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Tripathi M, Reddy SC, Singh S, Mahajan S. Psychosurgery in Indian Scenario: Time to Think with Phronesis. Neurol India 2024; 72:388-390. [PMID: 38817176 DOI: 10.4103/neuroindia.ni_1160_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/12/2021] [Indexed: 06/01/2024]
Abstract
With advances in technology, neurosurgical procedures are being examined for potential use in psychiatric conditions. However, the use of neurosurgical procedures in psychiatry carries the baggage of memories of psychosurgery. Different neurosurgical techniques carry their characteristic safety, efficacy, and complication profile. The introduction of deep brain stimulation has generated a new interest in surgical treatment with a distinct advantage over lesioning procedures used in the past. In such a scenario, it is essential that an informed discussion takes place regarding the use of these neurosurgical procedures in psychiatric disorders such that patient safety, informed consent, regulatory requirements, and research are taken care of.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sai Chaitanya Reddy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubhmohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smriti Mahajan
- Department of Psychiatry, Government Medical College, Chandigarh, India
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2
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Transcranial Direct Current Stimulation (tDCS) in Pediatric Populations—– Voices from Typically Developing Children and Adolescents and their Parents. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies.
Methods
An interview study with typically developing minors (n = 19, mean age 13,66 years) participating in a tDCS study, and their parents (n = 18) was conducted to explore their views and experiences and inform the ethical analysis.
Results
Children (10–13 years old) and adolescents (14–18 years old) reported good experiences with the stimulation. Next to financial incentives, main motives to participate in the study were curiosity and the possibility to help develop treatments for children affected by neurological disorders. They could also see a potential of using tDCS in a non-medical setting, especially regarding the provision of equal opportunity, e.g. in education. Parents also presented a positive attitude towards tDCS and their children participation in the basic research study. Nevertheless, their understanding of tDCS was rather poor. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Parents were also cautious about using tDCS for non-medical/enhancement purposes.
Conclusions
The study findings show a need for more transparent information about the state of the art of tDCS, its function and what it might be able to offer, especially considering the good acceptability of tDCS.
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Becker CR, Milad MR. Contemporary Approaches Toward Neuromodulation of Fear Extinction and Its Underlying Neural Circuits. Curr Top Behav Neurosci 2023; 64:353-387. [PMID: 37658219 DOI: 10.1007/7854_2023_442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.
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Affiliation(s)
- Claudia R Becker
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
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Yuen J, Rusheen AE, Price JB, Barath AS, Shin H, Kouzani AZ, Berk M, Blaha CD, Lee KH, Oh Y. Biomarkers for Deep Brain Stimulation in Animal Models of Depression. Neuromodulation 2022; 25:161-170. [PMID: 35125135 PMCID: PMC8655028 DOI: 10.1111/ner.13483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Despite recent advances in depression treatment, many patients still do not respond to serial conventional therapies and are considered "treatment resistant." Deep brain stimulation (DBS) has therapeutic potential in this context. This comprehensive review of recent studies of DBS for depression in animal models identifies potential biomarkers for improving therapeutic efficacy and predictability of conventional DBS to aid future development of closed-loop control of DBS systems. MATERIALS AND METHODS A systematic search was performed in Pubmed, EMBASE, and Cochrane Review using relevant keywords. Overall, 56 animal studies satisfied the inclusion criteria. RESULTS Outcomes were divided into biochemical/physiological, electrophysiological, and behavioral categories. Promising biomarkers include biochemical assays (in particular, microdialysis and electrochemical measurements), which provide real-time results in awake animals. Electrophysiological tests, showing changes at both the target site and downstream structures, also revealed characteristic changes at several anatomic targets (such as the medial prefrontal cortex and locus coeruleus). However, the substantial range of models and DBS targets limits the ability to draw generalizable conclusions in animal behavioral models. CONCLUSIONS Overall, DBS is a promising therapeutic modality for treatment-resistant depression. Different outcomes have been used to assess its efficacy in animal studies. From the review, electrophysiological and biochemical markers appear to offer the greatest potential as biomarkers for depression. However, to develop closed-loop DBS for depression, additional preclinical and clinical studies with a focus on identifying reliable, safe, and effective biomarkers are warranted.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA
| | - J. Blair Price
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Transcranial direct-current stimulation and pediatric attention deficit hyperactivity disorder (ADHD)-Findings from an interview ethics study with children, adolescents, and their parents. PROGRESS IN BRAIN RESEARCH 2021; 264:363-386. [PMID: 34167663 DOI: 10.1016/bs.pbr.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) is a brain stimulation technique for an alternative or complementary treatment for various neurological disorders, including pediatric ADHD. However, little is known about the experiences of participants undergoing tDCS treatments in clinical trials. Exploration of their views on the matter is an important contribution to the societal debate on ethical issues of tDCS, allowing for a responsible translation into clinical practice and timely identification of potential challenges. METHODS in-depth interviews study with children with ADHD undertaking tDCS and their parents (n=32). RESULTS Children reported overall good experiences with the stimulation, although they found participation in the clinical study very tiring and time consuming. Their responses to the actual effects of the stimulation were mixed. Parents were very keen for their children to participate in the study as they saw it as a promising and safe alternative to medication. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Unlike children, interviewed parents were cautious about using tDCS for non-medical/enhancement purposes. DISCUSSION There is a need for more transparent information about the state of the art of tDCS, its function and what it actually might be able to offer. It is especially important in order to prevent unrealistic hopes and to make sure that future pediatric patients and their carers are more aware of the potential side-effects and long-term effects of tDCS.
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Ma X, Li R. Case Report: Effect of Electroconvulsive Therapy on Obsessive-Compulsive Disorder Comorbid With Body Dysmorphic Disorder. Front Psychiatry 2021; 12:706506. [PMID: 34408682 PMCID: PMC8365030 DOI: 10.3389/fpsyt.2021.706506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition that is associated with considerable morbidity, and ~90% of individuals with OCD have another psychiatric comorbidity. Patients with comorbid OCD and body dysmorphic disorder (BDD) have limited insight and poor psychosocial function, respond poorly to drug treatment, and have an increased risk of suicide. Modified electroconvulsive therapy (ECT) has been attempted to improve symptoms of OCD when drug treatment does not have a satisfactory effect. This report describes a patient who had OCD comorbid with BDD that was successfully treated with modified ECT. Although the mechanism of its effect is unclear, modified ECT may be an alternative treatment for patients with comorbid OCD and BDD. Its efficacy and mechanism of action require further investigation in a large sample of patients with these comorbid disorders.
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Affiliation(s)
- Xiaoyan Ma
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Ranli Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
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Azriel A, Farrand S, Di Biase M, Zalesky A, Lui E, Desmond P, Evans A, Awad M, Moscovici S, Velakoulis D, Bittar RG. Tractography-Guided Deep Brain Stimulation of the Anteromedial Globus Pallidus Internus for Refractory Obsessive-Compulsive Disorder: Case Report. Neurosurgery 2020; 86:E558-E563. [PMID: 31313803 DOI: 10.1093/neuros/nyz285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy. CLINICAL PRESENTATION We present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSION The amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.
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Affiliation(s)
- Amit Azriel
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Maria Di Biase
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Elaine Lui
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Mohammed Awad
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Samuel Moscovici
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Richard G Bittar
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Deakin University, Victoria, Australia.,Precision Brain Spine and Pain Centre, Kew, Victoria, Australia
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Sierawska A, Prehn-Kristensen A, Moliadze V, Krauel K, Nowak R, Freitag CM, Siniatchkin M, Buyx A. Unmet Needs in Children With Attention Deficit Hyperactivity Disorder-Can Transcranial Direct Current Stimulation Fill the Gap? Promises and Ethical Challenges. Front Psychiatry 2019; 10:334. [PMID: 31156480 PMCID: PMC6531921 DOI: 10.3389/fpsyt.2019.00334] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/29/2019] [Indexed: 12/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.
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Affiliation(s)
- Anna Sierawska
- Division of Biomedical Ethics, Institute of Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | | | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Clinic for Child and Adolescent Psychiatry and Psychotherapy, Medical Center Bethel, Bielefeld, Germany
| | - Alena Buyx
- Institute for History and Ethics in Medicine Medical School, Technical University of Munich, Munich, Germany
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Tastevin M, Spatola G, Régis J, Lançon C, Richieri R. Deep brain stimulation in the treatment of obsessive-compulsive disorder: current perspectives. Neuropsychiatr Dis Treat 2019; 15:1259-1272. [PMID: 31190832 PMCID: PMC6526924 DOI: 10.2147/ndt.s178207] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
Deep brain stimulation (DBS) is a neuro-psychosurgical technique widely accepted in movement disorders, such as Parkinson's disease. Since 1999, DBS has been explored for severe, chronic and treatment-refractory psychiatric diseases. Our review focuses on DBS in obsessive-compulsive disorder (OCD), considered as a last treatment resort by most of learned societies in psychiatry. Two main stimulation areas have been studied: the striatal region and the subthalamic nucleus. But, most of the trials are open-labeled, and the rare controlled ones have failed to highlight the most efficient target. The recent perspectives are otherwise encouraging. Indeed, clinicians are currently considering other promising targets. A case series of 2 patients reported a decrease in OCD symptoms after DBS in the medial forebrain bundle and an open-label study is exploring bilateral habenula stimulation. New response criteria are also investigating such as quality of life, or subjective and lived-experience. Moreover, first papers about cost-effectiveness which is an important criterion in decision making, have been published. The effectiveness of tractography-assisted DBS or micro-assisted DBS is studying with the aim to improve targeting precision. In addition, a trial involving rechargeable pacemakers is undergoing because this mechanism could be efficient and have a positive impact on cost-effectiveness. A recent trial has discussed the possibility of using combined cognitive behavioral therapy (CBT) and DBS as an augmentation strategy. Finally, based on RDoc Research, the latest hypotheses about the understanding of cortico-striato-thalamo-cortical circuits could offer new directions including clinical predictors and biomarkers to perform adaptive closed-loop systems in the next future.
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Affiliation(s)
- Maud Tastevin
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Institut de Neurosciences des Systèmes, Aix Marseille University, Inserm UMR1106, France
| | - Jean Régis
- Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Institut de Neurosciences des Systèmes, Aix Marseille University, Inserm UMR1106, France
| | - Christophe Lançon
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Faculté des Sciences de Saint Jérôme, Aix Marseille University, Institut Fresnel - UMR 7249, Marseille, France
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10
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DeYoung CG, Krueger RF. Understanding Psychopathology: Cybernetics and Psychology on the Boundary between Order and Chaos. PSYCHOLOGICAL INQUIRY 2018. [DOI: 10.1080/1047840x.2018.1513690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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11
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Oñate-Cadena N, Cisneros-Otero M, Ruiz-Chow ÁA, Arellano-Reynoso A, Kobayashi-Romero LF, Pérez-Esparza R. Deep-brain stimulation in treatment-resistant obsessive-compulsive disorder: Clinical and molecular neuroimaging correlation. ACTA ACUST UNITED AC 2018; 49:62-65. [PMID: 32081211 DOI: 10.1016/j.rcp.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in cortico-striato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. METHODS Case report. CASE PRESENTATION A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. CONCLUSIONS Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures.
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Affiliation(s)
- Nelcy Oñate-Cadena
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Marcela Cisneros-Otero
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Ángel Alberto Ruiz-Chow
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Alfonso Arellano-Reynoso
- Departamento de Neurocirugía, Programa de Neurocirugía Funcional, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Luis Fabian Kobayashi-Romero
- Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Rodrigo Pérez-Esparza
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México; Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México.
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12
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Reduction of Artifacts Caused by Deep Brain Stimulating Electrodes in Cranial Computed Tomography Imaging by Means of Virtual Monoenergetic Images, Metal Artifact Reduction Algorithms, and Their Combination. Invest Radiol 2018; 53:424-431. [DOI: 10.1097/rli.0000000000000460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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13
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Farrand S, Evans AH, Mangelsdorf S, Loi SM, Mocellin R, Borham A, Bevilacqua J, Blair-West S, Walterfang MA, Bittar RG, Velakoulis D. Deep brain stimulation for severe treatment-resistant obsessive-compulsive disorder: An open-label case series. Aust N Z J Psychiatry 2018; 52:699-708. [PMID: 28965430 DOI: 10.1177/0004867417731819] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Deep brain stimulation can be of benefit in carefully selected patients with severe intractable obsessive-compulsive disorder. The aim of this paper is to describe the outcomes of the first seven deep brain stimulation procedures for obsessive-compulsive disorder undertaken at the Neuropsychiatry Unit, Royal Melbourne Hospital. The primary objective was to assess the response to deep brain stimulation treatment utilising the Yale-Brown Obsessive Compulsive Scale as a measure of symptom severity. Secondary objectives include assessment of depression and anxiety, as well as socio-occupational functioning. METHODS Patients with severe obsessive-compulsive disorder were referred by their treating psychiatrist for assessment of their suitability for deep brain stimulation. Following successful application to the Psychosurgery Review Board, patients proceeded to have deep brain stimulation electrodes implanted in either bilateral nucleus accumbens or bed nucleus of stria terminalis. Clinical assessment and symptom rating scales were undertaken pre- and post-operatively at 6- to 8-week intervals. Rating scales used included the Yale-Brown Obsessive Compulsive Scale, Obsessive Compulsive Inventory, Depression Anxiety Stress Scale and Social and Occupational Functioning Assessment Scale. RESULTS Seven patients referred from four states across Australia underwent deep brain stimulation surgery and were followed for a mean of 31 months (range, 8-54 months). The sample included four females and three males, with a mean age of 46 years (range, 37-59 years) and mean duration of obsessive-compulsive disorder of 25 years (range, 15-38 years) at the time of surgery. The time from first assessment to surgery was on average 18 months. All patients showed improvement on symptom severity rating scales. Three patients showed a full response, defined as greater than 35% improvement in Yale-Brown Obsessive Compulsive Scale score, with the remaining showing responses between 7% and 20%. CONCLUSION Deep brain stimulation was an effective treatment for obsessive-compulsive disorder in these highly selected patients. The extent of the response to deep brain stimulation varied between patients, as well as during the course of treatment for each patient. The results of this series are comparable with the literature, as well as having similar efficacy to ablative psychosurgery techniques such as capsulotomy and cingulotomy. Deep brain stimulation provides advantages over lesional psychosurgery but is more expensive and requires significant multidisciplinary input at all stages, pre- and post-operatively, ideally within a specialised tertiary clinical and/or academic centre. Ongoing research is required to better understand the neurobiological basis for obsessive-compulsive disorder and how this can be manipulated with deep brain stimulation to further improve the efficacy of this emerging treatment.
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Affiliation(s)
- Sarah Farrand
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrew H Evans
- 2 Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Simone Mangelsdorf
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Samantha M Loi
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ramon Mocellin
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - JoAnne Bevilacqua
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Mark A Walterfang
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Richard G Bittar
- 5 Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia.,6 Deakin University, Victoria, Australia.,7 Precision Brain Spine and Pain Centre, Victoria, Australia
| | - Dennis Velakoulis
- 1 Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
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14
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Bosanac P, Hamilton BE, Lucak J, Castle D. Identity challenges and 'burden of normality' after DBS for severe OCD: a narrative case study. BMC Psychiatry 2018; 18:186. [PMID: 29895269 PMCID: PMC5998583 DOI: 10.1186/s12888-018-1771-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deep Brain Stimulation (DBS) is an emerging and potentially powerful biological treatment for severe Obsessive-Compulsive Disorder (OCD), but the wider impact of the intervention and the sometimes dramatic reduction in symptoms need greater attention in research and practice. The aim of this case study is to explore the subjective experience of preparing for and undergoing DBS as a treatment for severe and treatment-refractory OCD and the experience of the impact of the treatment. METHODS This study of subjective experience before and after DBS is based on narrative analysis of two in-depth interviews conducted in November 2014 (1 year after DBS surgery) with a 30-year-old man and his father, utilizing Consolidated Criteria for Reporting Qualitative Studies (COREQ) criteria. RESULTS The parallel stories show how OCD posed severe challenges to identity and social milestones, with profound positive and negative impact on the person and family. Yet symptom remission was accompanied by expanded horizons, but also by uncertainty and intense distress associated with the changed identity. DISCUSSION The concept of 'burden of normality' is discussed, in light of a treatment experience with DBS for OCD that gives rise to a new array of life challenges and opportunities, with implications for clinical care. CONCLUSIONS The concept of burden of normality has, thus far, not extended to evaluations of people who have had DBS for severe OCD and that of their lived experience and recovery trajectory thereafter. This concept highlights that there is work to be done on expectations of normal living and on the transitioning self-concept, in the post-surgical period.
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Affiliation(s)
- Peter Bosanac
- St. Vincent's Hospital, Melbourne and Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | | | - James Lucak
- 0000 0000 8606 2560grid.413105.2St Vincent’s Hospital, Melbourne, Australia
| | - David Castle
- 0000 0001 2179 088Xgrid.1008.9St. Vincent’s Hospital, Melbourne and Department of Psychiatry, University of Melbourne, Melbourne, Australia
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15
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Kisely S, Li A, Warren N, Siskind D. A systematic review and meta-analysis of deep brain stimulation for depression. Depress Anxiety 2018; 35:468-480. [PMID: 29697875 DOI: 10.1002/da.22746] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers. METHOD We performed a systematic review and meta-analysis on the effectiveness of deep brain stimulation (DBS) in depression. Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System, and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, crossover, and parallel-group trials in which DBS was compared with sham treatment using validated scales. RESULTS Ten papers from nine studies met inclusion criteria, all but two of which were double-blinded RCTs. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 190 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (OR = 5.50; 95% CI = 2.79, 10.85; p < .0001) and reductions in mean depression score (SMD = -0.42; 95% CI = -0.72, -0.12; p = .006). However, the effect was attenuated on some of the subgroup and sensitivity analyses, and there were no differences for most other outcomes. In addition, 84 participants experienced a total of 131 serious adverse effects, although not all could be directly associated with the device or surgery. Finally, publication bias was possible. CONCLUSIONS DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.
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Affiliation(s)
- Steve Kisely
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia.,Griffith Institute of Health, Griffith University, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - Amy Li
- The University of Queensland Southern Clinical School, Queensland, Australia
| | - Nicola Warren
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
| | - Dan Siskind
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
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16
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Coles AS, Kozak K, George TP. A review of brain stimulation methods to treat substance use disorders. Am J Addict 2018; 27:71-91. [PMID: 29457674 DOI: 10.1111/ajad.12674] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/26/2017] [Accepted: 12/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are a leading cause of disability worldwide. While several pharmacological and behavioral treatments for SUDs are available, these may not be effective for all patients. Recent studies using non-invasive neuromodulation techniques including Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Deep Brain Stimulation (DBS) have shown promise for SUD treatment. OBJECTIVE Multiple studies were evaluated investigating the therapeutic potential of non-invasive brain stimulation techniques in treatment of SUDs. METHOD Through literature searches (eg, PubMed, Google Scholar), 60 studies (2000-2017) were identified examining the effect of rTMS, tDCS, or DBS on cravings and consumption of SUDs, including tobacco, alcohol, cannabis, opioids, and stimulants. RESULTS rTMS and tDCS demonstrated decreases in drug craving and consumption, while early studies with DBS suggest similar results. Results are most encouraging when stimulation is targeted to the Dorsolateral Prefrontal Cortex (DLPFC). CONCLUSIONS Short-term treatment with rTMS and tDCS may have beneficial effects on drug craving and consumption. Future studies should focus on extending therapeutic benefits by increasing stimulation frequency and duration of treatment. SCIENTIFIC SIGNIFICANCE The utility of these methods in SUD treatment and prevention are unclear, and warrants further study using randomized, controlled designs. (Am J Addict 2018;27:71-91).
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Affiliation(s)
- Alexandria S Coles
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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17
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Richieri R, Borius PY, Cermolacce M, Millet B, Lançon C, Régis J. A Case of Recovery After Delayed Intracranial Hemorrhage After Deep Brain Stimulation for Treatment-Resistant Depression. Biol Psychiatry 2018; 83:e11-e13. [PMID: 28527567 DOI: 10.1016/j.biopsych.2017.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Raphaëlle Richieri
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France.
| | - Pierre-Yves Borius
- Department of Neurosurgery, Pitié-Salpétrière University Hospital, Public Assistance Paris Hospitals, Paris, France
| | - Michel Cermolacce
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France
| | - Bruno Millet
- Department of Psychiatry, Pitié-Salpétrière University Hospital, Public Assistance Paris Hospitals, Paris, France
| | - Christophe Lançon
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France
| | - Jean Régis
- Department of Neurosurgery, La Timone Hospital, Public Assistance Marseille Hospitals, Marseille, France; Institut de Neurosciences des Systèmes, Institut National de la Santé et de la Recherche Médicale UMR 1106, Aix Marseille University, Marseille, France
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18
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Müller O, Rotter S. Neurotechnology: Current Developments and Ethical Issues. Front Syst Neurosci 2017; 11:93. [PMID: 29326561 PMCID: PMC5733340 DOI: 10.3389/fnsys.2017.00093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Oliver Müller
- BrainLinks-BrainTools, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Stefan Rotter
- BrainLinks-BrainTools, Albert Ludwigs University of Freiburg, Freiburg, Germany
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19
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Batra V, Tran TLN, Caputo J, Guerin GF, Goeders NE, Wilden J. Intermittent bilateral deep brain stimulation of the nucleus accumbens shell reduces intravenous methamphetamine intake and seeking in Wistar rats. J Neurosurg 2016; 126:1339-1350. [PMID: 27392268 DOI: 10.3171/2016.4.jns152524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE There is increasing interest in neuromodulation for addiction. Methamphetamine abuse is a global health epidemic with no proven treatment. The objective of this study was to examine the effects of intermittent nucleus accumbens shell (AcbSh) deep brain stimulation (DBS) on operant methamphetamine intake and on methamphetamine seeking when stimulation is delivered in an environment different from that of drug use. METHODS Eighteen rats were implanted with intravenous (IV) catheters and bilateral AcbSh electrodes and subsequently underwent daily sessions in 2-lever (active/methamphetamine and inactive/no reward) operant chambers to establish IV methamphetamine self-administration. After stable responding was achieved, 3 hours of DBS or sham treatment was administered (sham: 0 µA, n = 8; active: 200 µA, n = 10) in a separate nondrug environment prior to the daily operant sessions for 5 consecutive days. Immediately following each DBS/sham treatment, rats were placed in the operant chambers to examine the effects of remote stimulation on methamphetamine intake. After the 5 days of therapy were finished, rats reestablished a posttreatment baseline, followed by extinction training, abstinence, and 1 day of relapse testing to assess methamphetamine-seeking behavior. RESULTS There was a decrease in total methamphetamine intake in rats receiving active DBS versus sham on Days 1 (42%) and 2 (44%). Methamphetamine administration returned to baseline levels following the cessation of DBS therapy. Compared with baseline drug responding, methamphetamine seeking was reduced (57%) in the DBS group but not in the sham group. CONCLUSIONS It is feasible to deliver noncontinuous DBS outside of the drug use environment with a resultant decrease in IV methamphetamine intake and seeking. The AcbSh is a neuroanatomical substrate for psychostimulant reinforcement and may be a target for intermittent neuromodulatory therapies that could be administered during brief periods of sobriety.
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Affiliation(s)
| | - Thanh Lam N Tran
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Jessica Caputo
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Glenn F Guerin
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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20
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Richieri R, Borius PY, Lagrange G, Faget-Agius C, Guedj E, Mc Gonigal A, Régis JM, Lançon C, Bartolomei F. Unmasking Partial Seizure after Deep Brain Stimulation for Treatment-Resistant Depression: A Case Report. Brain Stimul 2016; 9:636-8. [PMID: 27255545 DOI: 10.1016/j.brs.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/30/2023] Open
Affiliation(s)
- Raphaëlle Richieri
- Department of Psychiatry, Addictology and Child Psychiatry. Assistance Publique des Hôpitaux de Marseille, La Conception University Hospital, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France.
| | - Pierre Yves Borius
- Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, France; Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France
| | - Guillaume Lagrange
- Department of Psychiatry, Addictology and Child Psychiatry. Assistance Publique des Hôpitaux de Marseille, La Conception University Hospital, France
| | - Catherine Faget-Agius
- Department of Psychiatry, Addictology and Child Psychiatry. Assistance Publique des Hôpitaux de Marseille, La Conception University Hospital, France
| | - Eric Guedj
- Biophysics and Nuclear Medicine Department, Timone University Hospital, Marseille, France; Aix-Marseille University, CERIMED, Marseille, France; Aix-Marseille University, CNRS, UMR7289, INT, Marseille, France
| | - Aileen Mc Gonigal
- Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France; Clinical Neurophysiology Department, Timone University Hospital, Marseille, France
| | - Jean Marie Régis
- Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, France; Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France
| | - Christophe Lançon
- Department of Psychiatry, Addictology and Child Psychiatry. Assistance Publique des Hôpitaux de Marseille, La Conception University Hospital, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France; Clinical Neurophysiology Department, Timone University Hospital, Marseille, France
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21
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The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects. CNS Drugs 2016; 30:419-42. [PMID: 27106297 PMCID: PMC4873415 DOI: 10.1007/s40263-016-0335-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since AN came to greater public recognition in the 1960s, including a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning, and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for AN is imperative as it continues to be a complex psychiatric disorder with high disease burden and mortality.
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23
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Affiliation(s)
- Paul B Fitzgerald
- Monash University Central Clinical School and Alfred Health, Monash Alfred Psychiatry Research Centre, Melbourne VIC, Australia
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