Bilateral Stereotactic Anterior Cingulotomy is Effective in the Treatment of Drug-Resistant Psychosis and Impulse Control Disorders Caused by Traumatic Brain Injury: A Case Report
Chottiwat Tansirisithikul MD*, Bunpot Sitthinamsuwan MD, MSc*, Umpaikanit Samanwongthai MD**, Sarutabhandu Chakrabhandu Na Ayutaya MD***, Sarun Nunta-aree MD, PhD*
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Srithanya Psychiatric Hospital, Department of Mental Health, Ministry of Public Health, Nonthaburi, Thailand *** Sakaeo Rajanagarindra Psychiatic Hospital, Department of Mental Health, Ministry of Public Health, Sakaeo, Thailand
Background : Psychotic disorders due to traumatic brain injury (PDDTBI) represent severe form of neuropsychiatric
problems that can occur after traumatic brain injury (TBI). Some patients develop treatment-refractory psychiatric symptoms.
Psychosurgery is a viable option with good efficacy in such debilitating cases.
Objective : To report efficacy of anterior cingulotomy for suppressing intractable psychotic and impulsive symptoms caused
by TBI.
Case Report : The authors report a case of 37-year-old male with a history of TBI which required craniectomy with hematoma
evacuation and subsequent cranioplasty. He developed severe paranoid delusion with auditory hallucination, anxiety and
impulsivity. The patient was admitted to the psychiatric hospital for recurrent, severe, treatment-refractory psychotic symptoms
and impulsivity. Despite multiple drug regimens, his psychiatric symptoms did not improve. He underwent psychosurgery
using bilateral anterior cingulotomy.
Results : His symptoms were significantly improved after the surgery. His delusion, hallucination and impulsivity disappeared
and his mood became stable. He could resume daily activity. There was no recurrent symptom at 2 years postoperatively.
Conclusion : Anterior cingulotomy is an effective treatment option for refractory PDDTBI, especially if the psychotic manifestation
coincides with affective symptoms.
Keywords : Psychotic disorder due to traumatic brain injury, Delusion, Impulse control disorder, Psychosurgery, Anterior cingulotomy
