Psychosurgery in the Treatment of Anorexia Nervosa
##plugins.themes.bootstrap3.article.details##
Anorexia nervosa is a severe restriction of food intake that can sometimes be associated to purging behaviour. Beyond the difficulty of manteining an addecuate body mass index, people affected by this disease suffer a constant fear of gaining weight, a severe distortion of body image, and a poor introspection of the gravity of the disease. Anorexia is associated with other commorbilities such as depression, anxiety, and personality disorders, which makes anorexia a complex disease with difficulties in treatment. In this article, different cases of three surgery techniques are discussed. The surgery seeks to operate the limbic system and frontostriatal circuit, which are believed to be implied in the body image perception. The results of the reported cases are encouraging and prommess to be a new alternative in the treatment of this chronic disease. However, it is still required more research and the development of new technologies.
Anorexia, bulimia, psychosurgery, limbic system, body image, anorexia, bulimia, sistema límbico, psicocirugía, imagen corporal,
2. Agrawal S, Lask L. Neuroscience of anorexia nervosa: state of the art. Documento presentado en The 9th London International Eating Disorders Conference; London, UK; 31 March-2 April, 2009.
3. Yager J, Devlin MJ, Halmi KA et al. Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington: American Psychiatric Association; 2006.
4. Sadock BJ, Sadock V, Ruiz P. Kaplan and Sadock’s comprehensive textbook of psychiatry. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2009.
5. Bunout D. Regulación de la ingesta alimentaria. s. d.
6. Hirst J. Biological causes of anorexia nervosa and bulimia nervosa. Biology [internet]. 1998;202. Disponible en: http://serendip.brynmawr.edu/bb/neuro/neuro98/202s98-paper3/Hirst3.html.
7. Chowdhury U, Gordon I, Lask B, Watkins B, Watt H, Christie D. Early-onset anorexia nervosa: is there evidence of limbic system imbalance? Int J Eating Disord. 2003;33(4):388-96.
8. Hernández M, Zarate A, Valencia FJ, Meneses O, Ochoa MG, Torre M et al. El papel actual de la cirugía del sistema límbico, el caso de la anorexia y la bulimia terminales. Arch Neurocien (Méx). 2009;14(1):11-21.
9. Goodman WK, Insel TR. Deep brain stimulation in psychiatry: Concentrating on the road ahead. Biol Psychiatry. 2009;65(4):263-6.
10. van Kuyck K, Gérard N, Van Laere K, Casteels C, Pieters G, Gabriëls L, Nuttin B- Towards a neurocircuitry in anorexia nervosa: Evidence from functional neuroimaging studies. J Psychiatr Res. 2009;43(14):1133-45.
11. Israel M, Steiger H. Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder. Biol Psychiatry. 2010;67:e53-4.
12. Barbier J, Gabriels L. Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report. Neurosurgery. 20011; 69:e745-51.
13. Greenberg BD, Gabriels LA, Malone DA Jr et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15(1):64-79.
14. Ruck C, Karlsson A, Steele JD et al. Capsulotomy for obsessive-compulsive disorder: long-term follow-up of 25 patients. Arch Gen Psychiatry. 2008;65(8): 914-21.
15. Marsh R, Maia TV, Peterson BS. Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. Am J Psychiatry. 2009; 166(6):664-674.