One of the most frequent indications of psychosurgical treatment is incurable obsessions. Up to now, capsulotomy or cingulotomy has been preferred. In our opinion, the variety of obsessive conditions require a more thorough approach to the selection of interbrain targets. Forty-seven patients with pure obsessive-compulsive disorders as well as disorders connected with depressions, epileptic syndrome, schizophreniform state and Gilles de la Tourette''s syndrome with extremely severe resistance to medical therapy were examined. Eighteen patients were operated on. Surgical treatment is permissible only in cases fulfilling the three following criteria: (1) clinicopsychopathological permissibility (duration of disease, resistance to medication, psychopathological status); (2) physiological permissibility (the presence of a brain target, defining the psychopathological status), and (3) technical permissibility (the availability of proper stereotactic, imaging, electrophysiological and other apparatus necessary to carry out the surgical treatment). One supposes that the outcome of surgical treatment is determined by all three criteria. For the purpose of improving the efficiency of stereotactic treatment, a number of methods of surgical treatment depending on the psychopathological status are suggested. For example, in case of comorbidity of obsession with the epileptiform syndrome, we suggest cingulotomy (capsulotomy) and amygdalotomy; in case of comorbidity with depression we suggest cingulotomy and innominatotomy. The long-term observation of the outcome of stereotactic treatment covers a period from 2 up to 9 years.
The aim of study to evaluate possibilities of functional neuroimaging (18F-FDG PET and +H MRS) in diagnosis and treatment evaluation in patients with resistant obsessive-compulsive disorders.18F-FDG PET was performed in 19 patients with treatment resistant OCD. Besides, single voxel MRS was used to image the heads of the caudate nucleus in 13 patients. Examinations were executed at the time of treatment cancellation in all cases. Moreover 18F-FDG PET and H MRS were carried out during every periods of complex treatment (including psychotherapy, psychosurgery (in all cases) and combined stimulation of the head of caudate nucleus and vagus nerve (in 3 cases). Parameters of stimulation and its duration were defined using neuroimaging data.Our results show that application of functional neuroimaging in patients with resistant forms of OCD enables to optimize treatment using adequate medicinal therapy and to prove a choice of brain structures-targets for stereotactic effects. Long-term neuropsychiatric monitoring, neuroimaging data and results of neurostimulation allow to advance a hypothesis about three brain levels of OCD formation in contrast to accepted assumption about four symptom dimensions: symmetry/ordering, hoarding, contamination/cleaning, and obsessions/checking.
Introduction: Depression is one of the most common mental health problem and it grows greater every year around the world. Aims: The main aims were to analyze the possibility of using functional and structural neuroimaging methods in diagnosis of different depression types and to find the predictors of pharmacological resistance. Materials & methods: 46 patients with depression syndrome were distributed into 3 groups: 1) Neurotic Depression (Diagnosis: Adjustment disorders)-ND group; 2) Endogenous Depression (Diagnosis: Recurrent Depression, Bipolar Affective Disorder-current depressive episode, Schizoaffective disorder, depressive type)-PD group, 3) Depression due to organic pathology (Diagnosis: Organic depressive disorder, Organic mixed affective disorder)-OD group. Controls were 18 years old-and gender-matched healthy participants. We used several methods of functional (positron-emission tomography, functional magnetic resonance imaging) and structural (voxel-based morphometry, diffusion-tensor imaging) neuroimaging. Results: We found several functional and structural abnormalities in limbic structures within all three groups. Some of them were the same, some were different. Also we found several functional and structural predictors of pharmacological resistance. Conclusions: We found several functional and structural abnormalities in all three depressive groups. Almost all of them were parts of so-called frontal-subcortical circuits, dysfunction of which, according to the present knowledge, could play crucial role in depression pathogenesis. Summarizing our own results and analyzing the data of our colleagues, we complement a theory of depression pathogenesis and propose an original point of view for neurobiological basis of different types of depressive disorders and its pharmacological resistance.
Introduction: Depressed patients demonstrate low frustration tolerance which increases the risk of suicide and causes difficulties in social adaptation. Resting-state neuroimaging studies revealed abnormalities in "default-mode" network in Major Depressive Disorder (MDD). To our knowledge, functional network responsible for frustration has not been investigated in depressed subjects previously. Aim: To investigate functional responses to frustration in MDD subjects and healthy controls (HCs). Methods: 15 subjects with MDD and 15 HCs underwent 10-min fMRI scanning. We used modified Stroop-test to investigate subjects' responses to frustration. There were two sessions: during the first one the subject had to determine the color of the text by pressing corresponding button while scanning; the second one was a "frustrative" part when the subject had to respond within a short period of time. We modified this interval so that it was almost impossible to respond correctly and keep within the allotted time. The subject was being informed on its performance during the test. Independent component analysis was used to isolate the frustration network in each subject. Group maps of the response network were compared. A within-group analysis was performed in the MDD group to explore effects of depression scores on functional connectivity. Results: We revealed differences in limbic functional connectivity patterns during the test perfomance in MDD in comparison to HCs. Conclusions: The findings suggest that low frustration tolerance in depressed patients can be explained by the impaired function of stress-response brain network and reveal perspectives for future research on depression and suicide risk.
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