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For instance, a recent study demonstrated that patients who have successfully undergone ALIC DBS nonetheless exhibit persistent deficit in impulse control and decision-making on formal neuropsychological testing, suggesting that these aspects of executive function may be mediated by a separate circuit other than the orbitofrontal loop targeted by DBS Grassi et al.

Rather than the current empiric approach to DBS programming, these data may ultimately allow for more selective, algorithmic selection of optimal stimulation parameters. Deep brain stimulation targets for OCD have evolved significantly over time, both in anatomic location and concept. It is now clear that targeting posteriorly and ventrally within the capsule leads to improved outcomes.

Deep Brain Stimulation for Mental Illnesses Raises Ethical Concerns - leapsmag

The overall trajectory of leads is also clearly important, as therapeutic effect is likely derived from direct stimulation of white matter tracts that lead to modulation of broad cortical and subcortical networks. Despite significant advance, the underlying alterations in the CSTC circuitry that mediate improved clinical efficacy remain unclear, the optimal stimulation site is still not precisely defined, and trial designs continue to be debated.

Nevertheless, improved anatomical and functional models of the involved regions, along with an infusion of technology, has led to promising new lines of study. AV and SS were responsible for conception of the article and critical review. SL and PK were co-first authors responsible for literature search and primary writing of the manuscript.

JJ-S and WG provided critical review of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Abelson, J. Deep brain stimulation for refractory obsessive-compulsive disorder. Psychiatry 57, — Ahmari, S. Repeated cortico-striatal stimulation generates persistent OCD-like behavior. Science , — Alexander, G.

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Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Ballantine, H. Treatment of psychiatric illness by stereotactic cingulotomy. Psychiatry 22, — Bari, A. Charting the road forward in psychiatric neurosurgery: proceedings of the american society for stereotactic and functional neurosurgery workshop on neuromodulation for psychiatric disorders. Psychiatry 89, — Beucke, J. Abnormally high degree connectivity of the orbitofrontal cortex in obsessive-compulsive disorder. JAMA Psychiatry 70, — Deeb, W.

The international deep brain stimulation registry and database for gilles de la tourette syndrome: how does it work? Denys, D. Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. North Am. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder.

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  4. Psychiatry 67, — Dougherty, D. Psychiatry 78, — Draganski, B. Evidence for segregated and integrative connectivity patterns in the human basal ganglia.

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    Figee, M. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Goodman, W. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Obsessive-compulsive disorder. The yale-brown obsessive compulsive scale. Development, use, and reliability. Psychiatry 46, — Grassi, G. Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual.

    CNS Spectr. Greenberg, B. Psychiatry 15, 64— Three-year outcomes in deep brain stimulation for highly resistant obsessive—compulsive disorder. Neuropsychopharmacology 31, — Gu, B. Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder. Brain J. Guehl, D. Neuronal correlates of obsessions in the caudate nucleus. Psychiatry 63, — Haber, S. The reward circuit: linking primate anatomy and human imaging. Neuropsychopharmacology 35, 4— Hartmann, C. Holtzheimer, P. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial.

    Lancet Psychiatry 4, — Jennings, J.

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    Distinct extended amygdala circuits for divergent motivational states. Nature , — Levine, J. Obsessive-compulsive disorder among schizophrenic patients: an exploratory study using functional magnetic resonance imaging data.

    This could be the next frontier in mental health treatment

    Psychiatry 39, — Luyten, L. Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Psychiatry 21, — Makris, N. Brain Imaging Behav. Mataix-Cols, D. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder.

    Psychiatry 61, — McGovern, R. And these new applications are raising profound ethical questions about individuality, personality, and even what it means to be human. If a participant experiences a personality change, does this change who they are or dehumanize them by altering their nature? These are some of the questions we have to consider. The U. The National Institutes of Health recently awarded grants to study the neuroethical issues surrounding the use of DBS in neuropsychiatric and movement disorders and appropriate consent for brain research.

    These new awards signal our commitment to research conducted in a responsible way as to anticipate all potential consequences, and to ensure that research subjects have a clear understanding of the potential benefits and risks of participating in studies. Adaptive DBS is a relatively new version of the technology that enables recording of brain cell activity that is then used to regulate the brain in real time.

    He and his team will closely observe researchers conducting aDBS studies and administering in-depth interviews to trial participants, their caregivers, and researchers, as well as individuals who declined to participate in such studies. The goal is to gain a better understanding of the ethical concerns at stake in order to guide responsible research.

    Lazaro-Munoz said one of the concerns is dehumanization. When we are not in control of ourselves, are we ourselves? However, there is a difference.

    Culturally we are more used to using drugs, not implanting devices into brain and computer interfaces. Many people think of it as science fiction.