Abstract

REFRACTORY AGGRESSION IN INTELLECTUAL DISABILITY: PSYCHIATRIC ASSESSMENT AND INDICATIONS FOR PSYCHOSURGERY

Objective: Psychosurgery is rarely discussed and is a form of last method of psychiatric intervention. It is timely to review the indications and components of psychiatric assessments for psychosurgery for aggression in intellectual disability in the literature. Methods: Articles were searched in the MEDLINE database using these search terms: “Aggression; challenging behaviour; mental retardation, intellectual disability; psychosurgery; stereotactic surgery; surgical interventionâ€. Results: Twelve case series and case reports were found. Refractory aggression in intellectual disability warranting psychosurgery includes the following elements: severity, long duration of symptoms, failures of multiple treatments, and profound impairment of functioning/quality of life. Progressive neurological disorders have to be ruled out. Informed consent from guardians and ethical approval are also essential for psychosurgery. Several tools have been employed to measure variables such as intelligence, aggression, and adaptive functioning. Conclusions: A set of inclusion and exclusion criteria is proposed based on the findings. Protocol for referral and assessment in the local setting is also recommended. With careful patient selection, psychosurgery is a feasible treatment option.