Treatment of obsessive‐compulsive disorder by psychosurgery

P. Hay, P. Sachdev*, S. Cumming, J. S. Smith, T. Lee, P. Kitchener, J. Matheson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

89 Citations (Scopus)

Abstract

We report a longitudinal study of 26 patients with medically intractable obsessive‐compulsive disorder (OCD) who were treated with psychosurgery and had a comprehensive follow‐up for a mean 10 years. Seventeen patients had combined orbitomedial and cingulate lesions, 6 cingulate lesions only and 3 orbitomedial lesions only. Eighteen patients were interviewed personally and lesions verified on magnetic resonance imaging scans in fourteen. On a 6‐point global rating scale, 10 (38%) patients had obvious improvement, another 6 (23%) showed mild improvement of doubtful clinical value, and the remaining 10 showed either no change (n= 6; 23%) or were judged to be worse (n= 4; 15%). Both obsessive and compulsive symptoms improved, and this change was independent of the changes in anxiety and depression scores. No significant predictors of improvement were identified. Patients with cingulate lesions only fared worse. Eight patients who had a second operation did not show much improvement. A comparison of a subgroup of patients with 10 matched nonsurgical OCD controls supported the contention that the improvement in OCD was attributable to the psychosurgery. Important adverse effects in the stereotactic surgery group (n= 20) were epilepsy (1 patient) and personality change (2 patients). The psychosurgery group performed relatively poorly on the Wisconsin Card Sort Test but did not show any deterioration in Wechsler Intelligence and Memory scores.

Original languageEnglish
Pages (from-to)197-207
Number of pages11
JournalActa Psychiatrica Scandinavica
Volume87
Issue number3
DOIs
Publication statusPublished - 1993
Externally publishedYes

Keywords

  • obsessive‐compulsive disorder
  • psychosurgery

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