Thermocoagulation for the Treatment of Anorexia Nervosa Associated with Obsessive-Compulsive Disorder: Case Report

Abstract

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are two psychiatric disorders that often overlap or are diagnosed as distinct disorders in the same individual. Although neurosurgical treatment is currently reserved for patients with refractory chronic OCD, it has been evidenced that it is also effective for the treatment of AN, since these two disorders share some pathophysiological neurocircuits. The present study aimed to report the case of a patient with AN, OCD, schizophrenia, and comorbid depression who underwent thermocoagulation of the nucleus accumbens associated with anterior cingulotomy and anterior capsulotomy, all of them bilaterally. Follow-up, performed 16 months after the procedure, showed substantial improvement in AN, OCD, and schizophrenia symptoms, demonstrating the effectiveness of this type of intervention in patients refractory to conservative treatment.

Resumo

A anorexia nervosa (AN) e o transtorno obsessivo-compulsivo (TOC) são dois transtornos psiquiátricos que, muitas vezes, se sobrepõem ou são diagnosticados como transtornos distintos no mesmo indivíduo. Embora o tratamento neurocirúrgico seja atualmente reservado para pacientes com TOC crônico refratário, foi evidenciado que também é eficaz para o tratamento de AN, uma vez que estes dois distúrbios compartilham alguns neurocircuitos fisiopatológicos. O presente estudo teve como objetivo relatar o caso de uma paciente com AN, TOC, esquizofrenia e depressão comórbida submetida a termocoagulação de nucleus accumbens em associação com cingulotomia anterior e capsulotomia anterior, todos bilateralmente. O seguimento, realizado 16 meses após o procedimento, mostrou melhora substancial de AN, TOC e sintomas de esquizofrenia, demonstrando a eficácia deste tipo de intervenção em pacientes refratários ao tratamento conservador.

Keywords

stereotaxic technique - radiofrequency - anorexia nervosa - obsessive-compulsive disorder - schizophrenia

Palavras-chave

técnica estereotáxica - radiofrequência - anorexia nervosa - transtorno obsessivo-compulsivo - esquizofrenia

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