Seminars in neurology
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Seminars in neurology · Jul 2009
Review Historical ArticlePsychiatric neurosurgery 2009: review and perspective.
In the treatment of psychiatric disorders, modern lesion procedures and nonablative deep brain stimulation (DBS) offer a degree of hope for patients who remain severely ill and impaired despite pharmacological and behavioral treatments. The available data support the therapeutic promise of these procedures, primarily for those suffering with obsessive-compulsive disorder (OCD) or major depressive disorder (MDD). ⋯ The data also show that psychiatric neurosurgical procedures can be implemented most successfully by dedicated interdisciplinary teams in the context of a multimodal treatment plan. Treatment using these procedures is further complicated by issues involving the criteria for patient selection, the long-term management of patients receiving psychiatric neurosurgery, and the different patterns of potential clinical benefits and burdens presented by DBS and contemporary lesion procedures.
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The prevalence of traumatic brain injury (TBI) is increasing, particularly in the population of veterans. Many times, the motor and sensory consequences of TBI are addressed, but the post-TBI neuropsychiatric sequelae, which may be as, or even more devastating than the motor and sensory deficits, are left unattended. ⋯ The neuropsychiatric sequelae of TBI not only interfere with day-to-day function, but can severely impede rehabilitation efforts. To date, there have been few large-scale studies looking at the effectiveness of the various treatment modalities, including psychotherapeutic and pharmacological interventions.