The cerebellar pacemaker for intractable behavioral disorders and epilepsy: follow-up report.

Thirty-eight patients who were intractably ill with a variety of behavioral disorders have been treated at Tulane with a chronically implanted cerebellar pacemaker. Included in the series ara schizophrenics, depressives, epileptics with behavioral pathology, and patients with severe organic brain pathology. The patients who have responded best to the treatment are those with depression, those with behavioral pathology consequent to epilepsy, and those with psychotic behavior consequent to structural brain damage. Results obtained in the chronic schizophrenic patients have been less favorable. The follow-up period ranges from a few months to 27 months. Overall, the results continue to be encouraging. Twenty-one percent of the patient group displayed structural evidence of cerebellar pathology that was not detected before operation, a finding which suggests that cerebellar damage may induce psychotic behavior.

Cerebellar pacemaker patients: an update.

Of the initial group of 38 patients in whom we have used cerebellar stimulation for treatment of intractable behavioral pathology, 25 continue to have beneficial effects. However, there have been significant technical problems due to failure of the equipment. While impairing treatment, these complications have provided inadvertent controls. The procedure must still be considered developmental at this time, despite promising therapeutic efficacy.

Psychiatric disorders in the medically ill.

Psychiatric disorders commonly coexist in patients with medical illness. Three disorders encountered frequently are anxiety disorders, depression, and delirium. The authors discuss these psychiatric disorders and their treatment in medically ill patients. Psychiatric consultation may be helpful in such cases.

Major depression in primary care.

Major depression in a primary care population is an important clinical entity. Although major depression is prevalent in primary care, it is frequently underdiagnosed and undertreated. The presence of major depression in the medically ill increases morbidity, mortality, and utilization of medical resources. Depression may be the initial manifestation of a medical disorder. The diagnosis of major depression in primary care requires a thorough work-up. This depressive disorder responds best to a combination of counseling and antidepressant medication. An algorithm is suggested to assist the clinician in the selection of an appropriate antidepressant.