Cingulotomy for Intractable Obsessive-compulsive Disorder

Lee Baer

237 citations0/0 files storedArchives of General Psychiatry

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Obsessive-Compulsive Spectrum Disorders Neurological disorders and treatments Electroconvulsive Therapy Studies

Abstract

BACKGROUND: The purpose of this study was to assess prospectively long-term change in obsessive-compulsive disorder (OCD) symptoms in patients with an OCD diagnosis that was confirmed by structured interview and with documented unsuccessful trials of multiple medications and attempts at behavior therapy. METHODS: We conducted an unblinded preoperative and follow-up assessment of comorbid diagnosis; OCD, depressive, and anxiety symptoms; and functional status in 18 patients who underwent cingulotomy. RESULTS: At a mean follow-up of 26.8 months, five patients (28%) met conservative criteria for treatment responders, and three others (17%) were partial responders. The group improved significantly in mean functional status, and few serious adverse events were found. Improvement in OCD symptoms was strongly correlated with improvement in depressive and anxiety symptoms. CONCLUSIONS: The rate of clinical improvement was consistent with a previous retrospective study in the same setting, indicating that 25% to 30% of the patients who previously were unresponsive to medication and behavioral treatments are significantly improved after cingulotomy. Cingulotomy remains a last resort treatment for severely incapacitated patients who have not responded to all other state-of-the-art pharmacological and behavioral treatments for OCD and is not to be taken lightly.

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References

1961An Inventory for Measuring Depression 1989The Yale-Brown Obsessive Compulsive Scale 1981The Sickness Impact Profile: Development and Final Revision of a Health Status Measure 1992Caudate Glucose Metabolic Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder 1994Regional Cerebral Blood Flow Measured During Symptom Provocation in Obsessive-Compulsive Disorder Using Oxygen 15—Labeled Carbon Dioxide and Positron Emission Tomography 1992Toward a Neuroanatomy of Obsessive-Compulsive Disorder 1985A Structured Interview for the DSM-III Personality Disorders 1989Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive- compulsive disorder

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