Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients
Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients
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DOI：
10.1371/journal.pone.0135524
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发表时间：
2015-08-27
期刊：
影响因子：
3.7
通讯作者：
Denys, Damiaan
中科院分区：
文献类型：
--
作者：
de Haan, Sanneke;Rietveld, Erik;Denys, Damiaan
脑深部电刺激（DBS）是一种相对较新的实验性治疗方法，用于治疗难治性强迫症（OCD）患者。治疗的效果通常用测量症状量的精神病理学量表来评估。然而，临床经验表明，DBS的影响不仅限于症状：例如，患者报告感知变化，感觉更强壮，更自信，做事不假思索。我们的目的是更好地了解强迫症患者在DBS治疗期间经历的各种变化。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，我们提出了从这个定性研究的结果。我们列出了四个领域的变化：（a）人，（B）（社会）世界，（c）人与世界互动的特征，（d）存在主义立场。我们随后提供了这些结果的解释。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达;即焦虑和紧张的经验让位于增加基本的信任和增加对自己能力的依赖。然后，我们讨论了我们的研究结果的临床意义，特别是在适当地告知患者他们可以从治疗中期待什么，包括CBT在治疗中的有用性，以及目前治疗成功的措施的局限性。最后，我们提出了一些具体的建议，为进一步的研究。
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.