy was founded in the 1930s by Egas Moriz which involves drilling a hole on each side of the skull and inserting an instrument that resembled an ice pick to destroy the nerve fibres underneath this was then refined with the creation of the leucotome which is an instrument with a retractable wire loop that could cut into the white matter of the brain and seven nerve fibres it was thought this could relieve patients of their distressing thoughts and behaviours.

Stereotactic psychosurgery

More recently neurosurgeons have developed far more precise ways of surgically treating mental disorders such as OCD, bipolar disorder, depression and eating disorders that failed to respond to psychotherapy or other forms of treatment.

 

brain scans are now used such as MRIs to locate exact points within the brain and sever Connexions very precisely which is also done under anaesthetic

Deep brain stimulation

Surgeons thread wise through the school this is a more modern type of psychosurgery which involves no tissue destruction and is only temporary. The batteries are implanted in the patient's chest. The batteries produce an adjustable high frequency current that interrupts the brain circuitry movement and if it doesn't work it can be turned off.

Early psychosurgery (effectiveness)

* Inappropriate and ineffective
* lobotomies had a fatality rate of up to 6% and a range of physical side effects such as brain seizures and a lack of emotional responsiveness (Comer 2002)

Modern psychosurgery (effectiveness)

·      Cosgrove and Rauch (2001) reported that stereotactic surgery was effective in 56% of OCD patients and 67% in patients with major affective disorders however the authors also claim that only 25 patients a year are treated in this way in the USA

 ·      Mayberg at al (2005) found that 4/6 patients with severe depression saw striking improvements after receiving DBS

Appropriateness of psychosurgery (effectiveness)

It's limited in its use and is only used in extreme cases that have otherwise been proven untreatable.

Future directions (effectiveness)

DBS is evolving is due to the fact that this procedure can provide the researcher with information that other scanning methods can't. It can give precise information on when activity in the brain is happening and where.

Valid consent (ethics)

·      Early psychosurgery techniques were used in mental asylums and prisons on patients who had not given their valid consent

·      The ethical debate continues to this day as patients with severe depression arguably are not in the right frame of mind to be able to give fully informed consent

Irreversible damage (ethics)

·      Major concern is that the effects of psychosurgery can't be reversed, early procedures resulted in significant changes to the patients cognitive capabilities such as memory loss as well as in some cases the severe blunting of emotions

·      modern methods have reduced the risk of severe damage however procedures such as DBS still carry risks of long term side effects such as seizures and altered states of mood