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July 1992

Psychosurgical Treatment of Obsessivecompulsive Disorder-Reply

Author Affiliations

Department of Psychiatry Massachusetts General Hospital Fruit Street Boston, MA 02114

Arch Gen Psychiatry. 1992;49(7):583-584. doi:10.1001/archpsyc.1992.01820070077015

In Reply.—  It is reassuring that Sach- dev and colleagues found rates of improvement similar to those in our group. We agree that face-to-face interviews are best to evaluate how patients are doing after psychosurgery, but unfortunately, almost all of the patients we were able to follow up lived great distances from our institution, and such contact was not feasible.We also agree that MRI confirmation of lesion location is of utmost importance, and we now use MRI to confirm the location of the probe before making the lesion, a technique that allows for precise localization of the lesions. We also have found that by using older techniques, some of the lesions may well have missed the cingulate bundle and that sometimes the cingulate gyrus and corpus callosum were affected.Caution is necessary in evaluating neuropsychologic assessments like the Wisconsin Card Sorting Test since the patients referred for psychosurgery are likely

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