bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2021-55-2-8-20bekhterev-557Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWИстория и перспективы применения психохирургических вмешательств при терапии психических расстройств. Аргументы «pro et contra»History and prospects of psychosurgical interventions in the treatment of mental disorders. The arguments «pro et contra»https://orcid.org/0000-0001-7829-2486ИвановМ. В.IvanovM. V.

Санкт-Петербург

St. Petersburg

profmikhailivanov@gmail.comhttps://orcid.org/0000-0001-5851-0626СтановаяВ. В.StanovayaV. V.

Санкт-Петербург

St. Petersburg

vika06.95@mail.ruhttps://orcid.org/0000-0002-5884-3110СкоромецТ. А.SkorometsT. A.

Санкт-Петербург

St. Petersburg

tskoromets@mail.ruhttps://orcid.org/0000-0002-7700-2704МихайловВ. А.MikhailovV. A.

Санкт-Петербург

St. Petersburg

vladmikh@yandex.ruhttps://orcid.org/0000-0003-0029-1509АкименкоМ. А.AkimenkoM. A.

Санкт-Петербург

St. Petersburg

akimenko-m@yandex.ruНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. БехтереваРоссияV.M. Bekhterev National Research Medical Center for Psychiatry and NeurologyRussian FederationНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева; Первый Санкт-Петербургский медицинский университет им. акад. И.П. ПавловаРоссияV.M. Bekhterev National Research Medical Center for Psychiatry and Neurology; First Saint Petersburg medical University named after I. P. Pavlov Ministry of health of the Russian FederationRussian Federation202104082021552820Copyright © Иванов М.В., Становая В.В., Скоромец Т.А., Михайлов В.А., Акименко М.А., 20212021Иванов М.В., Становая В.В., Скоромец Т.А., Михайлов В.А., Акименко М.А.Ivanov M.V., Stanovaya V.V., Skoromets T.A., Mikhailov V.A., Akimenko M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/557

Большинство пациентов, страдающих психическими расстройствами, могут эффективно лечиться с помощью таких методов, как фармакологическая терапия, психотерапия, электросудорожная терапия.  Данные методы лечения могут использоваться как по отдельности, так и в комбинации.  Тем не менее, часть пациентов либо не реагирует на терапию, либо испытывает выраженные побочные эффекты.  Именно для таких пациентов можно рассмотреть возможность применения нейрохирургических процедур. Психохирургию считают хирургией мозга, используемую для облегчения болезненных психических проявлений или для смягчения течения психического заболевания. О психохирургии можно говорить как о способе коррекции психических нарушений. Ее следует рассматривать, как звено в системе лечения и реабилитации больных с терапевтически резистентными психическими расстройствами.Несмотря на многовековую историю психохирургии, вопрос о целесообразности применения хирургических методов для лечения психических расстройств до настоящего времени остается одним из трудноразрешимых. В наши дни психохирургия является малотравматичной операцией, что связано с прицельными и дозированными вмешательствами на глубокие отделы головного мозга человека. В данном обзоре приведены основные этапы становления психохирургии, основные хирургические методы, используемые для лечения психических расстройств, а также рассмотрены будущие вероятные направления нейрохирургического лечения в психиатрической клинике. Приведена аргументация для использования этого вида лечения при формировании проявлений терапевтической резистентности. Принимая во внимание диаметральность в оценках целесообразности применения методов психохирургии, в заключительной части статьи рассмотрены аргументы «за и против» оперативного лечения психических расстройств.

Most patients with mental disorders can be effectively treated with therapies such as pharmacological therapy, psychotherapy, electroconvulsive therapy. These treatments can be used individually or in combination. However, some patients either do not respond to therapy or experience severe side effects. It is for these patients that neurosurgical procedures may be considered. Psychosurgery is considered brain surgery used to alleviate painful mental manifestations or to mitigate the course of mental illness. Psychosurgery can be talked about as a way to correct mental disorders. It should be considered as a link in the system of treatment and rehabilitation of patients with therapeutically resistant mental disorders.Despite the centuries-old history of psychosurgery, the question of the expediency of using surgical methods for the treatment of mental disorders still remains one of the intractable ones. Today, psychosurgery is a low-traumatic operation, which is associated with targeted and dosed interventions on the deep parts of the human brain. This review describes the main stages in the development of psychosurgery, the main surgical methods used to treat mental disorders, and also discusses the future probable directions of neurosurgical treatment in a psychiatric clinic. The argumentation for the use of this type of treatment in the formation of manifestations of therapeutic resistance is given. Taking into account the diametrality in assessing the feasibility of using the methods of psychosurgery, the concluding part of the article discusses the pros and cons of surgical treatment of mental disorders.

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The authors declare that there are no conflicts of interest present.