Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation
Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation
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DOI：
10.1177/00048674221100947
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发表时间：
2022-05-21
影响因子：
4.6
通讯作者：
Rossell, Susan
中科院分区：
文献类型：
--
作者：
Acevedo, Nicola;Castle, David;Rossell, Susan
脑深部电刺激是一种治疗难治性强迫症的新兴疗法。然而，可获得性有限，治疗方案多种多样，没有关于最佳做法的准则或共识。在此，我们结合来自科学调查、专家意见和我们的临床专业知识的联合收割机证据，从治疗难治性强迫症患者的脑深部电刺激护理的术前、手术和术后阶段提出几项临床建议。采用了以人为本的生物心理社会方法。简单地说，我们讨论了与反应，使用改进的教育材料，评估同意过程，由专家临床医生全面规划，更全球性的治疗效果评估，多学科辅助心理治疗和同伴支持计划的重要性相关的临床特征。此外，在发现差距的地方，提出了未来的研究建议，包括连接体手术靶向，硬件模型和卫生经济数据的科学评估。此外，我们鼓励通过临床登记和编程临床医生同行小组的方式进行数据和知识共享的协作组。我们的目标是开始讨论脑深部电刺激治疗难治性强迫症患者（一种罕见且严重的患者群体）疗效的决定因素，并有助于更标准化和循证实践。
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.