Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T16:55:37.411Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychosurgery: Stereotactic Subcaudate Tractotomy

An Indispensable Treatment

Published online by Cambridge University Press:  02 January 2018

P. K. Bridges ,
J. R. Bartlett ,
A. S. Hale ,
A. M. Poynton ,
A. L. Malizia  and
A. D. Hodgkiss
P. K. Bridges*
Affiliation:
UMDS, Guy's Hospital and Geoffrey Knight Unit, London
J. R. Bartlett
Affiliation:
SE Thames Regional Neurosurgical Centre and Geoffrey Knight Unit
A. S. Hale
Affiliation:
UMDS, St Thomas's Hospital, London
A. M. Poynton
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
A. L. Malizia
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
A. D. Hodgkiss
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
*
Dr P. K. Bridges, The Geoffrey Knight National Unit for Affective Disorders, Brook General Hospital, Shooters Hill Road, Woolwich, London SE18 4LW
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.

Method

Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.

Results

ST allows 40–60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% postoperatively, from 15% in cases of uncontrolled affective disorders is seen.

Conclusion

As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 5 , November 1994 , pp. 599 - 611
Copyright
Copyright © Royal College of Psychiatrists, 1994 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballantine, H. T., Bouckoms, J., Thomas, E. K., et al (1987) Treatment of psychiatric illness by stereotactic cingulotomy. Biological Psychiatry, 22, 807–819.Google Scholar
Bartlett, J. R., Bridges, P. K. & Kelly, D. (1981) Contemporary indications for psychosurgery. British Journal of Psychiatry; 38, 507–511.Google Scholar
Berrios, G. E. (1991) Psychosurgery in Britain and elsewhere: a conceptual history. In 150 years of British Psychiatry 1841–1991 (eds Berrios, G. E. and Freeman, H.), pp. 180–196. London: Gaskell.Google Scholar
Barker, W. A., Scott, J. & Eccleston, D. (1987) The Newcastle Chronic Depression Study: results of a treatment regime. International Clinical Psychopharmacology, 2, 261–272.Google Scholar
Bridges, P. K. (1972) Psychosurgery today: psychiatric aspects. Proceedings of Royal Society of Medicine, 65, 1104–1108.CrossRefGoogle ScholarPubMed
Bridges, P. K. (1983). … and a small dose of antidepressant might help. British Journal of Psychiatry, 142, 626–628.CrossRefGoogle Scholar
Bridges, P. K. (1984a) Psychiatry for all. Journal of the Royal Society of Medicine, 77, 911–914.CrossRefGoogle Scholar
Bridges, P. K. (1984b) Psychosurgery and the Mental Health Act Commission. Psychiatric Bulletin, 8, 146–148.CrossRefGoogle Scholar
Bridges, P. K. (1984c) Addendum to Psychosurgery and the Mental Health Act Commission. Psychiatric Bulletin, 8, 172.Google Scholar
Bridges, P. K. (1985) The Mental Health Act Commission and Second Opinions. Psychiatric Bulletin, 9, 120.Google Scholar
Bridges, P. K. (1989a) Psychosurgery, the Mental Health Act Commission and the Law. Psychiatric Bulletin, 13, 375–377.CrossRefGoogle Scholar
Bridges, P. K. (1989b) What's so special about two years anyway? British Journal of Psychiatry, 154, 884–885.Google Scholar
Bridges, P. K. (1992) Is psychosurgery safer than Section 57? Psychiatric Bulletin, 16, 510.CrossRefGoogle Scholar
Bridges, P. K. & Bartlett, J. R. (1977) Psychosurgery: Yesterday and Today. British Journal of Psychiatry, 131, 249–260.Google Scholar
Bridges, P. K. & Bartlett, J. R. (1985) Indications for psychosurgery: some theoretical aspects. In Psychiatry: the state of the art (eds Pichot, P., Berner, P., Wolf, R., et al), pp. 931–933. New York: Plenum.Google Scholar
Colville, (Lord) (1985) The Mental Health Act Commission and Second Opinions. Psychiatric Bulletin, 9, 2–3.Google Scholar
Cox, A. W. & Brown, M. H. (1975) Results of multi-target limbic surgery in the treatment of schizophrenia and aggressive states. In Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy (eds Sweet, W., Obrador, S. & Martin-Rodriguez, J. G.), pp. 469–479. Baltimore: University Park Press.Google Scholar
curson, D. A., Trauer, T., Bridges, P. K., et al (1983) Assessment of outcome after psychosurgery using the Present State Examination. British Journal of Psychiatry, 143, 118–123.Google Scholar
Damasio, A. R. (1975) Egas Moniz, Pioneer of Angiography and Leucotomy. The Mount Sinai Journal of Medicine, 42, 502–513.Google Scholar
Damasio, A. R. (1985) The Frontal Lobes. In Clinical Neuropsychology, 2nd edn (eds Halman, K. M. & Waterstein, E.). Oxford: Oxford University Press.Google Scholar
Delgado, P. L., Price, L. H., Heminger, G. R., et al (1992) Neurochemistry. In Handbook of Affective Disorders, 2nd edn (ed. Paykel, E. S.), pp. 219–253. Edinburgh: Churchill Livingstone.Google Scholar
Dieckmann, G. & Hassler, R. (1977) Treatment of Sexual Violence by Stereotactic Hypothalamotomy. In Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy (eds Sweet, W., Obrador, S. & Martin-Rodriguez, J. G.), pp. 451–462. Baltimore: University Park Press.Google Scholar
Dyer, C. (1988) Mental Health Commission defeated over paedophile. British Medical Journal, 296, 1660–1661 Google Scholar
Evans, B. M., Bridges, P. K. & Bartlett, J. R. (1981) Electroencephalographic changes as prognostic indicators after psychosurgery. Journal of Neurology, Neurosurgery and Psychiatry, 44, 444–447.Google Scholar
Freeman, W. & Watts, J. W. (1947) Retrograde degeneration of the thalamus following prefrontal lobotomy. Journal of Comparative Neurology, 86, 65–93.CrossRefGoogle ScholarPubMed
Freeman, W. & Watts, J. W. (1950) Psychosurgery, 2nd edn. Springfield, Illinois: Charles C. Thomas.Google Scholar
Gelder, M., Gath, D. & Mayou, R. (1989) Oxford Textbook of Psychiatry, p. 629. Oxford: Oxford University Press.Google Scholar
Gitlin, M. J. & Gerner, R. H. (1986) The dexamethasone suppression test and response to somatic treatment: a review. Journal of Clinical Psychiatry, 47, 16–21.Google Scholar
Goktepe, E. O., Young, L. B. & Bridges, P. K. (1975) A further review of the results of stereotactic subcaudate tractotomy. British Journal of Psychiatry, 126, 270–280.CrossRefGoogle Scholar
Guze, S. B. & Robins, E. (1970) Suicide and primary affective disorders. British Journal of Psychiatry, 117, 437–438.CrossRefGoogle ScholarPubMed
Hale, A. S., Proctor, A. & Bridges, P. K. (1987) Clomipramine, tryptophan and lithium in combination for resistant depression: seven case studies. British Journal of Psychiatry, 151, 213–217.Google Scholar
Hale, A. S., Sandler, M., Hannah, P., et al (1989) Tyramine conjugation test for prediction of treatment response in depressed patients. Lancet, 1, 234–236.CrossRefGoogle ScholarPubMed
Hansen, H., Andersen, R., Theilegaard, A., et al (1982) Stereotactic psychosurgery. Acta Psychiatrica Scandinavica, (suppl.) 66, 301.Google Scholar
Heath, R. G. (1977) Modulation of emotion with a brain pacemaker. Journal of Nervous and Mental Disease, 165, 300–317.CrossRefGoogle Scholar
Hodgkiss, A. D., Malizia, A. L., Bartlett, J. R., et al (1994) Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy 1979–1991. Journal of Neuropsychiatry (in press).Google Scholar
Honig, A., Bridges, P. K. & Bartlett, J. R. (1987) The stalemate position. International Journal of Social Psychiatry, 33, 195–203.Google Scholar
Kartsounis, L. D., Poynton, A., Bridges, P. K., et al (1991) Neuropsychological correlates of stereotactic subcaudate tractotomy. Brain, 114, 2657–2673.Google Scholar
Kelly, D., Richardson, A. & Mitchell-Heggs, N. (1973) Stereotactic limbic tractotomy: neurophysiological aspects and operative technique. British Journal of Psychiatry, 123, 133–140.Google Scholar
Kelly, D., Richardson, A. & Mitchell-Heggs, N. (1980) Anxiety and Emotions. Springfield, Ill.: Charles C. Thomas.Google Scholar
Kendell, R. E. & Zealley, A. K. (1988) Companion to Psychiatric Studies (4th edn), p. 723. Edinburgh: Churchill Livingstone.Google Scholar
Kiloh, L. G., Guy, R. G., Rushworth, D. S., et al (1974) Stereotactic amygdaloidotomy for aggressive behaviour. Journal of Neurology, Neurosurgery, and Psychiatry, 37, 437–444.CrossRefGoogle ScholarPubMed
Kiloh, L. G., Smith, J. S. & Johnson, G. F. (1988) Physical Treatments in Psychiatry. Oxford: Blackwell Scientific.Google Scholar
Kleinig, J. (1985) Ethical Issues in Psychosurgery. London: Allen & Unwin.Google Scholar
Knight, G. (1965) Stereotactic tractotomy in the surgical treatment of mental illness. Journal of Neurology and Psychiatry, 28, 304–310.Google Scholar
Knight, G. (1969a) Stereotactic surgery for the relief of suicidal and severe depression and intractable psychoneurosis. Postgraduate Medical Journal, 45, 1–13.CrossRefGoogle Scholar
Knight, G. (1969b) Bi-frontal stereotactic tractotomy: An atraumatic operation of value in the treatment of intractable psychoneurosis. British Journal of Psychiatry, 115, 257–266.CrossRefGoogle Scholar
Knight, G. (1973) Further observations from an experience of 660 cases of stereotactic tractotomy. Postgraduate Medical Journal, 49, 845–854.CrossRefGoogle ScholarPubMed
Laing, R. D. (1965) The Divided Self. Harmondsworth: Pelican.Google Scholar
Lovett, L. M. & Shaw, D. M. (1987) Outcome in bipolar affective disorder after stereotactic tractotomy. British Journal of Psychiatry, 151, 113–116.Google Scholar
Knight, G., Crimmins, R. & Shaw, D. M. (1989) Outcome in unipolar affective disorder after stereotactic tractotomy. British Journal of Psychiatry, 155, 547–550.Google Scholar
Malizia, A. L., Hale, A. S., Hannah, P., et al (1990) Tyramine sulphate excretion as a predictor of outcome in stereotactic subcaudate tractotomy. Journal of Psychopharmacology, 4, 273.Google Scholar
Mitchell-Heggs, N., Kelly, D. & Richardson, A. (1976) Stereotactic limbic leucotomy – a follow-up at 16 months. British Journal of Psychiatry, 128, 226–240.CrossRefGoogle Scholar
Newcombe, R. (1975) The lesion in stereotactic subcaudate tractotomy. British Journal of Psychiatry, 126, 478–481.Google Scholar
O'Callaghan, M. A. J. & Carrol, D. (1982) Psychosurgery: A Scientific Analysis. Lancaster: MTP Press.Google Scholar
Poynton, A. M. (1990) Psychosurgery in the eighties: a description of referrals for stereotactic tractotomy 1981–85 and a comparison between operated and non-operated patients. M.Phil. thesis, University of London.Google Scholar
Poynton, A. M., Bridges, P. K. & Bartlett, J. R. (1988a) Psychosurgery in Britain now. British Journal of Neurosurgery, 2, 297–306.Google Scholar
Poynton, A. M., Bridges, P. K. & Bartlett, J. R. (1988b) Resistant bipolar affective disorder treated by stereotactic subcaudate tractotomy. British Journal of Psychiatry, 152, 354–358.Google Scholar
Quaade, F. (1974) Stereotaxy for obesity. Lancet, 1, 267.Google Scholar
Quitkin, F. M. (1985) The importance of dose in prescribing antidepressants. British Journal of Psychiatry, 147, 593–597.CrossRefGoogle ScholarPubMed
Rawnsley, K. (1982) The Mental Health (Amendment) Act: A Sting in the Tail. Psychiatric Bulletin, 6, 375–384.Google Scholar
Roeder, F., Orthner, H. & Muller, D. (1972) The stereotactic treatment of paedophilic homosexuality and other sexual deviations. In Psychosurgery (eds Hitchcock, E., Louitinen, L. & Vaernet, K.). Springfield, Ill.: Charles E. Thomas.Google Scholar
Snaith, R. P., Ahmed, S. N., Mehta, S., et al (1971) Assessment of the severity of primary depressive illness. Psychological Medicine, 1, 143–149.Google Scholar
Snaith, R. P., Price, D. J. E. & Wright, J. F. (1984) Psychiatrist's attitudes to psychosurgery. British Journal of Psychiatry, 144, 293–297.Google Scholar
Strom-Olsen, R. & Carlisle, S. (1971) Bi-frontal stereotactic tractotomy. British Journal of Psychiatry, 118, 141–154.Google Scholar
Szasz, T. (1960) The myth of mental illness. American Psychologist, 15, 113–118.Google Scholar
Taylor, J. A. (1955) A personality scale of manifest anxiety. Journal of Abnormal and Social Psychiatry, 48, 285–290.CrossRefGoogle Scholar
Taylor, D. C. & Falconer, M. A. (1968) Clinical socioeconomic and psychological changes after temporal lobectomy for epilepsy. British Journal of Psychiatry, 114, 1247–1261.Google Scholar
Tooth, G. C. & Newton, M. P. (1961) Leucotomy in England and Wales 1942–54. Reports on Public Health and Medical Subjects No. 104. London: HMSO.Google Scholar
Valenstein, E. S. (1986) Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (Chapter 2). New York: Basic Books.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
World Health Organization (1976) Health Aspects of Human Rights. Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.