Journal Article Annotations
2023, 3rd Quarter

Interventional Psychiatry

Annotations by Liliya Gershengoren, MD
October, 2023

The Network Systems Underlying Emotions: The Rational Foundation of Deep Brain Stimulation Psychosurgery.

PUBLICATION #1 — Interventional Psychiatry

The Network Systems Underlying Emotions: The Rational Foundation of Deep Brain Stimulation Psychosurgery.

Lorena Vega-Zelaya, Jesús Pastor.

Abstract: Brain Sci. 2023 Jun 12;13(6):943. doi: 10.3390/brainsci13060943.

Science and philosophy have tried to understand the origin of emotions for centuries. However, only in the last 150 years have we started to try to understand them in a neuroscientific scope. Emotions include physiological changes involving different systems, such as the endocrine or the musculoskeletal, but they also cause a conscious experience of those changes that are embedded in memory. In addition to the cortico-striato-thalamo-cortical circuit, which is the most important of the basal ganglia, the limbic system and prefrontal circuit are primarily involved in the process of emotion perceptions, thoughts, and memories. The purpose of this review is to describe the anatomy and physiology of the different brain structures involved in circuits that underlie emotions and behaviour, underlying the symptoms of certain psychiatric pathologies. These circuits are targeted during deep brain stimulation (DBS) and knowledge of them is mandatory to understand the clinical-physiological implications for the treatment. We summarize the main outcomes of DBS treatment in several psychiatric illness such as obsessive-compulsive disorder, refractory depression, erethism and other conditions, aiming to understand the rationale for selecting these neural systems as targets for DBS.

Annotation

The finding:
The article presents a multidisciplinary approach to understanding emotions through the lens of neuroscience. It specifically delves into the application of Deep Brain Stimulation (DBS) for treating various psychiatric conditions, such as obsessive-compulsive disorder and treatment-resistant depression. The article cites multiple studies, including randomized trials, to substantiate the efficacy of DBS in these conditions. It also discusses the role of neural networks in the effectiveness of DBS, providing an evidence-based foundation for its use in psychiatric treatments.

Strength and weaknesses:
The article comprehensively covers the application of DBS in various psychiatric conditions. However, the article lacks robust discussion on the limitations or adverse effects of DBS, leaving readers with an overly optimistic view of the technique. Additionally, there may be limitations in the depth or scope of the research presented. Furthermore, while the article focuses on the efficacy of DBS, it does not does reflect on treatment accessibility or ethical considerations, which are crucial in psychiatric interventions.

Relevance:
The findings on the efficacy of DBS in treating various psychiatric conditions are highly relevant for C-L psychiatrists. We often encounter complex cases that have not responded well to traditional treatments, and the evidence presented in the article could offer an alternative, evidence-based intervention to consider. Understanding the neural networks involved and the clinical outcomes of DBS enable C-L psychiatrists to make more informed recommendations and potentially improving patient outcomes in challenging cases.