Evidence map›Paper›PMID 37984432›Full record

ArticlePsychiatry and clinical neurosciences2024

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

Nicola Acevedo, Susan Rossell, David Castle, Clare Groves, Mark Cook, Peter McNeill, James Olver, Denny Meyer, Thushara Perera, Peter Bosanac

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Psychiatry and clinical neurosciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 2 countries.

Nicola AcevedoCentre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.ORCID https://orcid.org/0000-0003-3059-3620
Susan RossellCentre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.ORCID https://orcid.org/0000-0002-7415-8252
David CastleSt Vincent's Hospital, Melbourne, Victoria, Australia.
Clare GrovesClarity Health, Melbourne, Victoria, Australia.
Mark CookSt Vincent's Hospital, Melbourne, Victoria, Australia.
Peter McNeillSt Vincent's Hospital, Melbourne, Victoria, Australia.
James OlverDepartment of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
Denny MeyerCentre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.
Thushara PereraBionics Institute, East Melbourne, Victoria, Australia.
Peter BosanacSt Vincent's Hospital, Melbourne, Victoria, Australia.
St Vincent's Hospital Melbourne · AUThe University of Melbourne · AUBionics Institute · AUCentre for Addiction and Mental Health · CAMelbourne Health · AUSwinburne University of Technology · AU

Funding

National Health and Medical Research Council GNT1154651Perpetual IMPACT IPAP2017/1439
6 · The paper itself

Abstract

aimDeep 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.

methodsEight 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.

resultsSix 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.

conclusionThe 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).

Indexed as

Deep Brain StimulationObsessive-Compulsive DisorderAnxietyHumansNucleus AccumbensTreatment Outcomedeep brain stimulationelectrode localizationinsightneurostimulationobsessive-compulsive disorder

Identifiers

PMID37984432
PMCPMC10952286
OpenAlexW4388863723

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.