Psychosurgery is used in -

Ans. is 'c' i.e., OCD Treatment if ICDo Drug treatment and behavioral therapy (including cognitive behavioral therapy) are regarded as first line treatments.1) Drug treatment: - SSRIs antidepressants (Fluoxetine, paroxetine, sertaline, Citalopram, fluvomoxamine) are the drugs of choice. Amongst the TCA only clomipramine is effective as it is the most selective for serotonin reuptake versus norepinephrine reuptake and is exceeded in this respect only by the SSRIs. Other drugs which can be added, if patient is not responding to clomipramine or SSRIs, are Valproate, Carbamazapine , Lithium, venlafaxine, Pindolol, MAOIs, buspirone and clonazepam.2) Behavior therapy ; - Most commonly used behavior therapy is exposure and response prevention. Other behavior techniques are systemic desensitization, Flooding, thought stopping, aversive conditioning and implosion therapy.3) Psychotherapy: - Psychoanalytic psychotherapy is used in certain selected patients who are psychologically oriented. Supportive psychotherapy must include attention to family members through provision of emotional support, reassurance, explanation and advice on how to manage and respond to the patient.4) ECT: - For extreme cases that are resistant and chronically debilitating, ECT (VPSC09) and psychosurgery are considerations.5) Psychosurgery : - Psychosurgery can be used in treatment of OCD that has become intractable, and is not responding to other methods of treatment. The procedures employed are : - i) Stereotactic limbic leucotomy (cingulotomy), and ii) Stereotactic Subcaudate tractotomy (capsulotomy).