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Neurosurgical treatment of anxiety disorders effective - but risky
July 19, 2006Severely ill patients with anxiety disorders or Obsessive-Compulsive Disorder undergoing neurosurgical treatment risk serious complications. The safety of the method must be carefully reconsidered. This according to the largest study made to date on the long-term effects of this surgical method.
"The frequency of adverse effects was higher than expected. Neurosurgery for mental disorders is currently gaining a lot of attention in the professional community with new ongoing trials in several countries and I think our results are another reason for caution", says psychiatrist Christian Rück at Karolinska Institutet in Sweden.
Fifty-one patients with either severe and chronic obsessive-compulsive disorder or other and anxiety disorders have been monitored for up to 23 years following capsulotomy, a neurosurgical operation which involves severing nerve fibres in the central part of the brain.
"Capsulotomy is an effective method for relieving anxiety and obsessions, and its effects remain many years after the operation," says Christian Rück, who has been carefully following up recipients of this treatment. "Many seriously troubled patients feel that the operation saved their lives. There is, however, a serious risk of side-effects."
The results of the study are to be presented in a forthcoming doctoral thesis at Karolinska Institutet. The effects of the operation were measured using questionnaires and thorough interviews with patients and their relatives. The follow-up also included neuropsychological examination and MRI examination of the brain.
One important finding is that the side-effects of the operation are more common than previously thought. Just over a third of the patients displayed signs of apathy and difficulties planning and executing activities. Some patients had developed epilepsy, disinhibition or urinary incontinence.
"There is clearly an unacceptably large risk of adverse reactions to the surgical methods that have been applied to date," says Dr Rück. "The first course of action for patients who don't respond to normal psychiatric treatment should be to use new, non-irreversible neuropsychological techniques."
Karolinska Institutet
"Capsulotomy is an effective method for relieving anxiety and obsessions, and its effects remain many years after the operation," says Christian Rück, who has been carefully following up recipients of this treatment. "Many seriously troubled patients feel that the operation saved their lives. There is, however, a serious risk of side-effects."
The results of the study are to be presented in a forthcoming doctoral thesis at Karolinska Institutet. The effects of the operation were measured using questionnaires and thorough interviews with patients and their relatives. The follow-up also included neuropsychological examination and MRI examination of the brain.
One important finding is that the side-effects of the operation are more common than previously thought. Just over a third of the patients displayed signs of apathy and difficulties planning and executing activities. Some patients had developed epilepsy, disinhibition or urinary incontinence.
"There is clearly an unacceptably large risk of adverse reactions to the surgical methods that have been applied to date," says Dr Rück. "The first course of action for patients who don't respond to normal psychiatric treatment should be to use new, non-irreversible neuropsychological techniques."
Karolinska Institutet
Anxiety Disorder Current Events and Anxiety Disorder News RSSFamily history predicts presence and course of psychiatric disorders
A family history of depression, anxiety, alcohol dependence or drug dependence is associated with the presence of each condition and also may predict its course and prognosis.
To predict the severity of mental disease, consider the family
We've all been asked at routine visits to the doctor to record our family's history with medical problems like cancer, diabetes or heart disease. But when it comes to mental disorders, usually mum's the word.
Postpartum anxiety delays puberty in offspring
Hormonal changes early in pregnancy cause maternal postpartum anxiety and behavior changes that can lead to a delayed onset of puberty in both birth and adoptive daughters, according to a new study conducted in mice.
Hopkins study: When adult patients have anxiety disorder, their children need help too
In what is believed to be the first U.S. study designed to prevent anxiety disorders in the children of anxious parents, researchers at the Johns Hopkins Children's Center have found that a family-based program reduced symptoms and the risk of developing an anxiety disorder among these children.
Medication may provide some benefit for older adults with anxiety disorder
Preliminary research suggests that use of the drug escitalopram provided some improvement in symptoms for older adults with generalized anxiety disorder, although the overall benefits were diminished because of nonadherence to the drug by some patients.
Anxious older adults may benefit from antidepressants
Many older adults worry - a lot. Almost one in 10 Americans over age 60 suffer from an anxiety disorder that causes them to worry excessively about normal things - like health, finances, disability and family.
Expectant brains help predict anxiety treatment success
A network of emotion-regulating brain regions implicated in the pathological worry that can grip patients with anxiety disorders may also be useful for predicting the benefits of treatment.
Childhood anxiety disorders can and should be treated, according to UT Southwestern national expert
Anxiety disorders in children and adolescents should be recognized and treated to prevent educational underachievement and adult substance abuse, anxiety disorders and depression, says a nationally recognized child psychiatrist from UT Southwestern Medical Center.
Siblings of mentally disabled face own lifelong challenges, according to researchers
People who have a sibling with a mental illness are more likely to suffer episodes of depression at some point in their lives, say researchers who analyzed four decades of data.
Stress-related disorders affect brain's processing of memory
Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).
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