Improvement in Severe Self-Mutilation Following Limbic Leucotomy: A Series of 5 Consecutive Cases
J Clin Psychiatry 2001;62(12):925-933
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Background: The efficacy of neurosurgical intervention for self-mutilation
behavior associated with severe, intractable psychiatric disorders remains undetermined.
We report the effects of limbic leucotomy in 5 consecutive patients with severe
Method: After unsolicited referrals from their psychiatrists
and careful consideration by the Massachusetts General Hospital Cingulotomy
Assessment Committee (MGH-CAC), 5 patients were treated with limbic leucotomy.
Their primary DSM-IV psychiatric diagnoses were either obsessive-compulsive
disorder or schizoaffective disorder. Comorbid severe, treatment-refractory
self-mutilation was an additional target symptom. Outcome was measured by an
independent observer using the Clinical Global Improvement, Current Global Psychiatric-Social
Status Rating, and DSM-IV Global Assessment of Functioning scales in addition
to telephone interviews with patients, families, their psychiatrists, and treatment
teams. The mean postoperative follow-up period was 31.5 months.
Results: All measures indicated sustained improvement in 4 of
5 patients. In particular, there was a substantial decrease in self-mutilation
behaviors. Postoperative complications were transient in nature, and postoperative
compared with preoperative neuropsychological assessments revealed no clinically
Conclusion: In carefully selected patients as described in this
report, limbic leucotomy may be an appropriate therapeutic consideration for
self-mutilation associated with severe, intractable psychiatric disorders.