Psychosis is a common disease, and with the accelerated pace of work and fierce competition in modern society, the incidence of psychosis is on the rise year by year. According to the literature, the incidence of psychiatric disorders in China is 0.5%, and in Guangdong, it is 2%. Patients with mental illness have a series of symptoms due to disorders in thinking, emotion, and mental behavior, resulting in loss of control of behavior, especially those with aggressive behavior, who are prone to injury, destruction, and arson, which are destructive and threaten the lives and property of family members, and have an impact on social security and social stability. Therefore, psychiatric treatment is not only a medical problem, but also a social problem. The surgical treatment of psychiatric disorders has a history of more than 70 years, which has attracted great interest from psychiatry, neurology, neurosurgery and medical ethics, and it can be said that no other treatment in clinical medicine has caused so much enthusiasm, controversy and misunderstanding as the surgical treatment of psychiatric disorders. The surgical treatment of psychosis was awarded the Nobel Prize (1949), but by the middle of the 20th century, the abuse of prefrontal lobotomy produced significant side effects that made the surgical treatment of psychosis controversial, and later, with the introduction of chlorpromazine, the surgical treatment of psychosis was drastically reduced. In the last decade or so, rapid advances in neuroscience research (especially in brain function) have led to a better understanding of some psychiatric disorders; evolving neurobiological evidence has also provided surgical justification for psychiatric surgery, such as altered glucose metabolism in specific regions of the brain in patients with OCD and depression. The development of neuroimaging, stereotactic surgical equipment, and minimally invasive or noninvasive surgical approaches has led to more precise and less invasive psychosurgery, with almost no surgical deaths. In recent decades, the remarkable efficacy of surgical treatment of OCD and depression as a last resort for refractory patients has led to a renewed interest in psychosurgery worldwide. In particular, deep brain electrical stimulation (DBS) has been a milestone in the renaissance of psychosurgery by achieving exciting results in the surgical treatment of psychiatric disorders along with great success in the treatment of movement disorders, making psychosurgery reversible and minimally invasive, with treatment varying from person to person. 1, the current state of psychosurgery treatment The acceptance of psychosurgery varies greatly throughout the world. There are ethical and legal differences between countries, but the main reason is that psychiatrists in different countries have different understanding of surgical treatment. In Europe and the United States, most psychiatrists believe that modern psychosurgery (destructive surgery) offers a last resort for some refractory obsessive-compulsive disorders, anxiety disorders, and depression, based on extensive retrospective studies of psychosurgery and a small number of prospective studies. In 1999, a U.S. survey also showed widespread acceptance of psychosurgery among psychiatrists, with 83% of National Psychiatric Association members identifying themselves as knowledgeable about surgical treatment of refractory OCD, and 74% of these psychiatrists indicating that they would refer appropriate patients for surgery. in 2002, in a psychotropic medication study session involving 124 psychiatrists In 2002, 85% of psychiatrists were aware of surgical treatment of OCD, and 68% of them were willing to refer refractory patients for surgical treatment. Since the introduction of the DBS approach to the surgical treatment of psychiatric disorders, this reversible approach, which does not produce any permanent side effects, has become more widely accepted, and some countries that had previously banned destructive surgery for psychiatric disorders (e.g., France) have officially approved DBS treatment for psychosurgery. In China, psychosurgery treatment officially started in the mid-1980s and attracted strong interest from a large number of neurosurgeons, treating hundreds of cases of various refractory psychiatric patients in just a few years, but it has never been accepted by the domestic psychiatric community, much less as an alternative treatment option for certain refractory psychiatric disorders. The main reasons are: (1) neurosurgeons do not know enough about modern psychosurgery, and a large number of surgeries have been selected for patients with chronic schizophrenia, failing to show good surgical results, while few patients with preferred indications for psychosurgery such as obsessive-compulsive disorder, anxiety disorder, and depression have been treated, making it rare for the psychiatric community to see good surgical results. (2) The level of functional neurosurgery varies from hospital to hospital, and it fails to correctly select and master psychosurgery methods. This also has a direct impact on the efficacy of surgery. (3) Psychiatrists are not deeply involved in this work, especially in some influential mental health centers. This affects both the effectiveness of surgery and the psychiatric community’s lack of opportunity to gain an objective understanding of surgical treatment. In recent years, psychosurgery has gradually attracted the attention of domestic functional neurosurgeons and a few psychiatrists again, and psychosurgical treatment has been carried out in some hospitals. Compared with the practice of psychosurgery 20 years ago, the theoretical level of psychosurgery is now much higher, and the improvement of surgical equipment and surgical techniques have been greatly improved. Some psychosurgical treatments have even attracted international psychosurgical attention, such as the surgical treatment of psychiatric disorders caused by drug abuse (addiction) and Tourette’s syndrome. Some hospitals have not only gained a lot of clinical experience in psychosurgery, but also made some achievements in basic research, such as brain metabolic changes produced by surgery for obsessive-compulsive disorder, animal studies of drug treatment surgery, neurotransmitter studies of psychosurgery, etc. 2, the selection of patients for psychiatric surgical treatment In general, psychosurgical treatment of patients must be chronic, refractory psychiatric patients, that is, those who have been given adequate and sufficient treatment by experienced psychiatrists, including psychotherapy, psychotropic drugs, behavioral therapy, psychoanalysis, electroconvulsive shock, etc., but still failed to improve the symptoms, and seriously affect the patient’s quality of life, if not surgical Severe psychiatric patients whose prognosis may be very poor without surgical intervention. In terms of disease type, obsessive-compulsive neurosis, anxiety disorders, and depression are the best indications for psychosurgical treatment; in addition, bipolar disorder, social phobia, impulsive and aggressive behavior, and certain chronic pain are also good indications for surgery. Chronic schizophrenia is not an indication for surgery because surgery does not improve the main symptoms of schizophrenia, such as hallucinations and delusions, but it can still produce good results for obsessive-compulsive symptoms, impulsive-aggressive behavior, and affective disorders that accompany chronic schizophrenia. Although controversial, substance abuse disorders (addiction), anorexia nervosa, and certain personality disorders (except antisocial and paranoid personality disorders) may also benefit from psychosurgery. In particular, surgical treatment of substance abuse disorders (drug addiction) has a success rate of over 70%, without particularly serious complications, and maintains good long-term outcomes. 3, the efficacy and side effects of psychosurgery Currently, the commonly used surgical methods include cingulate gyrus destruction, anterior limb destruction of the internal capsule, subcaudate nucleus conduction bundle severance, and posterior medial hypothalamic destruction. Different surgical methods are suitable for different psychiatric disorders, and their efficacy and side effects vary. (1) Cingulate gyrus disruption This surgery is the most used surgery in the United States and Canada, and is suitable for affective psychiatric disorders, effective for 60% of depression and 40% of bipolar disorders. In the United States, 200 cases of chronic pain with drug addiction and depression were reported in 1977. 90% of the patients had complete resolution of symptoms after surgery, and the greatest surgical risk was epilepsy (1%), with no deaths reported; short-term side effects included mild confusion, emotional impairment, and near-memory impairment, which usually recovered within a few weeks after surgery. (2) Internal capsular forelimb dissection Although the side effects after internal capsular forelimb dissection are more frequent and severe than those after cingulate gyrus dissection, its efficacy is much better, with significant improvement rates above 80% for both OCD, anxiety disorders, and social phobia, and is equally effective for depression. Short-term fatigue, confusion, and near-memory impairment are common side effects that usually recover within a few days. A few patients have delayed onset of lack of motivation, poor initiative, and personality disorders, which are more serious complications of internal capsule forelimb destruction. (3) Subcaudate nucleus conduction bundle dissection This procedure is effective for chronic recurrent depression, although treatment of obsessive-compulsive disorder has also been reported, but the efficacy is much lower than that of anterior limb disruption of the internal capsule. The main side effects are postoperative confusion, mild word and visual memory loss, which usually recover in a few weeks to months. (4) Posterior medial hypothalamic disruption This procedure is mainly used to treat aggressive and disruptive behavior and sympathetic tension and agitation symptoms, with very mild side effects and drowsiness in some patients.