Contemporary psychosurgery: indications, outcome and the Irish experience

Abstract

AbstractObjectives: To review recent use of psychosurgery in Britain and Ireland; to outline the indications and contraindications; and to summarise the Irish experience of psychosurgery.Method: The Geoffrey Knight National Unit for Affective Disorders (GKU), now based at the Maudsley Hospital has performed the largest number of psychosurgical operations in the last 30 years. This paper reviews criteria for referral and outcome of stereotactic subcaudate tractotomy at the GKU. The twenty-one referrals from Ireland to the Unit, resulting in eight operations over the fifteen year period 1981-1995, are considered separately.Results: The efficacy of stereotactic subcaudate tractotomy is of the order of 30-60% and there is a low incidence of long-term adverse effects. The outcome of the eight Irish patients who underwent psychosurgery compare favourably with the overall outcome figures for the Unit.Conclusions: Stereotactic subcaudate tractotomy remains a treatment of last resort in the rare cases of severely treatment-resistant affective disorders and obsessive compulsive disorders.