- The stimulated brain: A psychological perspective on deep brain stimulation for treatment-refractory obsessive-compulsive disorder
- Award date
- 24 April 2015
- Number of pages
- 's-Hertogenbosch: Boxpress
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with an estimated life-time prevalence of 2%. Severe OCD leads to pronounced suffering and has a major impact on family relationships, social life and the capacity to function at work. At present, clinical management of OCD consists of pharmacological treatment and cognitive behavioural therapy (CBT). Although both treatments are often effective, approximately 10% of patients remain severely affected and suffer from treatment-refractory OCD. A new and last-resort treatment option for this group of treatment-refractory patients is deep brain stimulation (DBS). DBS is a treatment in which two electrodes are implanted in specific brain areas. The activity of the electrodes can be programmed externally, which permits the modulation of dysfunctional neural networks that are involved in the pathophysiology of OCD.
This thesis describes our research findings regarding the effectiveness and safety of DBS, with an emphasis on the psychological perspective. It proves that DBS is an effective and safe approach for treatment-refractory OCD patients. Regarding its mechanism of action, DBS is suboptimal as a stand-alone biological treatment and CBT can lead to an additional significant decrease of OCD symptoms. This thesis supports the assumption that OCD symptoms and cognitive deficits have different neurobiological substrates that are relatively unrelated and suggests that the clinical improvement after DBS is not accomplished by improvement in cognitive functioning. The findings of this thesis add substantial evidence to the effectiveness of DBS for treatment-refractory OCD and therewith to the acceptance of DBS as a last resort treatment for OCD.
- Research conducted at: Universiteit van Amsterdam
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