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Clinical outcomes of deep brain stimulation for obsessive‐compulsive disorder: Insight as a predictor of symptom changes.

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Title: Clinical outcomes of deep brain stimulation for obsessive‐compulsive disorder: Insight as a predictor of symptom changes.
Authors: Acevedo, Nicola (AUTHOR), Rossell, Susan (AUTHOR), Castle, David (AUTHOR), Groves, Clare (AUTHOR), Cook, Mark (AUTHOR), McNeill, Peter (AUTHOR), Olver, James (AUTHOR), Meyer, Denny (AUTHOR), Perera, Thushara (AUTHOR), Bosanac, Peter (AUTHOR)
Source: Psychiatry & Clinical Neurosciences. Feb2024, Vol. 78 Issue 2, p131-141. 11p.
Subjects: Deep brain stimulation, Nucleus accumbens, Prognosis, Neural stimulation, Obsessive-compulsive disorder
Abstract: Aim: Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive‐compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long‐term comprehensive follow‐ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response. Methods: Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open‐label longitudinal trial, duration of follow‐up varied between 9 months and 7 years. Post‐operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy. Results: Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6–9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non‐responders, relative to the Nac. Conclusion: The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision‐making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820). [ABSTRACT FROM AUTHOR]
Copyright of Psychiatry & Clinical Neurosciences is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Clinical outcomes of deep brain stimulation for obsessive‐compulsive disorder: Insight as a predictor of symptom changes.
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  Data: <searchLink fieldCode="AR" term="%22Acevedo%2C+Nicola%22">Acevedo, Nicola</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rossell%2C+Susan%22">Rossell, Susan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Castle%2C+David%22">Castle, David</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Groves%2C+Clare%22">Groves, Clare</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cook%2C+Mark%22">Cook, Mark</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McNeill%2C+Peter%22">McNeill, Peter</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Olver%2C+James%22">Olver, James</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Meyer%2C+Denny%22">Meyer, Denny</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Perera%2C+Thushara%22">Perera, Thushara</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bosanac%2C+Peter%22">Bosanac, Peter</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Psychiatry+%26+Clinical+Neurosciences%22">Psychiatry & Clinical Neurosciences</searchLink>. Feb2024, Vol. 78 Issue 2, p131-141. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Deep+brain+stimulation%22">Deep brain stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Nucleus+accumbens%22">Nucleus accumbens</searchLink><br /><searchLink fieldCode="DE" term="%22Prognosis%22">Prognosis</searchLink><br /><searchLink fieldCode="DE" term="%22Neural+stimulation%22">Neural stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Obsessive-compulsive+disorder%22">Obsessive-compulsive disorder</searchLink>
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  Label: Abstract
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  Data: Aim: Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive‐compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long‐term comprehensive follow‐ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response. Methods: Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open‐label longitudinal trial, duration of follow‐up varied between 9 months and 7 years. Post‐operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy. Results: Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6–9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non‐responders, relative to the Nac. Conclusion: The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision‐making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820). [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Psychiatry & Clinical Neurosciences is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – SubjectFull: Obsessive-compulsive disorder
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      – TitleFull: Clinical outcomes of deep brain stimulation for obsessive‐compulsive disorder: Insight as a predictor of symptom changes.
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              Text: Feb2024
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