Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
Highlights
Psychosurgery was developed from the need to manage patients affected by untreatable mental pathologies
The denomination relies on the fact that such structures can be targeted together with the same stereotactic trajectory; this region has been stimulated for obsessive-compulsive disorders (OCDs) in one study that pointed out the anti-anxiety and antidepressant effect of VC/VS deep-brain stimulation (DBS) [40]; Malone and co-workers reported a 53% response rate at 12 months in 17 major depressive disorder (MDD) patients after VC/VS DBS [41]
Despite the efficacy of DBS and other instrumental therapeutics not yet being established for some psychiatric disorders, there are several premises for the future applications of “unclassical” treatments in psychiatry
Summary
Psychosurgery was developed from the need to manage patients affected by untreatable mental pathologies. The history of neurosurgical treatment for psychiatric disorders started in 1935, when Antonio Moniz, a Portuguese neurologist, proposed the prefrontal leucotomy to section the white matter connections between the prefrontal cortex and the thalamus. For such research, he received the Nobel Prize in 1949 [1]. Functional surgery based on deep-brain stimulation (DBS) was first tried, in patients with psychiatric disorders, more than sixty years ago [4]. The target is drawn on stereotactic MRI images; multiple and gradual sessions of US administration are performed, to reach lesional temperatures (at least 53 ◦ C) with a variable amount of energy requirement (20.000–40.000 J)
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