title: Long-term changes in the personality and psychopathological profile of opiate addicts after nucleus accumbens ablative surgery are associated with treatment outcome.
abstract: OBJECTIVE
  To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery.
  
  
  METHODS
  60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization's Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery.
  
  
  RESULTS
  The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments.
  
  
  CONCLUSIONS
  The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.
authors.affiliation: Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Shunnan
authors.initials: S
authors.lastname: Ge
authors.forename: Chongwang
authors.initials: C
authors.lastname: Chang
authors.forename: John R
authors.initials: JR
authors.lastname: Adler
authors.forename: Haikang
authors.initials: H
authors.lastname: Zhao
authors.forename: Xiaozan
authors.initials: X
authors.lastname: Chang
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.forename: Heming
authors.initials: H
authors.lastname: Wu
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.forename: Xuelian
authors.initials: X
authors.lastname: Wang
authors.forename: Guodong
authors.initials: G
authors.lastname: Gao
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D007406:Interview, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D009020:Morphine / Q000652:urine; D009497:Neurotic Disorders / Q000209:etiology / Q000523:psychology; D009714:Nucleus Accumbens / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000857:Olfaction Disorders / Q000209:etiology; D010551:Personality; D010555:Personality Inventory; D011612:Psychosurgery / Q000009:adverse effects; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D009020:Morphine