Most patients with mental disorders can be effectively treated with therapies such as pharmacological therapy, psychotherapy, electroconvulsive therapy. These treatments can be used individually or in combination. However, some patients either do not respond to therapy or experience severe side effects. It is for these patients that neurosurgical procedures may be considered. Psychosurgery is considered brain surgery used to alleviate painful mental manifestations or to mitigate the course of mental illness. Psychosurgery can be talked about as a way to correct mental disorders. It should be considered as a link in the system of treatment and rehabilitation of patients with therapeutically resistant mental disorders.Despite the centuries-old history of psychosurgery, the question of the expediency of using surgical methods for the treatment of mental disorders still remains one of the intractable ones. Today, psychosurgery is a low-traumatic operation, which is associated with targeted and dosed interventions on the deep parts of the human brain. This review describes the main stages in the development of psychosurgery, the main surgical methods used to treat mental disorders, and also discusses the future probable directions of neurosurgical treatment in a psychiatric clinic. The argumentation for the use of this type of treatment in the formation of manifestations of therapeutic resistance is given. Taking into account the diametrality in assessing the feasibility of using the methods of psychosurgery, the concluding part of the article discusses the pros and cons of surgical treatment of mental disorders.
Background: the heterogeneity of schizophrenia impedes our efforts to provide adequate treatment. One step toward optimizing treatment is to deepen our understanding of cognitive variety in this disorder. Perhaps due to this heterogeneity, although visual impairment is a frequent symptom of schizophrenia, many studies show inconsistent data. The aim of our study was to identify homogeneous groups of patients with schizophrenia based on susceptibility to the Ponzo illusion, cognitive impairment degree (BACS T-score) and severity of mental state during therapy (Total PANSS score) and to examine the relationship between clinical parameters and the value of the illusion. Patients and methods: a prospective six-week observational study included 30 patients with the paranoid form of schizophrenia in the second week of stable antipsychotic monotherapy, 11 of whom dropped out due to exclusion criteria. At the second and eighth weeks of treatment, patients were assessed for susceptibility to the Ponzo illusion, cognitive impairment using a battery of BACS tests, and severity of mental status during a semi-structured interview using the PANSS scale. Results: the cluster analysis identified 2 clusters of patients who differed in their susceptibility to the Ponzo illusion. Patients in the first cluster (n = 9) with a significantly higher score on negative PANSS symptoms and marked cognitive impairment in the second and eighth weeks of therapy were prone to overestimate the Ponzo illusion, while patients in the second cluster (n = 10) were less susceptible to the Ponzo illusion. Conclusions: this study allowed us to identify two clusters of patients differing in the severity of cognitive and visual impairments, the relationship of susceptibility to Ponzo illusion with such clinical indicators as negative and cognitive symptoms was demonstrated, which confirms the informative value of using the visual illusion methodology as a marker of mental state.
Summary. Mental disorders are clinically heterogeneous chronic diseases resulting from complex interactions between genotype variants and environmental factors. Epigenetic processes, such as DNA methylation and post-translational histone modification, determine the interpretation by the body at the cellular and tissue levels of various environmental factors. Given that epigenetic modifications are environmentally sensitive, stable and reversible, epigenetic research in psychiatry may be a promising approach to better understanding and treating mental illness. This review discusses the clinical opportunities and challenges posed by epigenetic research in psychiatry. Using individual examples, the main conclusions are drawn that confirm the role of adverse life events, alone or in combination with genetic risk, in the epigenetic programming of neuropsychiatric systems. Further epigenetic studies show encouraging results in the use of methylation changes as diagnostic markers of disease manifestations and provide predictive tools for assessing progression and response to treatment. The potential for the use of targeted epigenetic pharmacotherapy, combined with psychosocial methods, in the context of the personalized medicine of the future in psychiatry is discussed next. It concludes with a discussion of methodological limitations that can make it difficult to interpret epigenetic data in psychiatry. They mainly arise due to the heterogeneity of individuals, both at the level of the whole organism and at the level of tissues, and require new strategies to better assess the biological significance of epigenetic data and their translational use in psychiatry. Overall, we believe that epigenetics can provide new insights and a more comprehensive understanding of the etiology and pathogenesis of mental illness, and should ultimately improve the nosology, treatment and prevention of mental disorders.
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