Long-Term Changes in the Personality and Psychopathological Profile of Opiate Addicts after Nucleus Accumbens Ablative Surgery Are Associated with Treatment Outcome

Abstract

Objective: To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. Methods: 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization’s Quality of Life Questionnaire – Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. Results: The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. Conclusion: The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.

Long-Term Changes in Drug Craving and Nutritional Status of Opioid Addicts with Nucleus Accumbens Ablative Stereotactic Neurosurgery at Five Years Postoperatively

“…The nonrelapse patients had good comprehensive health and returned to normal life, and were similar to normal people. However, the relapse patients were still in a state of bad health, similar to that of the nonsurgical participants [16,39]. Therefore, BMI and BF% in nonrelapse patients could be an important measure of nutritional status to offer further evidence for comprehensive health and to support our previous study.…”

Long-Term Follow-Up of MRI-Guided Bilateral Anterior Capsulotomy in Patients with Refractory Schizophrenia

“…These symptoms usually disappeared within a few weeks after the operation. However, long-term complications such as bulimia, memory loss, and personality changes are problems which cannot be ignored [45]. Although the accurate positioning before operation could decrease the complications, the exploration of precise mechanism of schizophrenia should be the key point to eliminate the complications.…”

The nucleus accumbens and alcoholism: a target for deep brain stimulation

“…Several psychological indices were also improved in those who remained abstinent. 13 Although the exact mechanism of high-frequency DBS has not been elucidated, there are several hypotheses that question whether target inhibition-in a manner similar to an ablative lesionectomy-may occur via 1) a depolarization blockade, 3 2) GABA-mediated synaptic inhibition, 10 or 3) stimulation-mediated synaptic depletion. 66 Other theories suggest that DBS desynchronizes pathological neuronal network activity.…”