Majority of people who have Obsessive Compulsive DisorderOCD show dramatic improvement from compulsive thoughts and chores with medicines like Paroxetine, Clomipramine and other SSRIs. Studies in the use of Deep Brain Stimulation for treatment of Depression, Schizophrenia, Parkinson’s disease, OCD are showing promising results.
The NeuroPsyciatric Surgeons who do the surgery using advanced precise surgical methods are optimistic whereas the Psychiatrists who have been treating thousands of such patients are still wary and watchful about the result outcome.
To find about the success of DEEP BRAIN STIMULATION treatment for DEPRESSION read here: Similar treatment for Depression.
Section: Front Page
Page Number: 1
THE TIMES OF INDIA
Surgery cure for OCD patient
Malathy Iyer | TNN
Washing hands under a running tap was never enough for Jyoti Salunkhe, a 32-year-old from a village in Jalgaon taluka. She would follow it up with an arcane ritual—filling her mouth with water, spitting it out at four distinct spots on her left hand and another five on her right hand. It would take 50—at times, 90—such rounds of washing hands every day to allay Salunkhe’s fears of contamination.
She would also “wash’’ the “contaminated’’ walls of her home or the village school’s windowpanes. “People would keep asking us why she did such things,’’ her father Jayant Patil said.
The pattern changed drastically earlier this month after Salunkhe became the first patient to undergo neurosurgery in a public hospital in Mumbai to control her obsessive-compulsive disorder. Now, she washes her hands only when needed.
Doctors from Sion Hospital’s new neuropsychiatric surgery service operated on Salunkhe, free of cost, on April 11. The operation was definitely the first for a public hospital, and city doctors said it could be the first such surgery in any Mumbai health establishment.
“We are pleased at how well she has responded to surgery,’’ neurosurgeon Alok Sharma and psychiatrist Nilesh Shah, heads of their respective departments, told TOI.
WHAT IS OCD?
Obsessive compulsive disorder (OCD) is an anxiety disorder characterised by recurrent thoughts (obsessions) and/or repetitive behaviour (compulsions). Handwashing, counting, checking or cleaning are often resorted to in the hope of preventing obsessive thoughts or making them go away. But performing these ‘rituals’ provides only temporary relief and not performing them markedly increases anxiety. FROM OCD TO NORMALCY Jyoti Salunkhe Washed Her Hands 90 Times A Day. Now, After A Surgery, She Has Lost Her Fear Of ‘Contamination’
OCD, as Jalgaon resident Jyoti Salunkhe’s disorder is better known, is among the common mental health problems that affect 3 per cent of the general population. Most patients respond well to medication and psychotherapy but a small percentage like Salunkhe do not and they may need surgical correction.
“When she came to Sion Hospital, referred by a former student now practising in Jalgaon, we kept tabs on how often she would
wash her hands. She clocked between 55 and 90 times a day. But, after the surgery, she has been washing her hands only when necessary (like before meals),’’ Sion Hospital neurosurgery head Alok Sharma said.
Salunkhe’s operation was given the green signal only after a long assessment procedure, spanning days and involving several medical teachers from various departments. “Neuro-psychiatric surgery is only meant for patients who don’t respond to medications or behaviour therapy,’’ Sharma said. “Surgery is often the last resort but can be life-saving as some of the OCD patients get suicidial,’’ Sion Hospital psychiatry head Nilesh Shah added.
Suresh Badamath of Bangalore’s governmentrun Nimhans (National Institute of Mental Health And Neuro-Sciences) appreciated the fact that a Mumbai public hospital was offering neuropsychiatry procedure free of cost for poor patients. But he pointed out that surgery produced only “30 per cent-40 per cent’’ results.
“We use it sparingly. Nimhans has conducted only two such surgeries in the last 10 years,’’ he said. These operations were cleared by a committee comprising experts from the hospital as well as outside.
Badamath feared that surgery, if offered indiscriminately, could emerge as the first choice of patient’s relatives. “And the private sector may have no compunction in going along with that choice,’’ he said. However, for Salunkhe, the surgery has meant a new start and a reunion with her 10-year-old son and husband.
Salunkhe’s OCD showed up at the same time when her husband, under the influence of alcohol, started beating her. Salunkhe’s father, Jayant Patil, said: “My daughter’s mind got affected because her husband used to bang her head against the wall. She has been shuttling between my home and her in-laws’ home for the last 10 years because of this.’’
Her medicines kept increasing. She was given ECT (electric shock therapy) but that failed to improve matters. “She has been on six highpotency drugs for the last couple of years. Doctors said this was the maximum dosage they could allow here but yet there was no improvement,’’ Patil said. He spends about Rs 2,500 a month on the drugs.
For Sion Hospital doctors, the surgery means they have the most wholesome treatment package to offer mental health patients.
Twenty-nine-year-old Mahesh Goradia (name changed) from Mumbai was operated for untreatable aggressive and violent behavior and uncontrolled convulsions. “We targeted the amygdala, an area of the brain responsible for fear and violence, in his case. His aggression, violence and convulsions have stopped,’’ Sharma said.
But don’t neuropsychiatric surgeries have side-effects?
Well, in Salunkhe’s case, there has been no immediate side-effect (like convulsions) and her symptoms seem under control. But Shah had words of caution: “The neurons could reform a few months later and the symptoms could reappear.’’ But the surgical intervention would ensure that Salunkhe’s response to medicines and behaviour therapy was better, he added.
OCD: SIGNS & SYMPTOMS
People with OCD may be plagued by persistent, unwelcome thoughts or images
or by the urgent need to engage in certain rituals. They may be obsessed with
germs or dirt and wash their hands over and over. They may be filled with doubt
and feel the need to check things repeatedly.
TYPICAL OCD OBSESSIONS FEAR of contamination or dirt | REPEATED doubts | KEEPING things orderly and symmetrical | AGGRESSIVE or horrific impulses | SEXUAL images
FEAR of being contaminated by shaking hands with people or by touching objects others have touched HAVING doubts that you have locked the door or turned off the stove REPEATED thoughts that you have hurt someone in a traffic accident INTENSE distress when objects are not orderly, lined up properly or facing the right way IMAGES of hurting your child IMPULSES to shout obscenities in inappropriate situations
RISK FACTORS FAMILY history | STRESSFUL life events | PREGNANCY
Neuro-psychiatric surgery involves making lesions in the brain that break the neural circuits that are responsible for these symptoms.
In Jyoti Salunkhe’s case, the area to be treated surgically was first identified with the help of MRI scans; using complex calculations, coordinates were obtained of its exact location.
Doctors use specialised stereotactic neurosurgery equipment, which have sub-millimeter accuracy, to reach and treat the brain’s affected area. Salunkhe’s surgery was done though a 1-cm hole and she was conscious throughout the surgery.
SURGERY VS MEDICINE: THE DEBATE CONTINUES
When Portuguese physician Egan Moniz won a Nobel in the early 1950s, it made a big splash; he won it for developing a new surgical technique called pyschosurgery or surgery for the mentally ill. The infamous lobotomies, in which the patients’ brains were crudely operated and removed, thus become the norm. This continued till the mid-1970s. But, as the concept of patients’ rights came to the fore, there began a movement against psychosurgery. And, for the past 20-30 years, surgery has been trying gain respectability with its newer and minimally invasive methods.
A new nomenclature — neuropsychiatry —has emerged now. “Neuro-psychiatric surgery is done in very few centres in the world,’’ neurosurgeon Alok Sharma, who travelled to Harvard University’s Mass General Hospital to learn it, said. Before starting the neuropsychiatry surgical service at Sion Hospital, Sharma also met India’s first woman neurosurgeon, 75-year-old T S Kanaka from Chennai, who has done pioneering work in this field and offered him useful tips. Neuro-psychiatric surgery has evolved hugely in the last decade to the extent that a Canadian centre is using deep-brain stimulation surgery to treat severe depression. Schizophrenia is another area that neurosurgeons are active in.
OCD has a better prognosis than before, thanks to better medication and psychotherapies. Surgery is a remote treatment only for those who have failed medications and therapies in all permutations and combinations across time. Surgical optimism is not similar to the treatment of a cataract, blocks in the heart or even cancer. OCD can destroy the mental health of the entire family as its compulsive acts can cause continuous agony. Brain surgery should be sought after a serious review by a multi-disciplinary team with pragmatic expectations that the illness cannot be cured but only reasonably controlled.
Harish Shetty | PSYCHIATRIST
THE TIMES OF INDIA
Dr. Ashok Koparday
MBBS, FC SEPI
Center for Therapy, Education, Research in
Sex, Marriage, Relationships
Ex. Teaching Faculty
Seth G. S. Medical College and K. E. M. Hospital and
Grant Medical College and Sir J. J. Group of Hospitals
University of Mumbai, India