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Stip E, Javaid SF, Abdel Aziz K, Arnone D. Happy Birthday "One Flew Over the Cuckoo's Nest": A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:887-893. [PMID: 37424267 PMCID: PMC10657581 DOI: 10.1177/07067437231182658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.
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Affiliation(s)
- E. Stip
- Université de Montréal, Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - S. F. Javaid
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - K. Abdel Aziz
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - D. Arnone
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Rizvi A, Shaan F, Husain K, Reyazuddin M, Anjum N. High-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) in the First Episode of Catatonia: A Series of Four Cases. Cureus 2023; 15:e49112. [PMID: 38125235 PMCID: PMC10732329 DOI: 10.7759/cureus.49112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Four patients with benzodiazepine non-responsive catatonia were administered repetitive transcranial magnetic stimulation (rTMS) at the left dorsolateral prefrontal cortex at 120% of resting motor threshold, frequency of 10Hz, with a total of 3,000 pulses/session. Patients with mood disorders showed good responses. One patient with chronic resistant schizophrenia had worsening catatonic symptoms during rTMS that responded to electroconvulsive therapy. Maximum response was observed between sessions 8 and 12.
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Affiliation(s)
- Abid Rizvi
- Psychiatry and Behavioral Sciences, West Virginia University, Morgantown, USA
| | - Faisal Shaan
- Psychiatry, Jawaharlal Nehru Medical College, Aligarh, IND
| | - Karrar Husain
- Psychiatry, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Nayab Anjum
- Psychiatry, Jawaharlal Nehru Medical College, Aligarh, IND
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Liu XF, Zhao SW, Kratochvil Z, Jiang JC, Cui D, Wang L, Fan JW, Gu YW, Yin H, Cui JJ, Chang X, Cui LB. Affected cortico-striatal-cerebellar network in schizophrenia with catatonia revealed by magnetic resonance imaging: indications for electroconvulsive therapy and repetitive transcranial magnetic stimulation. PSYCHORADIOLOGY 2023; 3:kkad019. [PMID: 38666113 PMCID: PMC10917379 DOI: 10.1093/psyrad/kkad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 04/28/2024]
Abstract
Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders, including schizophrenia. Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood. However, emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia, which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Xiao-Fan Liu
- Department of Radiology, Xi'an Gaoxin Hospital, Xi'an 710075, China
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Shu-Wan Zhao
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | | | - Jia-Cheng Jiang
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Di Cui
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Lu Wang
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Jing-Wen Fan
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Yue-Wen Gu
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Hong Yin
- Department of Radiology, Xi'an People's Hospital, Xi'an 710004, China
| | - Jin-Jin Cui
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao Chang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Long-Biao Cui
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an 710032, China
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an 710061, China
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Xiao H, Meng Y, Liu S, Cao Y, Sun H, Deng G, Wang M, Zheng Y, Qiu C. Non-invasive brain stimulation for treating catatonia: a systematic review. Front Psychiatry 2023; 14:1135583. [PMID: 37260758 PMCID: PMC10227525 DOI: 10.3389/fpsyt.2023.1135583] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023] Open
Abstract
Background Non-invasive brain stimulation (NIBS) techniques offer new therapeutic options for modifying pathological neuroplasticity and have been proven to be beneficial in the treatment of neuropsychiatric disorders. Objective This study aimed to investigate the role of NIBS in treating catatonia. Materials and methods We conducted a systematic search to identify meta-analyses or systematic reviews on electroconvulsive therapy (ECT) and studies on the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on patients with catatonia from the PubMed, Web of Science, Embase, China National Knowledge Internet, Wanfang, and China Science and Technology Journal databases from inception until 31 July 2022. The methodological quality of the included studies was assessed with the AMSTAR2 or Joanna Briggs Institute Critical Appraisal tools. Paired t-tests and Wilcoxon signed-rank tests were used to compare changes in catatonia symptom scores after rTMS or tDCS. Results A total of 13 systematic reviews and one meta-analysis on ECT, two systematic reviews and 12 case reports on rTMS, and seven studies of 14 cases applying tDCS were identified. Systematic reviews of ECT consistently described improvement in catatonia symptoms across catatonia types and patient age groups. After treatment with rTMS (t = 4.489, p = 0.006) and tDCS (z = -3.065, p = 0.002), patients exhibited significant improvement. Conclusion ECT, rTMS, and tDCS were effective in treating catatonia. Early intervention with NIBS techniques may help improve catatonia symptoms in patients with schizophrenia. It may be advantageous to use rTMS or tDCS to maintain this improvement. NIBS techniques may thus represent a promising treatment for catatonia, but additional high-quality randomized controlled trials are needed.
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Affiliation(s)
- Hongqi Xiao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Shiyu Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yuan Cao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Huan Sun
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Gaoju Deng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Mei Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yaozong Zheng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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Invasive cortical stimulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:23-45. [PMID: 34446248 DOI: 10.1016/bs.irn.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The field of neuromodulation, at its essence, aims to apply electrical stimulation to the brain to ameliorate various pathology. Many methods of applying this stimulation exist, including invasive and non-invasive means. In the realm of invasive stimulation, stimulation of the cortex remains one of the earliest techniques investigated, yet one of the most underutilized today. Evidence for the efficacy of direct invasive cortical stimulation continues to mount, especially in recent years. In this chapter we will review the evidence for the use of invasive cortical stimulation as it applies to neuropathic pain, epilepsy, psychiatric disease, movement disorders, tinnitus, and post-stroke recovery, as well explore some potential mechanisms and future directions of the technique.
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Hansbauer M, Wagner E, Strube W, Röh A, Padberg F, Keeser D, Falkai P, Hasan A. rTMS and tDCS for the treatment of catatonia: A systematic review. Schizophr Res 2020; 222:73-78. [PMID: 32600779 DOI: 10.1016/j.schres.2020.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Catatonia is a potentially life threatening syndrome in various psychiatric disorders. As first line treatment, benzodiazepines and electroconvulsive therapy (ECT) are recommended. In some cases, benzodiazepines are ineffective and ECT is not available or contraindicated. Therefore, the search for new and alternative treatment strategies is of great importance. OBJECTIVE To review the evidence for alternative neurostimulation treatment strategies (rTMS and tDCS) for catatonia according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. METHOD We performed a systematic literature search in several electronic databases. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and the ClinicalTrials.gov database to detect registered studies. RESULTS We identified nine publications on rTMS treatment and four publications on tDCS in catatonia. Most of the publications reported clinically relevant improvement of catatonic symptoms. Only two publications reported insufficient improvement. The available Bush-Francis Catatonia Rating Scale scores showed statistical significant improvement following rTMS and tDCS. We could not identify any finished clinical studies or case series, dedicated to this topic. We also could not identify any publications that compared first line treatment options with rTMS or tDCS. CONCLUSIONS Based on the case report literature, rTMS and tDCS might be promising alternative treatment strategies for patients who do not respond to benzodiazepines or in case ECT is not available or contraindicated. There are even hints that rTMS or tDCS might be an option in patients who respond to ECT but need long-term treatment to control catatonic symptoms. Further clinical trials are needed to allow for an evidence-based evaluation of potential risks and benefits of rTMS and tDCS for catatonia.
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Affiliation(s)
- Maximilian Hansbauer
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany.
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Medical Faculty, Augsburg, Germany
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