Agarwal Prateek, Sarris Christina E, Herschman Yehuda, Agarwal Nitin, Mammis Antonios
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA.
J Clin Neurosci. 2016 Dec;34:53-58. doi: 10.1016/j.jocn.2016.08.009. Epub 2016 Sep 12.
Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients. The history of neurosurgery for schizophrenia, among other psychiatric diseases, has a very dark past. Therefore, this review examines peer-reviewed studies on the history of schizophrenia, its medical and surgical therapies, financial costs, and future directions for disease management. We highlight the historically poor relationship between neurosurgery and psychiatric disease and discuss current research in the understandings of schizophrenia. Guided by a strong code of ethics and new technology, including the use of stereotaxis and deep brain stimulation (DBS), the medical communities treating psychiatric disease are beginning to overcome the horrors of the past. DBS is currently being used with moderate success in the treatment of depression, obsessive compulsive disorder, Tourette's syndrome, and anorexia nervosa. With greater understanding of the neural circuitry of schizophrenia and the evolving role for DBS in psychiatric disease, the authors believe that schizophrenia, like other psychiatric diseases, can be treated with DBS.
精神分裂症是一种慢性进行性精神疾病，在21世纪仍然难以治疗。目前的药物治疗能够缓解症状并降低精神病发作的发生率。然而，随着疾病的进展，患者可能会对目前的药物制剂以及治疗中尝试的联合用药越来越难治。此外，这些药物中的许多都有显著的副作用，使从业者在治疗这些患者时陷入困境。精神分裂症以及其他精神疾病的神经外科治疗历史有着非常黑暗的过去。因此，本综述考察了关于精神分裂症的历史、其药物和手术治疗、经济成本以及疾病管理未来方向的同行评议研究。我们强调了神经外科与精神疾病之间历史上不佳的关系，并讨论了目前对精神分裂症认识的研究。在严格的道德准则和包括立体定向和深部脑刺激（DBS）在内的新技术的指导下，治疗精神疾病的医学界正开始克服过去的恐怖。目前，DBS在治疗抑郁症、强迫症、妥瑞氏症和神经性厌食症方面取得了一定的成功。随着对精神分裂症神经回路的更深入了解以及DBS在精神疾病中不断演变的作用，作者认为精神分裂症与其他精神疾病一样，可以用DBS进行治疗。
