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Neuroscience and Biobehavioral Reviews Nov 2021Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Chronic pain, with a prevalence of 20-30 % is the major cause... (Review)
Review
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Chronic pain, with a prevalence of 20-30 % is the major cause of human suffering worldwide, because effective, specific and safe therapies have yet to be developed. It is unevenly distributed among sexes, with women experiencing more pain and suffering. Chronic pain can be anatomically and phenomenologically dissected into three separable but interacting pathways, a lateral 'painfulness' pathway, a medial 'suffering' pathway and a descending pain inhibitory pathway. One may have pain(fullness) without suffering and suffering without pain(fullness). Pain sensation leads to suffering via a cognitive, emotional and autonomic processing, and is expressed as anger, fear, frustration, anxiety and depression. The medial pathway overlaps with the salience and stress networks, explaining that behavioural relevance or meaning determines the suffering associated with painfulness. Genetic and epigenetic influences trigger chronic neuroinflammatory changes which are involved in transitioning from acute to chronic pain. Based on the concept of the Bayesian brain, pain (and suffering) can be regarded as the consequence of an imbalance between the two ascending and the descending pain inhibitory pathways under control of the reward system. The therapeutic clinical implications of this simple pain model are obvious. After categorizing the working mechanisms of each of the available treatments (pain killers, psychopharmacology, psychotherapy, neuromodulation, psychosurgery, spinal cord stimulation) to 1 or more of the 3 pathways, a rational combination can be proposed of activating the descending pain inhibitory pathway in combination with inhibition of the medial and lateral pathway, so as to rebalance the pain (and suffering) pathways.
Topics: Anxiety; Bayes Theorem; Brain; Chronic Pain; Female; Humans; Pain Perception
PubMed: 34411559
DOI: 10.1016/j.neubiorev.2021.08.013 -
British Medical Journal (Clinical... Oct 1981
Topics: Humans; Informed Consent; Mental Disorders; Mentally Ill Persons; Patient Advocacy
PubMed: 6793181
DOI: No ID Found -
Journal of the National Medical... Jul 1950
Topics: Humans; Psychosurgery
PubMed: 15428888
DOI: No ID Found -
British Medical Journal Oct 1974
Topics: Adult; Agoraphobia; Anti-Anxiety Agents; Behavior Therapy; Benzodiazepines; Female; Humans; Phenelzine; Phobic Disorders; Psychosurgery; Psychotherapy, Group
PubMed: 4153595
DOI: No ID Found -
British Medical Journal Jul 1973
Topics: Ethics, Medical; Humans; Methods; Psychosurgery; Schizophrenia; Stereotaxic Techniques
PubMed: 4577721
DOI: 10.1136/bmj.3.5870.50-a -
Postgraduate Medical Journal Dec 1973The limbic system can be considered to consist of a central ‘core’ from which three well-defined circuits emerge. These are the the and the The functions of the... (Review)
Review
The limbic system can be considered to consist of a central ‘core’ from which three well-defined circuits emerge. These are the the and the The functions of the primitive limbic brain are modulated by a higher order control—the frontal lobe. Emotional responses and physiological changes have been obtained by stimulation of fronto-limbic pathways and limbic circuits and these have been used for location of target sites in psychosurgery. For the relief of intractable depression and anxiety, lesions are generally made in the lower medial quadrant or posteroorbital part of the frontal lobe, where there is a concentration of fronto-limbic connections. In primary obsessional neurosis lesions at this site produce less satisfactory results, but these illnesses may be helped by lesions in the cingulate gyrus, which is part of the Papez circuit. Patients with epilepsy and aggressive outbursts may respond to temporal lobotomy, or to operations, such as amygdalotomy, where lesions are placed in the defence reaction circuit.
Topics: Amygdala; Animals; Anorexia Nervosa; Emotions; Epilepsy; Feeding Behavior; Frontal Lobe; Gyrus Cinguli; Humans; Limbic System; Memory; Obsessive-Compulsive Disorder; Psychosurgery
PubMed: 4618902
DOI: 10.1136/pgmj.49.578.825 -
Journal of the Royal Society of Medicine Feb 1984
PubMed: 20894515
DOI: No ID Found -
Comptes Rendus Biologies 2015At the Paris Colloquium held forty years ago, and which this paper celebrates, the issue of psychosurgery had not been tackled yet. At that time psychosurgery was...
At the Paris Colloquium held forty years ago, and which this paper celebrates, the issue of psychosurgery had not been tackled yet. At that time psychosurgery was tainted by the controversial history of lobotomy and leucotomy. Supporters of psychosurgery at the time of the Colloquium were preparing their fourth International Conference, which was held in Madrid the following year. This represented a key characteristic of the collective, institutional and symbolic action of psychosurgery practitioners. At the end of the seventies, their strategy changed as noted below. Furthermore, we focus on the special importance of the results presented and commented on by psychosurgery supporters, including its conception and classification throughout the rhetoric historically involved (its supposed ventriloquism, its persuasive strength). Based on this view, we suggest a critical reflection encompassing old and new psychosurgery, while questioning the value of new rhetorical devices for the assessment and presentation of psychosurgery results after the surge of Deep Brain Stimulation.
Topics: Deep Brain Stimulation; History, 20th Century; History, 21st Century; Humans; Mental Disorders; Psychosurgery
PubMed: 26149524
DOI: 10.1016/j.crvi.2015.06.004 -
East Asian Archives of Psychiatry :... Jun 2016The abuse of stimulants such as cocaine, amphetamine, and methamphetamine is a huge problem in many parts of the world. Abuse of these drugs does not ruin just the... (Review)
Review
The abuse of stimulants such as cocaine, amphetamine, and methamphetamine is a huge problem in many parts of the world. Abuse of these drugs does not ruin just the user's life, but also adversely affects those around them. Despite many years of research, there are no approved medications for stimulant dependence, and treatment is focused on psychotherapy and abstinence. Over the last 10 to 20 years, there have been some major changes in approach to medication development for stimulant dependence. These include assessing ligands for non-dopaminergic sites, atypical dopamine transporter ligands, blocking long-term potentiation and / or memory reconsolidation, vaccines against the stimulant, and molecular approaches including pharmacogenomics and gene silencing. Also included in this overview are non-drug treatments such as deep brain stimulation and psychosurgery. This overview highlights recent preclinical and clinical studies of treatment development for stimulant dependence.
Topics: Amphetamine-Related Disorders; Cocaine-Related Disorders; Humans
PubMed: 27377486
DOI: No ID Found -
BMJ Clinical Evidence Jan 2012Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive... (Review)
Review
INTRODUCTION
Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive compulsive disorder (OCD) have an episodic course, whereas the other half have continuous problems. Prevalence in children and adolescents is 2.7%. The disorder persists in about 40% of children and adolescents at mean follow-up of 5.7 years.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatments for obsessive compulsive disorder in adults? What are the effects of initial treatments for obsessive compulsive disorder in children and adolescents? What are the effects of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of maintenance treatment for obsessive compulsive disorder in children and adolescents? What are the effects of treatments for obsessive compulsive disorder in adults who have not responded to initial treatment with serotonin reuptake inhibitors (SRIs)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 43 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: addition of antipsychotics to serotonin reuptake inhibitors, behavioural therapy alone or with serotonin reuptake inhibitors, cognitive therapy or cognitive behavioural therapy (CBT) (alone or with serotonin reuptake inhibitors), electroconvulsive therapy, optimum duration of maintenance treatment, psychosurgery, serotonin reuptake inhibitors (citalopram, clomipramine, fluoxetine, fluvoxamine, paroxetine, or sertraline), and transcranial magnetic stimulation.
Topics: Electroconvulsive Therapy; Emotions; Humans; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Psychosurgery; Treatment Outcome; United States Food and Drug Administration
PubMed: 22305974
DOI: No ID Found