Present-day indications for capsulotomy.

Although the majority of patients with anxiety disorders respond well to behavioural techniques of exposure and response prevention, to pharmacotherapy, or, more commonly, to combinations of the two approaches, a small percentage of patients remain refractory and are severely disabled by their symptoms. Some of these individuals constitute candidates for neurosurgical intervention, e.g. cingulotomy and capsulotomy. Therefore, such operations are performed, if to a very limited extent, both in the United States and in Europe to-day. At the Karolinska, patients are accepted for capsulotomy who suffer from chronic, severe, incapacitating, and otherwise intractable anxiety disorders, i.e. obsessive-compulsive disorder, generalized anxiety disorder and phobias. The present-day inclusion and exclusion criteria are described, and the safety and the efficacy of capsulotomy in these extreme forms of anxiety disorders are discussed.