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Psychosurgery in the new millennium » bob

Posted by manowar on January 13, 2002, at 18:00:22

In reply to Re: Psychiatry -in its present form-SHOULD BE OUTLAWED » manowar, posted by bob on January 13, 2002, at 2:11:06

>
> > --And if a person does not get better within a certain time period, psychosurgery should become a consideration. Why mess around with the Vagus Nerve, when a Neurologist can get right to the source (brain) and plug in a pacemaker, just like they do for heart patients?
> >
> > Let’s move on, we have the technology, and we can make it happen!
> >
> > --Tim
>
> Tim:
>
> What type of psychosurgery are you suggesting, cingulotomy, or something else? What do you mean when you say we should plug a pacemaker straight into the brain?
>
> Bob
Bob, yes- cigulotomy is one—though seems to be a last resort and I don’t know how effective it is.

Electrode implants is another.

Its been a while, and being that it's Sunday and I want to watch football- I'm too lazy to try to find the articles on the electrode thing, so I'll do my best with the poor memory I have.

This may be and probably is pretty inaccurate, but here goes:

I read somewhere that way back after the James Olds findings about wire heading rats (back in the 50's), scientist and doctors began to perform psychosurgery by surgically implanting electrodes in the brains of humans. They experimented on just a few very, very ill patients (Extreme Schizophrenics, Catatonic depressives, etc...). All they did is implant an electrode to a certain area of the brain. The electrode had a wire that lead to like a nine-volt battery that the guy had in his pocket or something. The electrode automatically fired every few seconds or so, causing a cascading of neurotransmitter activity. I think there were some minor complications that were easily dealt with, but for the most part, these patients got better immediately.

I think, though, that a law was passed, outlawing this type of surgery. I guess the idea of multitudes of wire headed people repulsed enough doctors that they decided not to go down that road.

It is quite spooky, but so what if it works?

I also think that doctors can remove just a tiny bit of brain tissue, which completely relives depression. Isn't that basically what cigulotomy is?

Cigulotomy could be a very viable option for refractory depressives.

If anyone is interested in having this done, check out this website:

http://neurosurgery.mgh.harvard.edu/

Here is an article from the Harvard site:

**********************************************

Surgical intervention to treat a psychiatric illness


by G. Rees Cosgrove, M.D., F.R.C.S. (C.)
Neurosurgical Service
Massachusetts General Hospital

--------------------------------------------------------------------------------

We at the Massachusetts General Hospital perform a type of limbic system surgery called bilateral stereotactic cingulotomy. The primary indications for which this prodedure is considered is medically intractable obsessive compulsive disorder. Certain patients with chronic pain syndromes, refractory depression, and addictive disorders may also be candidates for the procedure.

Since it is our opinion that this operation is an adjunct to, but not a substitute for, ongoing psychiatric care, we require that a patient be referred by a letter from the treating psychiatrist. This letter should summarize the patient's history including the various treatments which have been tried. It should also provide evidence that (a) the patient has had all reasonable forms of non-operative treatment without benefit and (b) that the psychiatrist continue post-operative psychiatric care and supervision for as long as necessary. The patient and a close family member must give consent to the operation.

We are eager to be helpful to patients with obsessive-compulsive disorders, but it is our policy that those patients with obsessive and ritualistic behaviors have an adequate trial of exposure and response prevention behavior therapy before they are accepted for evaluation and that they are prepared to undergo similar behavioral therapy post-operatively.

A copy of the Behavior Therapy Guidelines for OCD written by Dr. Baer is available by contacting the MGH Cingulotomy Unit at the address below. If a patient has undergone such a trial, psychiatric records describing the type of therapy and the response to it should be supplied. But if the patient has not had this trial, it should be emphasized that this is an essential part of the treatment for OCD, that it has been proven to be as effective as medication and that ordinarily, both behavior therapy and medication must be used simultaneously (before operation and after operation) to help patients badly afflicted with OCD.

If you need assistance in arranging for this specific therapy, please contact the national headquarters which can be reached by writing P.O.Box 70, Milford, CT 06460 or calling 203/878-5669.

Before a patient can be considered for cingulotomy at MGH a refering physcian's form for cingulotomy needs to be completed. It can be obtained from the MGH Cingulotomy Unit at the address below. It should be returned with pertinent copies of hospital and treatment records.

After all of this necessary information is received, it will be reviewed by the MGH Cingulotomy Assessment Committee which consists of three MGH psychiatrists, two neurosurgeons and one neurologist. This Committee meets once a month, usually on the last Wednesday. The Committee may decide: 1. That the patient is a suitable candidate for cingulotomy or 2. That further information is needed to clarify the diagnosis and need for operation or 3. Additional non-operative treatment would be helpful or 4. That, regrettably, the patient is not a suitable candidate for surgery. The treating psychiatrist will be informed of the Committee's decision by one of its members.

If the patient is considered to be a possible candidate, he/she will be seen and interviewed by one psychiatrist, the two neurosurgeons and the neurologist. This evaluation is concerned with being certain about the diagnosis and that the patient and his/her family are fully informed about the risks and possible benefits of surgical intervention. On rare occasions these personal interviews yield further information that will cause the patient to be rejected for cingulotomy.

An account of our experience with stereotactic cingulotomy was published in Biological Psychiatry 1987; 22:807-819.

Referring physicians, the patient, or the patient's family should contact:

The MGH Cingulotomy Committee or
Dr. G. Rees Cosgrove for further information:
MGH Cingulotomy Committee
Neurosurgical Service--Edwards 410
Massachusetts General Hospital
Boston, MA 02114
phone: (617) 726-3407

--Tim


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