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    Efficacy and Safety of Gamma Ventral Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder: A Single-Center Experience
    (Elsevier Science Inc, 2020) Peker, Selcuk; Samanci, Mustafa Yavuz; Yilmaz, Meltem; Sengoz, Meric; Ulku, Nazan; Ogel, Kultegin
    BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic disease with a lifetime prevalence of 3% and is associated with severe impairment in familial and socio-occupational functioning. Gamma ventral capsulotomy (GVC) is a treatment choice in carefully chosen patients, with few published reports. In this study, we aimed to report the efficacy and safety of GVC in 21 patients with treatment-resistant OCD. METHODS: This is a retrospective single-center study. Twenty-one patients meeting the selection criteria were included. Patients were considered responders if there were >= 35% reduction in post-GVC Yale-Brown Obsessive Compulsive Scale scores and considered in remission if scores were <= 8. The mean and median clinical follow-up durations were 60.7 and 56 months, respectively (range, 38-149 months). RESULTS: The mean baseline Yale-Brown Obsessive Compulsive Scale score of 35.7 (n = 21) decreased to 15.3 (n = 20) at 36 months follow-up evaluation (P < 0.0001). Fifteen patients (75%) achieved a full response. Of those patients, 7 (35%) were considered to be in remission. There were no partial responders, and 5 patients (25%) were classified as nonresponders. The pre-GVC mean Beck Depression Inventory-II score of 35.1 (n = 21) decreased to 13.8 (n = 20) at 36 months follow-up evaluation (P < 0.0001). Three patients (14.3%) had a transient post-GVC headache that resolved within a week, and 2 patients (9.5%) had persistent headaches that responded to 2-week oral corticosteroid treatment. A brain cyst developed after GVC in 2 patients (10%). No clinically notable abnormalities were seen on neurologic examination at any follow-up. CONCLUSIONS: Gamma ventral capsulotomy is a reasonable treatment method in select patients with treatment-resistant OCD.
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    Mentalization, Session-to-Session Negative Emotion Expression, Symbolic Play, and Affect Regulation in Psychodynamic Child Psychotherapy
    (Amer Psychological Assoc, Div Psychotherapy, 2019) Halfon, Sibel; Yilmaz, Meltem; Cavdar, Alev
    Internalizing and externalizing problems have been related to negative emotionality, and affect regulation deficits in several studies. Certain psychodynamic models of treatment use children's symbolic play activity as a medium to mentalize negative emotions in order to develop children's affect regulation. However, the complex associations among these constructs and their associations with outcome have not been examined. This study aimed to investigate, first. whether average mentalization practices in treatment, as well as session-to-session expression of negative emotions and symbolic play predict gains in affect regulation and. second, whether changes in these variables are associated with clinically significant change in symptoms and global function. The sample included 40 outpatient children, who underwent long-term psychodynamic treatment. Nine hundred seventy-five sessions were coded for children's symbolic play, affect expression (anger and dysphoric affect). and affect regulation characteristics, and each treatment was scored for average adherence to mentalizing principles. Time Series Panel Analyses (TSPA) indicated session-to session use of symbolic play predicted gains in affect regulation. A significant 2-way interaction indicated that dysphoric affect expression in high mentalization adherent treatments was associated with higher affect regulation than in low adherent treatments. Partial correlation analyses indicated that mentalization adherence in treatment was associated with symptomatic improvement at trend level of significance, and changes in affect regulation and symbolic play were significantly associated with gains in global function. Findings point to the importance of use of symbolic play, and dysphoric affect expression in the context of mentalization practices for gains in affect regulation and outcome.