Interstitial laser anterior capsulotomy for obsessive–compulsive disorder: lesion size and tractography correlate with outcome

2021 ◽  
pp. jnnp-2021-327730
Author(s):  
David Satzer ◽  
Anil Mahavadi ◽  
Maureen Lacy ◽  
Jon E Grant ◽  
Peter Warnke
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Internal Capsule ◽  
Lesion Size ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Ablation Volume ◽  
Cognitive Behavioural ◽  
Anterior Capsulotomy

BackgroundAnterior capsulotomy is a well-established treatment for refractory obsessive–compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging.ObjectiveTo characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement.MethodsPatients with severe OCD refractory to pharmacotherapy and cognitive–behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.ResultsEighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3–51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4–1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal–ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001).ConclusionsLaser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal–subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.

scholarly journals Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Douglas. Kondziolka ◽  
John C. Flickinger ◽  
Robert. Hudak
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Internal Capsule ◽  
Severe Form ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Bilateral Lesions ◽  
Anterior Capsulotomy

Abstract BACKGROUND: Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients. OBJECTIVE: To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD. METHODS: We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used. RESULTS: There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18. CONCLUSION: Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.

Manualised Cognitive–Behavioural Therapy in the Intensive Treatment of Adolescent Obsessive–Compulsive Disorder

2006 ◽  
Vol 23 (3) ◽  
pp. 200-220 ◽  
Author(s):  
Danay Savva ◽  
Clare Rees
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Cognitive Behavioural Therapy ◽  
Symptom Severity ◽  
Behavioural Therapy ◽  
Self Report ◽  
Obsessive Compulsive ◽  
Global Functioning ◽  
Compulsive Disorder ◽  
Cognitive Behavioural

AbstractThis article offers a preliminary investigation of the delivery of an intensive version of manualised cognitive–behavioural therapy for adolescent obsessive–compulsive disorder (OCD). The aim was to address issues of treatment accessibility within the area, including a shortage of therapists who feel competent and possess the expertise to successfully deliver these protocols. Two male adolescents, with a principal diagnosis of OCD, participated in eight weekly 150-minute sessions. A series of diagnostic, symptom severity, global functioning, and self-report measures were completed at pretreatment, across treatment weeks, at posttreatment, and at 6-week follow-up. Further, monitoring of multiple baselines across behaviours for each adolescent across treatment weeks served to extend results beyond mere end points. Process issues specific to each adolescent, his family, and the therapeutic relationship were considered. Along with the overall outcome results, such information aimed to provide useful data for clinicians interested in implementing the program. Reductions in OCD symptomology and symptom severity for both participants at posttreatment and at 6-week follow-up suggest that an intensive format of treatment delivery might benefit some adolescents.

scholarly journals Cognitive–behavioural therapy with post-session d-cycloserine augmentation for paediatric obsessive–compulsive disorder: pilot randomised controlled trial

2014 ◽  
Vol 204 (1) ◽  
pp. 77-78 ◽  
Author(s):  
David Mataix-Cols ◽  
Cynthia Turner ◽  
Benedetta Monzani ◽  
Kayoko Isomura ◽  
Caroline Murphy ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Randomised Controlled

SummaryA partial N-methyl-d-aspartate agonist, d-cycloserine, enhances fear extinction when given before or shortly after exposure to feared stimuli in animals. In this pilot double-blind placebo-controlled trial (trial number: ISRCTN70977225), 27 youth with obsessive–compulsive disorder were randomised to either 50mg d-cycloserine or placebo administered immediately after each of ten cognitive–behavioural therapy (CBT) sessions, primarily consisting of exposure and ritual prevention. Both groups improved significantly and maintained their gains at 1-year follow-up, with no significant advantage of d-cycloserine over placebo at any time point. The effects of CBT may not be augmented or accelerated when d-cycloserine is administered after sessions.

Cognitive Behavioural Therapy for Obsessive-Compulsive Disorder with Comorbid Schizophrenia: A Case Report with Repetitive Measurements

2013 ◽  
Vol 42 (3) ◽  
pp. 374-378 ◽  
Author(s):  
Kristen Hagen ◽  
Stian Solem ◽  
Bjarne Hansen
Keyword(s):  
Case Studies ◽  
Obsessive Compulsive Disorder ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Study Approach ◽  
Cognitive Behavioural

Background: Obsessive-compulsive disorder (OCD) has been observed in a substantial proportion of patients with schizophrenia. Although cognitive-behavioural therapy (CBT) is well documented for OCD, few case studies are available regarding CBT for comorbid OCD in schizophrenia. Aims: The study aims to present a case study to augment the limited knowledge concerning CBT treatment for OCD in patients with schizophrenia. Method: The research adopted a case study approach, with a baseline condition and repeated assessments during the 3-week treatment and 6-month follow-up period. Results: The treatment was successful and the patient achieved clinical significant change in OCD symptoms. The patient had a reduction on the Y-BOCS from 24 to 5 (79%) and from 38 to 10 (73%) on the OCI-R from before treatment to 6 months follow-up. He did not fulfil the criteria for an OCD diagnosis at the end of the 3-week treatment period, or the follow-up at 3- and 6 months. Conclusions: The results strengthen the impressions given by previous case studies suggesting that CBT may be a promising treatment for OCD in patients with schizophrenia.

Obsessive-compulsive disorder

2015 ◽  
Author(s):  
Paul M. Salkovskis ◽  
Joan Kirk
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Experimental Studies ◽  
Behavioural Therapy ◽  
Cognitive Factors ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Behavioural Theory ◽  
Cognitive Behavioural ◽  
Negative Appraisals

Chapter 8 explores obsessive-compulsive disorder (OCD). It first outlines the nature of OCD, its prevalence, the development of current treatments, the behavioural theory of OCD and behaviour therapy in practice, deficit theories and cognitive factors, cognitive behavioural therapy (CBT) for OCD, experimental studies of normal intrusive thoughts, distorted thinking and negative appraisals, treatment implications of the cognitive behavioural theory, and strategies in the treatment of OCD.

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