Recent headlines read that India had performed its first psychosurgery.
A 38-year-old Australian woman who had been experiencing depression for 26 years became the first person in Mumbai, possibly India, to undergo a psychiatric operation (deep brain stimulation) since the Mental Healthcare Act was passed in 2017. A Kenyan national patient diagnosed with schizophrenia was successfully treated via the country’s first deep brain stimulation surgery for schizophrenia at the Marengo Asia Hospital Gurugram.
This is a significant milestone and a notable step in mental health treatment. It signifies advancements in medical technology and expertise. It shows a commitment to exploring alternative treatment options for severe mental health disorders. This will help generate awareness, spark further research, and contribute to the overall understanding and development of surgical interventions for mental health conditions.
Deep brain stimulation is a surgical procedure that involves implanting electrodes into specific areas of the brain to relieve the symptoms of a variety of neurological and psychiatric conditions. Thin electrodes are surgically implanted into specific areas of the brain. These electrodes are linked to a small device known as a neurostimulator, which is typically implanted beneath the collarbone. The neurostimulator sends electrical impulses to the brain, which modulate abnormal electrical activity and relieve symptoms.
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When other treatments fail to address the symptoms, the procedure is considered to achieve the best results. It is frequently used in conjunction with medications and therapy. The stimulation parameters can be adjusted to meet the needs of each patient, allowing for a more personalized treatment approach. It has been demonstrated to be both safe and effective for improving the quality of life of many patients.
Deep brain stimulation is being researched as a potential treatment option for both depression and schizophrenia. It is important to note that the use of this procedure for these conditions is still in the early stages of research and clinical trials. Although studies have yielded promising results in some cases, the efficacy and long-term effects of this intervention are still under investigation and it is not yet considered a standard treatment. Research on this procedure as a treatment is limited, and the results have been mixed.
While deep brain stimulation has shown promise as a treatment option for certain neurological and psychiatric conditions, it is essential to consider the potential side effects and disadvantages associated with the procedure. Implantation of the electrodes carries the standard risks associated with any surgical procedure, such as infection, bleeding, and adverse reactions to anaesthesia. There is also a low risk of damage to the surrounding brain structures during electrode placement. The implanted hardware, including electrodes and neurostimulator devices, may lead to complications over time, such as device malfunction, displacement or breakage of electrodes, and issues with battery life. It can also lead to cognitive and behavioural changes. It can lead to other effects, such as muscle contractions, paraesthesia, abnormal sensations, speech difficulties, balance problems, and visual disturbances.
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The Mental Health Care Act 2017 has provided a provision for the restriction of psychosurgery. It is important to explain to the patient the surgery in detail, along with its risks and benefits, other treatment options, and care management. After this, informed consent should be obtained from the patient. In addition, the concerned psychiatrist must obtain approval from the Mental Health Review Board to perform the surgery as planned. The psychiatrist must submit the following to the board for approval:
- A clinical summary of the case
- Other details asked to be provided.
- The informed consent obtained from the client
- Certified copies of the individual’s medical records
- An explanation and justification for the need, suitability, and safety of the proposed psychosurgery
Although the procedure has shown positive results for specific conditions, it may not be equally effective for everyone. The response rates can vary, and some individuals may not experience significant symptom improvement or may require additional treatment in conjunction with the procedure.
It is important to understand that this procedure is usually considered when other treatments such as medication and therapy are not able to address the symptoms; it is generally reserved for severe cases. It is crucial for individuals considering this surgery to have thorough discussions with their medical team regarding the potential risks, benefits, and alternatives.
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Each case is unique, and decisions regarding treatment should be made on an individual basis, considering the severity of the condition, the individual’s medical history, and their specific goals and expectations. This step by the country not only represents a step forward in advancing mental health treatment options but also highlights the commitment to addressing the needs of individuals with severe psychiatric conditions.
