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A prospective clinical study of stereotactic subcaudate tractotomy

Published online by Cambridge University Press:  09 July 2009

A. M. Poynton ,
L. D. Kartsounis  and
P. K. Bridges
A. M. Poynton*
Affiliation:
Geoffrey Knight National Unit for Affective Disorders and the National Hospital far Neurology and Neurosurgery, London
L. D. Kartsounis
Affiliation:
Geoffrey Knight National Unit for Affective Disorders and the National Hospital far Neurology and Neurosurgery, London
P. K. Bridges
Affiliation:
Geoffrey Knight National Unit for Affective Disorders and the National Hospital far Neurology and Neurosurgery, London
*
1Address for correspondence: Dr Amanda M. Poynton Psychiatry Directorate, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL.
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Synopsis

This study describes a cohort of 23 patients undergoing stereotactic subcaudate tractotomy. Research Diagnostic Criteria indicated that 70% suffered major depressive disorder; the remainder mostly had a bipolar affective disorder. There were serial assessments pre-operatively and at 2 weeks and 6 months post-operatively using the Hamilton Rating Scale for depression, the Present State Examination (PSE), Newcastle Scale, the Beck Depression Inventory, and the Taylor Manifest Anxiety Scale. Neuropsychological assessment included tests thought to be sensitive to frontal lobe dysfunction, as well as tests of general intelligence, attention, memory, language and visuo-spatial function.

Post-operatively, depression rating scale scores decreased significantly but most patients continued to exhibit a number of PSE syndromes. Depression rating scale scores were correlated with 1 year global outcome: there was no significant correlation except for the 6 month assessment when lower Hamilton scores were found to be associated with better global outcome. Correlations between the neuropsychological tests and the Hamilton and Beck depression scales at 2 weeks post-operatively suggested that an improvement in psychiatric condition was associated with greater efficiency on some tests of attention and verbal recall, as well as faster performance on a sorting task. By contrast, the changes at 6 months suggested an association between improvement in psychiatric condition and less efficient performance on certain neuropsychological tests including verbal recognition memory, attention and two tests of frontal lobe dysfunction.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 763 - 770
Copyright
Copyright © Cambridge University Press 1995

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References

Angst, J. (1988). Clinical course of affective disorders. In Depressive Illness: Prediction of Course and Outcome (ed. Helgason, T. and Daly, R. J.), pp. 1–44. Springer-Verlag: Berlin.Google Scholar
Bartlett, J., Van Boxel, P., Bridges, P. K. & Sepping, P. (1979). Monitoring psychosurgery: clinical and research observations. In Modern Concepts in Psychiatric Surgery (ed. Hitchcock, E. R., Ballantine, H. T. and Meyerson, B. A.), pp. 311–323. North Holland Biomedical Press/Elsevier: Amsterdam.Google Scholar
Bartlett, J., Bridges, P. & Kelly, D. (1981). Contemporary indications for psychosurgery. British Journal of Psychiatry 138, 507–511.Google Scholar
Beck, A. T., Ward, C. H. H., Mendleson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Borkowski, J. G., Benton, A. L. & Spreen, O. (1967). Word fluency and brain damage. Neuropsychologia 5, 135–140.CrossRefGoogle Scholar
Bridges, P. K. (1972). Psychosurgery today: psychiatric aspects. Proceedings of the Royal Society of Medicine 65, 40–44.Google ScholarPubMed
Bridges, P. K. & Bartlett, J. R. (1977). Psychosurgery: yesterday and today. British Journal of Psychiatry 131, 249–260.Google Scholar
Carney, M. P. W., Roth, M. & Garside, R. F. (1965). The diagnosis of depressive symptoms and prediction of ECT response. British Journal of Psychiatry 111, 659–674.CrossRefGoogle Scholar
Corsellis, J. A. N. & Jack, A. B. (1973). Neuropathological observations on yttrium implants and on undercutting in the orbito-frontal areas of the brain. In Surgical Approaches in Psychiatry (ed. Laitinen, L. and Livingston, K. E.), pp. 90–95. Medical and Technical Publishing: Lancaster.Google Scholar
Coughlan, A. K. & Warrington, E. K. (1978). Word-comprehension and word-retrieval in patients with localised cerebral lesions. Brain 101, 163–185.CrossRefGoogle Scholar
Curson, D. A., Trauer, T., Bridges, P. K. & Gillman, P. K. (1983). Assessment of outcome after psychosurgery using the Present State Examination. British Journal of Psychiatry 143, 118–123.CrossRefGoogle ScholarPubMed
Goktepe, E. O., Young, L. B. & Bridges, P. K. (1975). A further review of the results of stereotactic subcaudate tractotomy. British Journal of Psychiatry 126, 270–380.CrossRefGoogle Scholar
Hamilton, M. (1967). Development of a Rating Scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Jackson, M. & Warrington, E. K. (1986). Arithmetic skills in patients with unilateral cerebral lesions. Cortex 22, 611–620.Google Scholar
Kartsounis, L. D., Poynton, A., Bridges, P. K. & Bartlett, J. R. (1991). Neuropsychological correlates of stereotactic subcaudate tractotomy: a prospective study. Brain 114, 2657–2673.CrossRefGoogle ScholarPubMed
Kimura, D. (1977). Acquisition of a motor skill after left-hemisphere damage. Brain 100, 527–542.CrossRefGoogle ScholarPubMed
Knight, G. (1965). Stereotactic tractotomy in the surgical treatment of mental illness. Journal of Neurology, Neurosurgery and Psychiatry 28, 304–310.CrossRefGoogle ScholarPubMed
Lezak, M. D. (1976). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Luria, A. R. (1966). Human Brain and Psychological Processes. Harper and Row: New York.Google Scholar
McKenna, P. & Warrington, E. K. (1983). The Graded Naming Test. NFER-Nelson: Windsor.Google Scholar
Milner, B. (1963). Effects of different brain lesions on card sorting: the role of the frontal lobes. Archives of Neurology, Chicago 9, 90–100.CrossRefGoogle Scholar
Nelson, H. E. (1976). A Modified card sorting test sensitive to frontal lobe defects. Cortex 12, 313–324.CrossRefGoogle ScholarPubMed
Nelson, H. E. (1982). National Adult Reading Test. NFER-Nelson: Windsor.Google Scholar
Newcombe, R. (1975). The lesion in stereotactic subcaudate tractotomy. British Journal of Psychiatry 126, 478–481.CrossRefGoogle Scholar
Nie, H. N., Hull, C. H., Jenkin, J. G., Stainbrenner, K. & Brent, D. H. (1975). SPSSX Statistical Package for the Social Sciences, 2nd edn. McGraw Hill: New York.Google Scholar
Poynton, A., Bridges, P. K. & Bartlett, J. R. (1988). Psychosurgery in Britain now. British Journal of Neurosurgery 2, 297–306.CrossRefGoogle ScholarPubMed
Poynton, A. M. (1990). Psychosurgery in the eighties: a description of referrals for stereotactic subcaudate tractotomy 1981–1985 and a comparison between operated and non-operated patients. M.Phil. thesis, University of London.Google Scholar
Raven, J. C. (1958). Advanced Progressive Matrices, Set 1. H. K. Lewis: London.Google Scholar
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society of London, B 298, 199–209.Google ScholarPubMed
Shallice, T. & Evans, M. E. (1978). The involvement of the frontal lobes in cognitive estimation. Cortex 14, 294–303.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robbins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Stuss, D. T. & Benson, D. F. (1986). The Frontal Lobes. Raven Press: New York.Google Scholar
Taylor, J. A. (1955). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychiatry 48, 285–290.Google Scholar
Warrington, E. K. (1984). Recognition Memory Test. NFER-Nelson: Windsor.Google Scholar
Warrington, E. K. & James, M. (1988). Visual apperceptive agnosia: a clinico-anatomical study of three cases. Cortex 24, 13–22.Google Scholar
Wechsler, D. (1945). A standardised memory scale for clinical use. Journal of Psychology 19, 87–95.CrossRefGoogle Scholar
Wechsler, D. (1955). Wechsler Adult Intelligence Scale. The Psychological Corporation: New York.Google Scholar
Willison, J. R. (1988). Neuropsychological investigations of a set of mental speed tests. Ph.D. thesis, University of London.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar