Obsessive-compulsive disorder and ventromedial frontal lesions: clinical and neuropsychological findings
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Obsessive-compulsive disorder and ventromedial frontal lesions : clinical and neuropsychological findings. / Irle, E; Exner, C; Thielen, K; Weniger, G; Rüther, E; Thielen, Karsten.
I: The American Journal of Psychiatry, Bind 155, Nr. 2, 02.1998, s. 255-63.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › fagfællebedømt
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TY - JOUR
T1 - Obsessive-compulsive disorder and ventromedial frontal lesions
T2 - clinical and neuropsychological findings
AU - Irle, E
AU - Exner, C
AU - Thielen, K
AU - Weniger, G
AU - Rüther, E
AU - Thielen, Karsten
PY - 1998/2
Y1 - 1998/2
N2 - OBJECTIVE: The authors sought to determine the long-term outcome of subjects with severe and refractory obsessive-compulsive disorder (OCD) who had undergone ventromedial frontal leukotomy during the 1970s. Special emphasis was given to the analysis of specific lesion sites.METHOD: Sixteen OCD subjects who had undergone ventromedial frontal leukotomy were evaluated clinically and neuropsychologically and compared to seven well comparison OCD subjects without leukotomy. The 16 leukotomized subjects were divided into three groups according to the main lesion sites as determined by current magnetic resonance imaging scans.RESULTS: The leukotomized OCD subjects showed significant improvement of obsessive-compulsive symptoms; subjects with frontostriatal lesions tended to have improved most. The subjects with combined diagnoses of OCD and obsessive personality disorder (N = 3) had improved significantly less. Of 11 subjects with lesions of the ventral striatum, eight had developed substance dependence postoperatively. Intellectual functions were largely preserved in subjects with ventromedial frontal lesions only or frontostriatal lesions. However, all subjects showed subnormal performance on the Wisconsin Card Sorting Test. Subjects with lesions of the dorsolateral frontal convexity also showed memory problems, attentional slowing, and lower performance IQ.CONCLUSIONS: Restricted ventromedial frontal leukotomy should be discussed as a last-resort treatment for severe and refractory OCD but not obsessive personality disorder. Lesions of the ventral striatum were significantly related to the occurrence of substance dependence, suggesting a role of this area in human addictive behavior.
AB - OBJECTIVE: The authors sought to determine the long-term outcome of subjects with severe and refractory obsessive-compulsive disorder (OCD) who had undergone ventromedial frontal leukotomy during the 1970s. Special emphasis was given to the analysis of specific lesion sites.METHOD: Sixteen OCD subjects who had undergone ventromedial frontal leukotomy were evaluated clinically and neuropsychologically and compared to seven well comparison OCD subjects without leukotomy. The 16 leukotomized subjects were divided into three groups according to the main lesion sites as determined by current magnetic resonance imaging scans.RESULTS: The leukotomized OCD subjects showed significant improvement of obsessive-compulsive symptoms; subjects with frontostriatal lesions tended to have improved most. The subjects with combined diagnoses of OCD and obsessive personality disorder (N = 3) had improved significantly less. Of 11 subjects with lesions of the ventral striatum, eight had developed substance dependence postoperatively. Intellectual functions were largely preserved in subjects with ventromedial frontal lesions only or frontostriatal lesions. However, all subjects showed subnormal performance on the Wisconsin Card Sorting Test. Subjects with lesions of the dorsolateral frontal convexity also showed memory problems, attentional slowing, and lower performance IQ.CONCLUSIONS: Restricted ventromedial frontal leukotomy should be discussed as a last-resort treatment for severe and refractory OCD but not obsessive personality disorder. Lesions of the ventral striatum were significantly related to the occurrence of substance dependence, suggesting a role of this area in human addictive behavior.
KW - Behavior, Addictive
KW - Comorbidity
KW - Compulsive Personality Disorder
KW - Corpus Striatum
KW - Female
KW - Frontal Lobe
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Neuropsychological Tests
KW - Obsessive-Compulsive Disorder
KW - Psychosurgery
KW - Severity of Illness Index
KW - Substance-Related Disorders
KW - Treatment Outcome
M3 - Journal article
C2 - 9464207
VL - 155
SP - 255
EP - 263
JO - The American Journal of Psychiatry
JF - The American Journal of Psychiatry
SN - 0002-953X
IS - 2
ER -
ID: 120577061