Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation

Staudt, Michael D.; Herring, Eric; Gao, Keming; Miller, Jonathan P.; Sweet, Jennifer A.

doi:10.3389/fnins.2019.00108

Cited by 58 publications

(66 citation statements)

References 91 publications

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“…Concerns about the potential cognitive effects of AC have limited its more widespread use in clinical practice 24 – 26 . These concerns may originate, in part, from the widespread mis-use and abuse of psychiatric surgery in the 1950s 27 , 28 . Despite the significant advances in the field (e.g., the advent of stereotaxy, MRI-guided targeting, and more strict ethical oversight), lesional procedures are still viewed as risky or dangerous by a substantial proportion of psychiatrists 29 and the general public 30 .…”

Section: Introductionmentioning

confidence: 99%

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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Magnetic resonance-guided focused ultrasound (MRgFUS) anterior capsulotomy is a novel treatment option for patients with refractory obsessive compulsive disorder (OCD) or major depressive disorder (MDD). However, there is concern that lesional psychiatric surgery procedures may have adverse effects on cognition. In this study, we examined whether MRgFUS capsulotomy causes cognitive decline in patients with psychiatric illness. Ten patients with refractory OCD (n = 5) or MDD (n = 5) underwent MRgFUS capsulotomy. Cognitive functioning was measured at baseline as well as 6 months and 12 months postoperatively, with a battery of neuropsychological tests assessing domains of executive function, memory, and processing speed. Scores were analyzed at the individual-level, and changes ≥2 standard deviations were considered clinically significant. We also examined whether changes in clinical symptoms were associated with changes in cognitive performance. At baseline intellectual functioning was in the average to high-average range for the group. Following MRgFUS capsulotomy, there were no deteriorations in cognition that reached ≥2 standard deviations at 6 or 12 months. Eight out of ten patients demonstrated a ≥2 standard deviation improvement in at least one cognitive score at 6 or 12 months postoperatively. Improvements in clinical symptoms correlated significantly with self-reported improvements in frontal lobe function (p < 0.05), but not with objective measures of cognitive functioning. To summarize, MRgFUS capsulotomy did not result in cognitive decline in this cohort of patients with refractory OCD or MDD, suggesting that this procedure can be offered to patients with a very low risk of cognitive side effects.

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Section: Introductionmentioning

confidence: 99%

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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“…More precisely localized regional interventions would include regional lobotomy, deep-brain stimulation of specific structures (e.g., the amygdala), and /or regional transcranial magnetic stimulation (rTMS). All have been advocated for BPSB and related psychobehaviors in the literature (43).…”

Section: Discussionmentioning

confidence: 99%

Dementia is Associated with a Syndrome of Global Neuropsychiatric Disturbance

Royall¹,

Rf²

2019

Preprint

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words) 66Objective: Global factors have been identified in measures of cognitive performance 67 (i.e., Spearman's g) and psychopathology (i.e., "General Psychopathology", "p"). 68Dementia is also strongly determined by the latent phenotype "δ", derived from g. We 69 wondered if the Behavior and Psychological Symptoms of Dementia (BPSD) might arise 70 from an association between δ and p.71 Methods: δ and p were constructed by confirmatory factor analyses in data from the 72 Alzheimer's Disease Neuroimaging Initiative (ADNI).δ and orthogonal factors 73 representing "domain-specific" variance in memory (MEM) and executive function (EF) 74 were regressed onto p and orthogonal factors representing "domain-specific" variance in 75 positive (+) and negative (-) symptoms rated by the Neuropsychiatric Inventory Nursing 76 Home Questionnaire (NPI-Q) by multiple regression in a structural equation model 77 (SAM) framework.78 Results: Model fit was excellent (CFI = 0.98, RMSEA = 0.03).δ was strongly associated 79 with p, (+) and (-) and strongly associated with p (r = -0.57, p<0.001). All three 80 associations were inverse (adverse). Independently of δ , MEM was uniquely associated 81 with (+), while ECF was associated with (-). Both associations were moderately strong. 82ECF was also weakly associated with p. 83 Conclusions: Dementia severity (δ) derived from general intelligence (g) is specifically 84 associated with general psychopathology (p). This is p's first demonstration in an elderly 85 sample and the first to distinguish the global behavioral and psychological symptoms 86 specific to dementia (BPSSD) from behavioral disturbances arising by way of non-87 dementing, albeit likely disease-specific, processes affecting domain-specific cognitive 88 and behavioral constructs. Our findings call into question the utility of proposed regional 89 interventions in BPSSD, and point to the need to explore global interventions against 90 dementia-specific behavioral features. 91 92 93 94 Introduction: 95 96 The so-called Behavioral and Psychological Symptoms of Dementia (BPSD) are a major 97 source of comorbidity and caregiver burden (1). BPSD increase exposure to 98 psychopharmacological agents and their associated adverse drug reactions (ADR) (2). 99They are a major factor in caregiver stress (3)(4), increase the risk of institutionalization 100 (5) and inflate the costs associated with dementia care (3). 102Regardless, surprisingly little is known about the biological substrates of BPSD, their 103 natural history or risk factors. It is widely assumed that BPSD arise from the regional 104 neuropathology(ies) specific to the disease(s) in which they develop. Some investigators 105 have attempted to use to BPSD to develop etiologically precise BPSD signatures. 106However, in young adults, a global "general psychpathology" factor "p" has been 107 proposed to influence all psychopathological behavioral domains (6-7) and is 108 demonstrable in a wide range of conditions (8).

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“…Beside convulsive therapies, the other treatment that was widely used to treat schizophrenia was psychosurgery. Staudt et. al.…”

Section: Psychosurgerymentioning

confidence: 99%

Schizophrenia: Epidemiology, Causes, Neurobiology, Pathophysiology, and Treatment

Volkan¹

2020

jhms

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Schizophrenia is a severe mental illness that has devastating consequences for those who suffer from the disorder. The epidemiology of schizophrenia indicates that it occurs relatively often, in many different contexts, and in conjunction with other disorders, decreasing quality of life and causing premature death. There has been an enormous amount of research into the causes of schizophrenia and there is now have a much better understanding of the genetic, environmental, and psychological factors that contribute to the disease. While there are numerous ways to understand and conceptualize schizophrenia, a unified picture of the neurobiology, changes in brain structure, cognitive and social-cognitive impairments related to the disorder has yet to emerge. Convulsive therapies and psychosurgery were used unsuccessfully, indiscriminately and without scientific validation in the past to treat schizophrenia. Medical advances including advanced imaging technology have now provided the ability to perform specifically focused neuromodulation and psychosurgery in severe and treatment resistant cases of schizophrenia. While still at a preliminary stage, these approaches have the potential to yield effective treatments in the future. For the last 70 years antipsychotic medication has become the prevailing treatment for schizophrenia. However, many people suffering from the disorder have trouble with side-effects and adhering to a regimen of antipsychotic medication. Newer pharmacological agents are being developed and include not only novel antipsychotic drugs, but anti-inflammatory and immunomodulating agents as well. These new agents, used either alone or in combination, have the potential to improve outcomes for people suffering from schizophrenia. Nevertheless, conclusively better pharmacotherapies will likely not arise until there is better understanding of the pathophysiology underlying schizophrenia. After the development of antipsychotic medication, psychotherapeutic methods for treating schizophrenia fell out of favor, but there is currently some reversal of this trend. The use of newer psychotherapies and modified forms of older therapeutic treatments are not only targeting the symptoms of schizophrenia but are also now focusing on recovery from the disorder. These newer approaches as well as efforts at preventing schizophrenia show promise in reducing the suffering caused by this disease.

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Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation

Cited by 58 publications

References 91 publications

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

Dementia is Associated with a Syndrome of Global Neuropsychiatric Disturbance

Schizophrenia: Epidemiology, Causes, Neurobiology, Pathophysiology, and Treatment

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