The origins and persistence of psychosurgery in the state of Iowa

Abstract

<jats:p>Neurosurgery for the treatment of psychological disorders has a checkered history in the United States. Prior to the advent of antipsychotic medications, individuals with severe mental illness were institutionalized and subjected to extreme therapies in an attempt to palliate their symptoms. Psychiatrist Walter Freeman first introduced psychosurgery, in the form of frontal lobotomy, as an intervention that could offer some hope to those patients in whom all other treatments had failed. Since that time, however, the use of psychosurgery in the United States has waxed and waned significantly, though literature describing its use is relatively sparse. In an effort to contribute to a better understanding of the evolution of psychosurgery, the authors describe the history of psychosurgery in the state of Iowa and particularly at the University of Iowa Department of Neurosurgery. An interesting aspect of psychosurgery at the University of Iowa is that these procedures have been nearly continuously active since Freeman introduced the lobotomy in the 1930s. Frontal lobotomies and transorbital leukotomies were performed by physicians in the state mental health institutions as well as by neurosurgeons at the University of Iowa Hospitals and Clinics (formerly known as the State University of Iowa Hospital). Though the early technique of frontal lobotomy quickly fell out of favor, the use of neurosurgery to treat select cases of intractable mental illness persisted as a collaborative treatment effort between psychiatrists and neurosurgeons at Iowa. Frontal lobotomies gave way to more targeted lesions such as anterior cingulotomies and to neuromodulation through deep brain stimulation. As knowledge of brain circuits and the pathophysiology underlying mental illness continues to grow, surgical intervention for psychiatric pathologies is likely to persist as a viable treatment option for select patients at the University of Iowa and in the larger medical community.</jats:p>

History and prospects of psychosurgical interventions in the treatment of mental disorders. The arguments «pro et contra»

“…После того, как в черепе пациента было сделано отверстие над лобной долей, инструмент вводили в подкорковое белое вещество. После этого проволочная петля вытягивалась, и инструмент вращался, создавая повреждения ткани мозга [28]. перспективных нейрохирургических методов лечения психических расстройств.…”

“…Затем W. Freeman и J. Watts, заинтересовавшись работой E. Moniz, перенесли технику лейкотомии в Соединенные Штаты [28]. Именно в США позже был накоплен самый большой опыт по проведению этих операций в различных модификациях [6].…”

“…Во-первых, лоботомия подверглась профессиональной и общественной критике в связи с злоупотреблением ею, неизбирательностью применения, а также выполнением в нестерильных условиях лицами без соответствующей нейрохирургической подготовки [13,28,46]. Так, например, в некоторых психиатрических больницах наиболее частыми показаниями к лоботомии служили «непослушное» и «агрессивное» поведение, что свидетельствует о том, что операции проводились, в основном, в интересах больницы, а не пациента, с целью создания спокойствия и порядка в «непослушных» палатах [29,39].…”

“…Во-вторых, после лоботомии нередко возникали тяжелые осложнения, приводящие к инвалидизации, а в некоторых случаях и к летальному исходу [28].…”

Deep Brain Stimulation for Obsessive–Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution

“…For example, a metaanalysis performed by Brown et al showed a 37% reduction in Y-BOCs scores following cingulotomy and 57% for capsulotomy at 12 month post-procedure follow up (19). The field's apparent hesitancy to pursue surgical intervention may be due in part to the controversial use of the highly indiscriminate prefrontal lobotomy to treat psychiatric disorders in the 1940's and 1950's, and this hesitancy has persisted despite the more accurate and discriminatory cingulotomy and capsulotomy, as they are also non-reversible and destructive lesioning procedures (20,21). Advances in many areas of neurosurgery have led to the development of new, precise procedures such as radiosurgery and neurostimulation (22,23).…”