Sunday, November 27, 2011

The relationship between the brain and Obsessive-compulsive disorder

“In one extraordinary case a patient performed his own psychosurgery. Solyom, Turnbull, and Wilensky (1987) reported the case of a young man with a serious OCD whose ritual hand washing and other behaviours made it impossible for him to continue his schooling or lead a normal life. Finding that his life was no longer worthwhile, he decided to end it. He placed the muzzle of .22 caliber rifle in his mouth and pulled the trigger. The bullet entered the base of the brain and damaged the frontal lobes. He survived, and he was amazed to find that his compulsions were gone. Fortunately, the damage did not disrupt his ability to make or execute plans; he went back to school and completed his education, and now has a job. His IQ was unchanged. Ordinary surgery would have been less hazardous and messy, but it could hardly have been more successful.” (Foundation of Behavioral Neuroscience, Eight edition, page 472)
            From the story mentioned above we can conclude that Obsessive-compulsive disorder (OCD) is a disorder that closely related with the physical of the brain. For some reason the young man has fortunately cure his disorder by accidently severe the part of the brain that made him suffered, and he did successfully without any report of infection or brain dysfunction which hardly achieved even with proper brain surgery-well of course he had undergo some operation after the attempt. The question rose is which part was cut and how does this help?
            According to neuro-imaging studies, researchers found out that OCD is related to the anomalies along the frontal-subcortical brain circuit. The activity in this area exhibit increase activity in OCD patient compared to normal people. Treatment with drugs is the way to decrease the activities in the area.
            In the modern medical practice, psychosurgery is the last option in treating OCD. It is called cingulotomy (see link :http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=3594 ) The surgery will be carried out if the psychological therapies and pharmacological treatments had failed to treat. In the surgery, some part of the brain will be severe but it does not require an open skull operation. It uses a “gamma knife” to destroy the cingulum bundle which connecting the prefrontal cortex with the limbic system.
            The prefrontal cortex is the region which associated with the control of movement and more involved in formulating plans and strategies while the limbic system is a group of several brain structures involved in learning, emotion, memory, and motivation. By separating these two parts of the brain, it helps to reduce intense anxiety and the symptom of obsessive-compulsive disorder. This is possible since the plan that processed in the prefrontal cortex does not influenced by the emotion because in most cases, the patient trapped in the OCD due to the pattern of cognitive impairment. For example obsession about being responsible for causing harm or failing to prevent harm which lead to checking compulsion and reassurance-seeking. He or she will “play” with the toggle or switch button for many times until he or she fell assured that the microwave oven already been switch off.
There are several more types of neurosurgery to treat this disorder. However, all this surgery cannot be undo. That’s why it is often be the last resort in treating OCD.



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