Sich frei fühlen oder frei sein?

U. Spitzer; M. Figee; M. Mantione; D. Denys

doi:10.1055/s-0038-1628690

Nervenheilkunde, Table of Contents

Nervenheilkunde 2009; 28(09): 634-642
DOI: 10.1055/s-0038-1628690

Übersichtsarbeit

Schattauer GmbH

Sich frei fühlen oder frei sein?

Zur Psychologie des Erlebens von Zwangspatienten unter TiefenhirnstimulationTo feel free or to be free?

U. Spitzer

¹Klinik für Psychiatrie AMC der Universität Amsterdam

,

M. Figee

¹Klinik für Psychiatrie AMC der Universität Amsterdam

,

M. Mantione

¹Klinik für Psychiatrie AMC der Universität Amsterdam

,

D. Denys

¹Klinik für Psychiatrie AMC der Universität Amsterdam

› Author Affiliations

Abstract

Zusammenfassung

Die Tiefenhirnstimulation (deep brain stimulation, DBS) stellt ein neuartiges Therapieverfahren für Patienten mit therapierefraktärer schwerer Zwangserkrankung dar. Auf die von Zwangspatienten empfundene mangelnde Kontrolle und Entscheidungsfreiheit kann mittels elektrischer Stimulation positiv eingewirkt werden. Es stellt sich die Frage, wie diese „artifizielle Freiheit” von den Patienten erlebt wird. Anhand einer Kasuistik und eines Gruppenvergleichs (mit zwei Kontrollgruppen) wird die Psychologie des Zwangs und insbesondere die subjektive Wahrnehmung von Freiheit und Kontrolle mit der Methode des strukturierten Interviews bei Zwangspatienten unter DBS charakterisiert. Die Patienten erleben unter DBS nicht nur eine Veränderung ihres „Freiheitsgefühls”, sondern vor allem eine Veränderung des Raums ihrer alternativen Handlungsmöglichkeiten, sie „sind” also im praktischen Sinne frei.

Summary

Deep brain stimulation (DBS) is a relatively recent therapeutic intervention for patients with therapy-resistant obsessive compulsive disorder. The experienced lack of personal freedom and control can be positively altered by the use of electrical brain stimulation. This raises the question as to whether this “artificial freedom” is subjectively experienced by the patients. Qualitative data from a case report and from standardized interviews of three groups – OCD-patients treated pharmacologically, DBS-treated OCD-Patients, and student control subjects – are presented and a quantitative statistical analysis of betweengroup comparison are used to discuss the psychological aspects of freedom and control in OCD-patients, in particular, on and off DBS. It turns out that DBS-patients not only report subjective changes of their “feelings of freedom” but rather a change of their freedom of agency. In other words, they experience a change in their actual freedom and not just in the realm of subjective feelings about freedom.

Schlüsselwörter

Zwangserkrankung - Tiefenhirnstimulation - Erfahrung - Kontrolle - Freiheit

Keywords

Obsessive compulsive disorder - deep brain stimulation - subjective experience - cognitive control - personal freedom

Full Text

References

Literatur
1 Abelson JL. et al. Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder. Biol Psychiatry 2005; 57: 510-516.
2 Alexander G. et al. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Ann Rev Neurosci 1986; 09: 357-381.
3 Alexander GE, Crutcher MD. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci 1990; 13: 266-271.
4 Alexander GE. et al. Basal ganglia-thalamocortical circuits: Parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog Brain Res 1990; 85: 119-146.
5 Anderson D, Ahmed A. Treatment of patients with intractable obsessive-compulsive disorder with anterior capsular stimulation. J Neurosurg 2003; 98: 1104-1108.
6 Aouizerate B. et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. J Neurosurg 2004; 101: 682-686.
7 Bejerot S. Psychosurgery for obsessive-compulsive disorder – concerns remain. Acta Psychiatrica 2003; 107: 241-243.
8 Breiter HC. et al. Functional magnetic resonance imaging of symptom provocation in obsessivecompulsive disorder. Arch Gen Psychiatry 1996; 53: 595-606.
9 Denys D. et al. Deep Brain Stimulation of the Nucleus Accumbens in Treatment-refractory patients with Obsessive-Compulsive Disorder, unpublished.
10 Deutschl G. Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: a therapy approaching evidence-based standards. J Neurol 2003; 250 (Suppl. 01) I/43-I/46.
11 Fontaine D. et al. Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson disease. J Neurosurg 2004; 100: 1084-1086.
12 Greenberg BD. et al. Three-year outcomes in deep brain stimulation for highly resistant obsessivecompulsive disorder. Neuropsychopharmacology 2006; 31 (11) 2384-2393.
13 Hansen E. et al. The caudate nucleus in obsessivecompulsive disorder. Reduced metabolism following treatment with paroxetine: a PET study. J Neuropsychopharmacol 2002; 05: 1-10.
14 Jiménez F. et al. A patient with a resistant major depression disorder treated with deep brain simulation in the inferior thalamic peduncle. Neurosurgery 2005; 57: 585-593.
15 Kang DH. et al. Brain glucose metabolic changes associated with neuropsychological improvements after 4 months of treatment in patients with obsessive-compulsive disorder. Acta Psychiatr Scand 2003; 107: 291-297.
16 Kischka U. et al. Frontal-subkortikale neuronale Schaltkreise. Fortschritte der Neurologie Psychiatrie 1997; 65: 221-231.
17 Mallet L. et al. Compulsions, Parkinson’s disease, and stimulation. Lancet 2002; 360: 1302-1304.
18 McCracken CB, Grace AA. High-frequency deep brain stimulation of the nucleus accumbens region suppresses neuronal activity and selectively modulates afferent drive in rat orbitofrontal cortex in vivo. J. Neuroscience 2007; 27 (46) 12601-12610.
19 Nakatani E. et al. Effects of behavior therapy on regional cerebral blood flow in obsessive-compulsive disorder. Psychiatry Res 2003; 124: 113-120.
20 Nuttin BJ. et al. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 1999; 354 (9189): 1526.
21 Nuttin BJ. et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 2003; 52: 1263-1274.
22 Okun MS. et al. Internal capsule and nucleus accumbens region DBS : Responses observed during active and sham programming. J Neurol Neurosurg Psychiatry 2007; 78: 310-4.
23 Schlaepfer T, Lieb K. Deep brain stimulation for treatment of refractory depression. Lancet 2005; 366: 1420-1422.
24 Schlaepfer T. et al. Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression. Neuropsychopharmacology 2008; 33: 368-377.
25 Schwartz J. et al. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1996; 53: 109-113.
26 Seijo-Zazo E. et al. A proposed new target for deep brain stimulation in obsessive-compulsive disorder. Rev Neurol 2007; 424-428.
27 Sturm V. et al. The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsiveand anxiety-disorders. J Chemical Neuroanatomy 2003; 26: 293-299.
28 Greenberg BD. et al. The evolution of deep brain stimulation for neuropsychiatric disorders. Front Biosci 2008; 13: 4638-48.