Have you ever wondered why certain treatment methods are more appropriate for certain situations when compared with others? Since treatment within psychology is so varied, different types of it are based on different assumptions. Considering the biological approach, think of the brain and the nervous system; since they work together to produce our thoughts, feelings and reactions, would it not be suitable to have some methods of treatment that tackle these biological aspects, such as psychosurgery?
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Jetzt kostenlos anmeldenHave you ever wondered why certain treatment methods are more appropriate for certain situations when compared with others? Since treatment within psychology is so varied, different types of it are based on different assumptions. Considering the biological approach, think of the brain and the nervous system; since they work together to produce our thoughts, feelings and reactions, would it not be suitable to have some methods of treatment that tackle these biological aspects, such as psychosurgery?
As the name suggests, the biological approach to treatment only considers the biological factors that can contribute to mental illness and aims to tackle these at their root, thereby hoping to treat the illness under question. This is based on three assumptions, which we'll briefly discuss below.
Psychosurgery involves brain surgery to treat mental disorders such as obsessive-compulsive disorder (OCD), schizophrenia and depression. It is a collaboration between psychiatrists and neurosurgeons.
Psychosurgery aims to remove the connections in the brain areas responsible for symptoms and reflects the medical model of mental health, which assumes that mental illness has physical causes. As a result, there are both benefits of psychosurgery and psychosurgery side effects.
Let's take a look at some common types of psychosurgery used today. Modern psychosurgery usually targets the brain's limbic system (which controls emotions) and uses heat to burn away small brain tissue in brain regions.
The common procedures are anterior capsulotomy, anterior cingulotomy, subcaudal tractotomy, and limbic leucotomy. Another type of procedure is deep brain stimulation; this procedure does not remove brain tissue but uses electrical pulses to simulate different brain areas.
An anterior capsulotomy is most commonly used to treat OCD. Radiofrequency heat lesions or gamma radiation are used to burn away connections and create a lesion in the anterior portion of the inner brain capsule.
The inner brain capsule is a brain communication pathway. Nearly all the information relayed in and out of the cerebral cortex passes through this pathway,
The anterior capsulotomy is effective in approximately 50% of patients who show a reduction in OCD symptoms (Brown et al., 2016¹; Rück et al., 2008²). The possible side effects of this procedure are weight gain, problems with executive function, apathy and disinhibition issues (Rück et al., 2008²).
Subcaudate tractotomy is used to treat anxiety, depression, and OCD. The procedure targets and destroys a small portion of the white matter tracts (white matter consists of axons that transmit signals in the brain) under and in front of the caudate nucleus (responsible for goal-directed action).
Bridges et al. (1994)3 conducted a study in which 40–60% of patients who underwent subcaudal tractotomy could potentially live normal lives afterwards if they continued to take medication.
Limbic leucotomy is used as an intervention for OCD and depression. It is a combination of anterior cingulotomy and subcaudal tractotomy. It is usually used when a patient does not respond to cingulotomy. Lai et al. (2020) performed a systematic review and meta-analysis and found that the response rate for limbal leucotomy was 47%.4
Side effects of limbic leucotomy psychosurgery are short-term and include transient hallucinations, amnesia and mania (Sinha et al., 2015).5
Deep brain stimulation is a procedure that uses electrical impulses to simulate different areas of the brain. These electrical impulses regulate abnormal brain activity and balance chemical imbalances. This stimulation is done with a neurostimulator device, which sends electrical impulses to electrodes placed in the brain. The neurostimulator is placed in the person's chest and connected to the electrodes via wires.
Deep brain stimulation can be used to treat movement disorders such as the symptoms of Parkinson's disease. It is also used to treat OCD.
Before deep brain stimulation is used, MRI scans are performed to determine where to place the electrodes.
Deep brain stimulation requires a surgical procedure in which the neurostimulator is implanted under the skin in the chest area.
In addition, small holes must be drilled in the skull to implant the electrodes. From this, you can see this is a very invasive treatment.
A meta-analysis by Alonso et al. (2015)6 found that patients' scores on the Yale-Brown Obsessive-Compulsive Scale improved by 45.1%, and 60% of patients responded to treatment.
Anterior cingulotomy is usually used to treat obsessive-compulsive disorder (OCD) and sometimes as a treatment for depression. The procedure is performed with a laser system or thermal energy to create a tiny lesion in the anterior cingulate gyrus.
The anterior cingulate gyrus controls cognitive functions such as impulse control, emotion regulation, and decision-making.
Sheth et al. (2013)7 found at the first follow-up (average 10.7 months after the procedure) that 35% of patients had a complete response to the treatment of OCD symptoms. At the final follow-up, depression severity had also decreased in 17% of patients. The possible side effects associated with this procedure are headaches, nausea, vomiting and seizures (Agarwal et al., 2016)8.
Let's now evaluate the process of psychosurgery and discuss its strengths, weaknesses and possible side effects.
In the same way we, as individuals, have evolved over the years, methods of treatment have as well; psychosurgery is no different. The strengths of psychosurgery have mainly been observed in the modern-day treatment method.
Even though there is now a rise and advancement in psychotherapy methods, many individuals don't respond to these. For those with treatment-resistant OCD, anterior cingulotomy can be effective. Sheth et al. (2013)7 found that up to 70% patients that suffered from treatment-resistant OCD benefitted in some way from the anterior cingulotomy procedure.
In the same way, Brown et al. (2016)1 found that the procedure of an anterior capsulotomy reduced symptoms of more than half the patients with OCD that did not respond to other traditional methods.
A study conducted in 1975 examined 208 patients who underwent a subcaudate tractotomy; it was found that almost two-thirds of the patients that suffered from anxiety or depression showed improvement, as did 50% of patients diagnosed with OCD.9
Further, research on limbic leucotomy psychosurgery has shown a 73% improvement rate in individuals suffering from major depressive disorder (MDD) and OCD who initially underwent the anterior cingulotomy procedure but did not respond.10
We have discussed the success rates of psychosurgery in patients with treatment-resistant mental illnesses and seen that it does, in fact, improve symptoms. However, as with any treatment method, it does not come without its own weaknesses, the most common of which are the side effects associated with these procedures.
Surgery is complicated in any area of the body, but more so in the brain. A complication could arise that can be dealt with at the moment, but whether or not it will have a lasting impact on the patient can only be found once the patient is awake and responsive.
Psychosurgery does not account for other factors, such as childhood events or environmental factors that may contribute to mental health. Therefore, the intervention can be argued as reductionist.
Reductionist approaches are argued to over-simplify a phenomenon by reducing a complex phenomenon to one component whilst ignoring other factors that may be contributors.
In addition, psychodynamic psychologists argue that biological interventions simply mask the problem instead of getting rid of the root problem; in theory, it's argued this makes relapse more likely.
Let's look at some of the side effects that can arise from psychosurgery and, more specifically, deep brain stimulation.
Let's look at some of the side effects that can arise from psychosurgery and deep brain stimulation.
The different types of psychosurgery are associated with the following side effects.
Brain haemorrhage, stroke, infection, breathing problems, nausea, heart problems, seizures, pain and swelling at the site where the electrodes were implanted, etc.
Similarly, there are serious side effects associated with deep brain stimulation.
Some side effects are feelings of numbness or tingling, muscle tightness in the face or arm, problems with speech or balance, mood swings, visual issues, lightheadedness, etc.
Keeping the complex nature of this procedure in mind, the recovery process is a slow and lengthy one - the effects of the surgery are mainly seen up to 12 months after it was originally performed.
Psychosurgery is brain surgery to treat mental disorders such as schizophrenia and depression. Psychosurgery aims to remove the connections in the brain's areas responsible for the symptoms.
Psychosurgery is still used today, but only as a last-resort treatment when all other methods have failed.
Psychosurgery is a collaborative brain surgery effort between psychiatrists and neurosurgeons. The procedure involves removing or destroying small parts of the brain that are contributing to adverse symptoms.
One of the psychosurgery procedures used today is anterior capsulotomy. It involves using high-frequency heat lesions or gamma radiation to burn away connections in the anterior part of the brain's internal capsule.
The benefit of psychosurgery is it can relieve symptoms in patients for whom other treatments have not worked.
However, psychosurgery also has side effects such as weight gain, problems with executive function, apathy, disinhibition, headaches, nausea, vomiting, and seizures.
What is psychosurgery?
Psychosurgery involves brain surgery to treat mental disorders such as schizophrenia and depression.
What is the reasoning behind psychosurgery?
Removing the connections in areas of the brain responsible for symptoms.
What are the assumptions made under the biological approach to treatment?
Evolutionary influences, localisation of brain function and neurotransmitters.
How is deep brain stimulation different from the other methods of psychosurgery?
It does not remove brain tissue but uses electrical pulses to simulate different areas of the brain.
When is psychosurgery used today?
Psychosurgery is only used as a last avenue of treatment when all others have failed.
What part of the brain does modern psychosurgery usually target?
The limbic system, which is involved in controlling our emotions.
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