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Psychosurgical Treatment of Obsessivecompulsive Disorder-Reply

Psychosurgical Treatment of Obsessivecompulsive Disorder-Reply Abstract In Reply.— It is reassuring that Sach- dev and colleagues found rates of improvement similar to those in our group. We agree that face-to-face interviews are best to evaluate how patients are doing after psychosurgery, but unfortunately, almost all of the patients we were able to follow up lived great distances from our institution, and such contact was not feasible.We also agree that MRI confirmation of lesion location is of utmost importance, and we now use MRI to confirm the location of the probe before making the lesion, a technique that allows for precise localization of the lesions. We also have found that by using older techniques, some of the lesions may well have missed the cingulate bundle and that sometimes the cingulate gyrus and corpus callosum were affected.Caution is necessary in evaluating neuropsychologic assessments like the Wisconsin Card Sorting Test since the patients referred for psychosurgery are likely References 1. Swedo SE, Shapiro MB, Grady CL, Cheslow KL, Leonard HL, Kumar A, Friedland R, Rapoport SI, Rapoport JL. Cerebral glucose metabolism in childhood-onset obsessivecompulsive disorder . Arch Gen Psychiatry . 1989;46:518-523.Crossref 2. Baxter LR, Phelps ME, Mazziotta JC, Guze BH, Schwartz JM, Selin LE. Local cerebral glucose metabolic rates in obsessivecompulsive disorder . Arch Gen Psychiatry . 1987;44:211-218.Crossref 3. Nordahl TE, Benkelfat C, Semple WE, Gross M, King AC, Cohen RM. Cerebral glucose metabolic rates in obsessive-compulsive disorder . Neuropsychopharmacology . 1989;2:23-28.Crossref 4. Mindus P, Nyman H, Mogard J, Meyerson BA, Ericson K. Orbital and caudate glucose metabolism studied by PET in patients undergoing capsulotomy for OCD . In: Jenike MA, Asberg M, eds. Understanding Obsessive-Compulsive Disorder . E Toronto, Ontario: Hogrefe & Huber Publishers; 1991: 52-57. 5. Martinot JL, Allilaire JF, Mazoyer BM, Hantouche E, Huret JD, Legaut-Demare F, Deslauriers AG, Hardy P, Pappata S, Baron JC, Syrota A. OCD: a clinical, neuropsychological and PET study . Acta Psychiatr Scand . 1990; 82:233-242.Crossref 6. Mindus P, Nyman H. Normalization of personality characteristics in patients with incapacitating anxiety disorders after capsulotomy . Acta Psychiatr Scand . 1991;83: 283-291.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Psychosurgical Treatment of Obsessivecompulsive Disorder-Reply

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References (6)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1992.01820070077015
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply.— It is reassuring that Sach- dev and colleagues found rates of improvement similar to those in our group. We agree that face-to-face interviews are best to evaluate how patients are doing after psychosurgery, but unfortunately, almost all of the patients we were able to follow up lived great distances from our institution, and such contact was not feasible.We also agree that MRI confirmation of lesion location is of utmost importance, and we now use MRI to confirm the location of the probe before making the lesion, a technique that allows for precise localization of the lesions. We also have found that by using older techniques, some of the lesions may well have missed the cingulate bundle and that sometimes the cingulate gyrus and corpus callosum were affected.Caution is necessary in evaluating neuropsychologic assessments like the Wisconsin Card Sorting Test since the patients referred for psychosurgery are likely References 1. Swedo SE, Shapiro MB, Grady CL, Cheslow KL, Leonard HL, Kumar A, Friedland R, Rapoport SI, Rapoport JL. Cerebral glucose metabolism in childhood-onset obsessivecompulsive disorder . Arch Gen Psychiatry . 1989;46:518-523.Crossref 2. Baxter LR, Phelps ME, Mazziotta JC, Guze BH, Schwartz JM, Selin LE. Local cerebral glucose metabolic rates in obsessivecompulsive disorder . Arch Gen Psychiatry . 1987;44:211-218.Crossref 3. Nordahl TE, Benkelfat C, Semple WE, Gross M, King AC, Cohen RM. Cerebral glucose metabolic rates in obsessive-compulsive disorder . Neuropsychopharmacology . 1989;2:23-28.Crossref 4. Mindus P, Nyman H, Mogard J, Meyerson BA, Ericson K. Orbital and caudate glucose metabolism studied by PET in patients undergoing capsulotomy for OCD . In: Jenike MA, Asberg M, eds. Understanding Obsessive-Compulsive Disorder . E Toronto, Ontario: Hogrefe & Huber Publishers; 1991: 52-57. 5. Martinot JL, Allilaire JF, Mazoyer BM, Hantouche E, Huret JD, Legaut-Demare F, Deslauriers AG, Hardy P, Pappata S, Baron JC, Syrota A. OCD: a clinical, neuropsychological and PET study . Acta Psychiatr Scand . 1990; 82:233-242.Crossref 6. Mindus P, Nyman H. Normalization of personality characteristics in patients with incapacitating anxiety disorders after capsulotomy . Acta Psychiatr Scand . 1991;83: 283-291.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jul 1, 1992

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