Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases.

Abstract

BACKGROUND:

The efficacy of neurosurgical intervention for self-mutilation behavior associated with severe, intractable psychiatric disorders remains undetermined. We report the effects of limbic leucotomy in 5 consecutive patients with severe self-mutilation behaviors.

METHOD:

After unsolicited referrals from their psychiatrists and careful consideration by the Massachusetts General Hospital Cingulotomy Assessment Committee (MGH-CAC), 5 patients were treated with limbic leucotomy. Their primary DSM-IV psychiatric diagnoses were either obsessive-compulsive disorder or schizoaffective disorder. Comorbid severe, treatment-refractory self-mutilation was an additional target symptom. Outcome was measured by an independent observer using the Clinical Global Improvement. Current Global Psychiatric-Social Status Rating, and DSM-IV Global Assessment of Functioning scales in addition to telephone interviews with patients, families, their psychiatrists, and treatment teams. The mean postoperative follow-up period was 31.5 months.

RESULTS:

All measures indicated sustained improvement in 4 of 5 patients. In particular, there was a substantial decrease in self-mutilation behaviors. Postoperative complications were transient in nature. and postoperative compared with preoperative neuropsychological assessments revealed no clinically significant deficits.

CONCLUSION:

In carefully selected patients as described in this report, limbic leucotomy may be an appropriate therapeutic consideration for self-mutilation associated with severe, intractable psychiatric disorders.

• Authors: B H Price, I Baral, G R Cosgrove, S L Rauch, A A Nierenberg, M A Jenike, E H Cassem
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 62 Issue 12 Pg. 925-32 (Dec 2001) ISSN: 0160-6689 [Print] United States
• PMID: 11780871 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Brain Mapping
• Dominance, Cerebral (physiology)
• Female
• Follow-Up Studies
• Gyrus Cinguli (physiopathology, surgery)
• Humans
• Limbic System (physiopathology, surgery)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Obsessive-Compulsive Disorder (physiopathology, psychology, surgery)
• Postoperative Complications (physiopathology, psychology)
• Psychiatric Status Rating Scales
• Psychosurgery
• Psychotic Disorders (physiopathology, psychology, surgery)
• Self Mutilation (physiopathology, psychology, surgery)
• Treatment Outcome