Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.
Department of Psychiatry, The University of Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2022 Oct;56(10):1219-1225. doi: 10.1177/00048674221100947. Epub 2022 May 21.
Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.
深部脑刺激是一种新兴的治疗难治性强迫症患者的方法。然而，其可及性有限，治疗方案存在异质性，并且针对最佳实践尚无指南或共识。在这里，我们结合科学研究、专家意见和临床专业知识的证据，为难治性强迫症患者的深部脑刺激治疗的术前、手术和术后阶段提出了一些临床建议。我们采用了以人为本的生物心理社会方法。简要地说，我们讨论了与反应相关的临床特征、使用改进的教育材料、评估性同意过程、由专家临床医生进行全面编程、更全面的治疗效果评估、多学科辅助心理治疗以及同伴支持计划的重要性。此外，在确定存在差距的地方，提出了未来的研究建议，包括连接组手术靶向、硬件模型的科学评估和健康经济数据。此外，我们鼓励通过临床登记册和编程临床医生的同行小组共享数据和知识的协作组。我们旨在就深部脑刺激治疗难治性强迫症患者的疗效决定因素展开讨论，这是一个罕见和严重的患者群体，并有助于更标准化和基于证据的实践。
