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深部脑刺激对强迫症患者生活体验的影响:对18名患者的深入访谈

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients.

作者信息

de Haan Sanneke, Rietveld Erik, Stokhof Martin, Denys Damiaan

机构信息

Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.

Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands; Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

PLoS One. 2015 Aug 27;10(8):e0135524. doi: 10.1371/journal.pone.0135524. eCollection 2015.

Abstract

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study. We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c) characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one's abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research.

摘要

深部脑刺激(DBS)是一种相对较新的、用于治疗难治性强迫症(OCD)患者的实验性疗法。治疗效果通常使用测量症状数量的精神病理学量表进行评估。然而,临床经验表明,DBS的效果不仅限于症状:例如,患者报告了感知方面的变化、感觉更强壮和更自信,以及不假思索地做事。我们的目标是更好地全面了解强迫症患者在DBS治疗期间所经历的各种变化。为此,我们对18名强迫症患者进行了深入的半结构化访谈。在本文中,我们展示了这项定性研究的结果。我们将这些变化分为四个领域列出:关于(a)个人、(b)(社会)世界、(c)个人与世界互动的特征以及(d)生存姿态。随后,我们对这些结果进行了解释。特别是,我们认为这些变化中的许多可以被视为同一过程的不同表现形式;也就是说,焦虑和紧张的体验让位于基本信任的增加和对自身能力的更多依赖。然后,我们讨论了我们研究结果的临床意义,特别是关于如何恰当地告知患者他们可以从治疗中期待什么、在治疗中纳入认知行为疗法(CBT)的有用性以及当前治疗成功衡量标准的局限性。最后,我们提出了一些进一步研究的具体建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/578a/4552296/9cde52cc3b3c/pone.0135524.g001.jpg

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