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The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients

BACKGROUND: Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or assoc...

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Autores principales: Vilela-Filho, Osvaldo, Ragazzo, Paulo C., Canêdo, Darianne, Barreto, Uadson S., Oliveira, Paulo M., Goulart, Lissa C., Reis, Manoel D., Campos, Telma M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8492415/
https://www.ncbi.nlm.nih.gov/pubmed/34621590
http://dx.doi.org/10.25259/SNI_599_2021
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author Vilela-Filho, Osvaldo
Ragazzo, Paulo C.
Canêdo, Darianne
Barreto, Uadson S.
Oliveira, Paulo M.
Goulart, Lissa C.
Reis, Manoel D.
Campos, Telma M.
author_facet Vilela-Filho, Osvaldo
Ragazzo, Paulo C.
Canêdo, Darianne
Barreto, Uadson S.
Oliveira, Paulo M.
Goulart, Lissa C.
Reis, Manoel D.
Campos, Telma M.
author_sort Vilela-Filho, Osvaldo
collection PubMed
description BACKGROUND: Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noticed in any of these patients. To improve the control of aggression, subcaudate tractotomy was added to the previous surgical protocol. The main goal of the present study was to investigate the impact of this modified surgical approach on delusions and hallucinations. METHODS: Retrospective analysis of the medical records of psychotic patients presenting with treatment-resistant aggressiveness, delusions, and hallucinations submitted to bilateral subcaudate tractotomy + bilateral anterior cingulotomy + bilateral amygdalotomy in our institution. RESULTS: Five patients, all males, with ages ranging from 25 to 65 years, followed up by a mean of 45.6 months (17–72 months), fulfilled the inclusion criteria. Delusions and hallucinations were abolished in four of them. CONCLUSION: These results suggest that the key element for relieving these symptoms was the subcaudate tractotomy and that the orbitofrontal and ventromedial prefrontal cortices play an important role in the genesis of hallucinatory and delusional symptoms of schizophrenia and other psychoses.
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spelling pubmed-84924152021-10-06 The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients Vilela-Filho, Osvaldo Ragazzo, Paulo C. Canêdo, Darianne Barreto, Uadson S. Oliveira, Paulo M. Goulart, Lissa C. Reis, Manoel D. Campos, Telma M. Surg Neurol Int Original Article BACKGROUND: Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noticed in any of these patients. To improve the control of aggression, subcaudate tractotomy was added to the previous surgical protocol. The main goal of the present study was to investigate the impact of this modified surgical approach on delusions and hallucinations. METHODS: Retrospective analysis of the medical records of psychotic patients presenting with treatment-resistant aggressiveness, delusions, and hallucinations submitted to bilateral subcaudate tractotomy + bilateral anterior cingulotomy + bilateral amygdalotomy in our institution. RESULTS: Five patients, all males, with ages ranging from 25 to 65 years, followed up by a mean of 45.6 months (17–72 months), fulfilled the inclusion criteria. Delusions and hallucinations were abolished in four of them. CONCLUSION: These results suggest that the key element for relieving these symptoms was the subcaudate tractotomy and that the orbitofrontal and ventromedial prefrontal cortices play an important role in the genesis of hallucinatory and delusional symptoms of schizophrenia and other psychoses. Scientific Scholar 2021-09-20 /pmc/articles/PMC8492415/ /pubmed/34621590 http://dx.doi.org/10.25259/SNI_599_2021 Text en Copyright: © 2021 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Vilela-Filho, Osvaldo
Ragazzo, Paulo C.
Canêdo, Darianne
Barreto, Uadson S.
Oliveira, Paulo M.
Goulart, Lissa C.
Reis, Manoel D.
Campos, Telma M.
The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title_full The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title_fullStr The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title_full_unstemmed The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title_short The impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
title_sort impact of subcaudate tractotomy on delusions and hallucinations in psychotic patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8492415/
https://www.ncbi.nlm.nih.gov/pubmed/34621590
http://dx.doi.org/10.25259/SNI_599_2021
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