title: Schizophrenia and neurosurgery: A dark past with hope of a brighter future.
abstract: Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients. The history of neurosurgery for schizophrenia, among other psychiatric diseases, has a very dark past. Therefore, this review examines peer-reviewed studies on the history of schizophrenia, its medical and surgical therapies, financial costs, and future directions for disease management. We highlight the historically poor relationship between neurosurgery and psychiatric disease and discuss current research in the understandings of schizophrenia. Guided by a strong code of ethics and new technology, including the use of stereotaxis and deep brain stimulation (DBS), the medical communities treating psychiatric disease are beginning to overcome the horrors of the past. DBS is currently being used with moderate success in the treatment of depression, obsessive compulsive disorder, Tourette's syndrome, and anorexia nervosa. With greater understanding of the neural circuitry of schizophrenia and the evolving role for DBS in psychiatric disease, the authors believe that schizophrenia, like other psychiatric diseases, can be treated with DBS.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Sarris
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Herschman
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA. Electronic address: antonios.mammis@rutgers.edu.
authors.forename: Antonios
authors.initials: A
authors.lastname: Mammis
mesh_terms: D046690:Deep Brain Stimulation; D005544:Forecasting; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D009493:Neurosurgery / Q000266:history* / Q000639:trends*; D011612:Psychosurgery / Q000266:history* / Q000639:trends*; D012559:Schizophrenia / Q000601:surgery* / Q000628:therapy*
keywords: Deep brain stimulation; Psychosurgery; Schizophrenia