Psychosurgery Reduces Uncertainty and Increases Free Will? A Review

Ridder, Dirk De; Vanneste, Sven; Gillett, Grant; Manning, Patrick J.; Glue, Paul; Langguth, Berthold

doi:10.1111/ner.12405

Cited by 60 publications

(25 citation statements)

References 154 publications

(234 reference statements)

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“…Uncertainty is defined as a state in which a given representation of the world cannot be adopted to guide subsequent belief53 and can be reduced by acquiring more information from the environment51 or by drawing on memory54. The rostral to dorsal anterior cingulate cortex has a role in acquiring new data in an attempt to reduce uncertainty5556. It is therefore unsurprising that our results indicate that activity in the anterior cingulate region correlates with withdrawal, which will trigger an urge for action, encoded by the dorsal anterior cingulate cortex and insula57.…”

Section: Discussionmentioning

confidence: 99%

“…Another conceptual way of looking at this is that the self-referential posterior cingulate cortex communicates with the dorsal anterior cingulate cortex, involved in acquiring more input, and the pregenual anterior cingulate cortex, involved in suppressing more, and that the reference resetting in the posterior cingulate cortex controls the balance between input gathering and input suppression55. Therefore, the functional connectivity between these 3 areas was analyzed.…”

Section: Discussionmentioning

confidence: 99%

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Allostasis in health and food addiction

Ridder

Manning

Leong

et al. 2016

Sci Rep

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Homeostasis is the basis of modern medicine and allostasis, a further elaboration of homeostasis, has been defined as stability through change, which was later modified to predictive reference resetting. It has been suggested that pleasure is related to salience (behavioral relevance), and withdrawal has been linked to allostasis in addictive types. The question arises how the clinical and neural signatures of pleasure, salience, allostasis and withdrawal relate, both in a non-addicted and addicted state. Resting state EEGs were performed in 66 people, involving a food-addicted obese group, a non-food addicted obese group and a lean control group. Correlation analyses were performed on behavioral data, and correlation, comparative and conjunction analyses were performed to extract electrophysiological relationships between pleasure, salience, allostasis and withdrawal. Pleasure/liking seems to be the phenomenological expression that enough salient stimuli are obtained, and withdrawal can be seen as a motivational incentive because due to allostatic reference resetting, more stimuli are required. In addition, in contrast to non-addiction, a pathological, non-adaptive salience attached to food results in withdrawal mediated through persistent allostatic reference resetting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Allostasis in health and food addiction

Ridder

Manning

Leong

et al. 2016

Sci Rep

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“…The authors mention that moving the electrode trajectory somewhat more ventrally in the anterior internal capsule might explain some of their better success rate than a previous study, but this argument can be questioned. It has been argued that the three commonly used targets for psychosurgery, cingulotomy, anterior capsulotomy, subcaudate tractotomy, as well as limbic leucotomy (combination of cingulotomy and subcaudate tractotomy) all exert their effect by a final common pathway, involving the pregenual anterior cingulate cortex (7). Anatomically, this convergence may derive from the superolateral branch of the medial forebrain bundle, a structure that connects these frontal areas to the origin of the mesolimbic dopaminergic 'reward' system in the midbrain ventral tegmental area, and a target for the treatment of depression that up to now has yielded the highest success rate (86%) (8).…”

mentioning

confidence: 99%

“…Hence, the results of psychosurgery can be improved in at least three ways: (I) more individualized targeting; (II) better stimulation designs; and (III) more physiological stimulation (7). A first improvement can be based on finding better targets, depending on assumed different subtypes of depression.…”

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confidence: 99%

Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: possibilities, limits and future perspectives

Ridder

Vanneste

Langguth

2017

Annals of Translational Medicine

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The authors of this study (1), who have a strong tradition of well-designed studies treating mental disorders by deep brain stimulation (DBS) attempt to find out whether the beneficial effects of DBS of the ventral part of the anterior limb of the internal capsule (vALIC) for treatment resistant depression (TRD) are due to placebo or a real effect.The authors' approach was to start with an openlabel phase lasting one year during which the stimulation parameters (active contact, amplitude, stimulation frequency, and pulse width) were optimized, i.e., individually adjusted to the patient. After this period both responders (n=9) and non-responders (n=7) were randomized in a double blinded fashion to sham-real or real-sham stimulation, as to verify whether the effects obtained in the open label phase were due to placebo or not. The open label phase showed that DBS of the vALIC resulted in >50% improvement on HADS-17 in 40% of patients, and the double-blind placebo phase demonstrated that this effect was very likely a real effect due to the DBS and not due to placebo. Beyond the demonstration of the efficacy of DBS of the vALIC for TRD, the study illustrates the feasibility of appropriate placebo-controlled study designs for the evaluation of DBS in psychiatric disorders. Moreover, this study raises some interesting questions that go beyond the intent of the study and are relevant for DBS in general, irrespective of the indication.First of all, DBS or brain stimulation in general seems to be able to benefit patients with mental or brain disorders who cannot be helped with any other treatment, and this warrants its further use, albeit that it comes at a risk. The patients who enrol in brain implant studies are very sick and often very desperate people who commonly enrol as a last resort, which makes them extremely vulnerable to negative outcomes. This is clearly demonstrated by the fact that two patients who felt they did not benefit from the DBS ended their lives (one suicide, one euthanasia), but also that there were four more suicide attempts in the nonresponder group and two patients with suicide ideation. It is unclear whether this high rate of suicide/suicide attempt is due to the severity of the depression of these participants, the hopelessness of ever improving "if even brain surgery doesn't help", or whether it is DBS-induced. It might therefore be of interest to compare this suicide or suicide attempt rate to a clinically similar group of patients who are not treated by DBS.The 40% responder rate is similar to other DBS studies for TRD, as the authors mention, but interestingly and intriguingly, 30-50% response rates are also similar to outcomes in brain stimulation for other indications as shown by meta-analyses or case series for pain, tinnitus,

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“…Much progress has been made in the world in understanding the reasons for the prevalence of drug abuse. Addiction potential is an inner state, in which a person has a high level of willingness for addiction (3,4).…”

Section: Introductionmentioning

confidence: 99%

Parental Bonding and Academic Burnout on Addiction Potential Among Students

Ziari

Mirmohammadkhani

Vafaei

et al. 2017

Middle East J Rehabil Health Stud

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Background: The risk of drug abuse during youth and adolescence depends on the individual's family structure. Parents' interaction methods and parenting styles are an important part of the social context. Since the interaction between parents and children has a great influence on students' addiction, this study was conducted to assess the relationship between parental bonding and academic burnout with addiction potential among students studying in Semnan University of Medical Sciences. Methods: This study was a cross sectional descriptive analytical study conducted on 245 students studying in Semnan University of Medical Sciences (2014 -2015) using the valid Pierson's questionnaire about parental bonding, school burnout, and addiction potential. The scores of addiction potential, school-burnout, and parental child bonding were obtained. The correlation and multiple regression models were then investigated.

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Psychosurgery Reduces Uncertainty and Increases Free Will? A Review

Cited by 60 publications

References 154 publications

Allostasis in health and food addiction

Allostasis in health and food addiction

Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: possibilities, limits and future perspectives

Parental Bonding and Academic Burnout on Addiction Potential Among Students

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