One of the most serious and difficult-to-treat conditions in child and adolescent psychiatry is self-injurious behavior (SIB). SIB can be associated with a number of psychiatric disorders, including mental retardation, schizophrenia, borderline personality disorder, pervasive developmental disorders, stereotypic movement disorder, and Tourette's Disorder. A variety of neurosurgical procedures have been used to treat both intractable SIB and severe Tourette's Disorder. Understandably, there are few reports concerning psychosurgery in children and adolescents for any condition or disorder. This report describes the use of cingulotomy and subsequent limbic leucotomy in an adolescent boy with Tourette's Disorder for SIB. His repetitive and medically serious SIB and failure of all other treatments prompted this intervention after careful, comprehensive review and discussion. Following the second surgery, the severity and frequency of his SIB were reduced.

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Treatment-resistant depression (TRD) continues to challenge current therapeutic options, especially pharmacologic treatments often used as first-line management. Thus, multimodality treatments, including neurostimulation techniques, are sought for symptom improvement. Since the first use of electroconvulsive therapy (ECT), the field of neurostimulation has strived to find treatments that improve safety, efficacy, and the side-effect profile to provide relief for patients suffering from TRD. Development in neurostimulation is spurred by ongoing innovation in technology, but also by increasing awareness that TRD frequently requires multimodal approaches for optimal symptom relief. This article reviews the most recent advances in ECT, transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) for use in TRD. ECT, TMS, and DBS are all researched in the treatment of depression, with ECT and TMS having approval from the US Food and Drug Administration, but differ widely in techniques, protocols, and patient selection parameters. ECT has the most data backing efficacy, but needs ancillary support (anesthesia, support staff) for implementation, and considerable stigma still represents an obstacle to widespread use. TMS and DBS, although less efficacious than ECT, are gaining popularity and as additional knowledge is acquired in regards to ideal use, circumstances may allow for them to become mainstream treatments for TRD in the next decade. [ Psychiatr Ann . 2016;46(4):240–246.]