- Out of control: Losing oneself in compulsivity
W. van den Brink
G.A. van Wingen
- Award date
- 1 July 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
In Part I of this thesis, we study some of the conceptual issues around compulsivity and investigate risk aversion in OCD. In chapter 2, we explore the concept of compulsive behavior across disorders and we propose a definition of compulsive behavior. In chapter 3, we investigate the validity of the widespread belief that OCD patients are more risk-averse than healthy controls. For that purpose, we examine neural activity during risk processing using functional magnetic resonance imaging (fMRI) and simultaneously assess risk attitude using a separate behavioral paradigm in OCD patients and in healthy controls.
Part II focuses on DBS treatment in patients with a psychiatric disorder and specifically in patients with OCD. In chapter 4, we review the literature on the efficacy and safety of DBS in patients with a psychiatric disorder, including patients with OCD, major depressive disorder, addiction and Tourette syndrome. In chapter 5 and chapter 6 we investigate hypomania and hyperimpulsivity as possible side effects of DBS in psychiatric patients. Finally, in chapter 7, we explore the effects of NAc DBS on the frontostriatal circuitry in OCD patients using fMRI and EEG.
Part III focuses on DBS as a treatment for addiction. In chapter 8, we present a review of the existing pre-clinical and clinical literature to make an evidence-based decision about the best target area for DBS in patients with an addiction. In chapter 9, we present data about the first patient of our study treated with NAc DBS for heroin addiction. Finally in chapter 10, we describe our experiences during the recruitment of addiction patients for DBS and we raise the question whether DBS is a feasible option for patients with addiction.
In Part IV we summarize our findings, put them in the context of the existing literature and discuss their implications for future research and clinical practice.
- Research conducted at: Universiteit van Amsterdam
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