对强迫症障碍进行深度大脑刺激的临床结果:洞察力作为症状变化的预测因素
Nicola Acevedo1,2, Susan Rossell1,2, David Castle2,3
1Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.
Psychiatry and clinical neurosciences
|November 20, 2023
概括
深度大脑刺激 (DBS) 有效地治疗难治性强迫症 (OCD),症状改善维持长期. 对症状的洞察力和置处于核背部的位置预测了积极的结果.
科学领域:
- 神经外科 神经外科
- 精神病学是一个精神病学.
- 神经学 神经学
背景情况:
- 难治性强迫症 (OCD) 带来了重大的挑战.
- 深度大脑刺激 (DBS) 是一种新兴的严重强迫症治疗方法.
- 强迫症中DBS反应的长期疗效和预测因素需要进一步研究.
研究的目的:
- 为了评估核 (NAc) DBS对强迫症的长期疗效.
- 确定强迫症患者对DBS临床反应的预测因子.
- 探索DBS治疗期间症状变化的调解者.
主要方法:
- 一个开放标签的纵向试验,涉及八名接受NAc DBS的强迫症参与者.
- 随访持续时间从9个月到7年,精细调节刺激参数和辅助治疗.
- 混合线性建模和局部化被用于分析症状变化和响应预测因素.
主要成果:
- 六名参与者 (75%) 在6-9周内实现了临床反应,长期随访后持续改善.
- 耶鲁棕色强迫症强迫性评分 (YBOCS) 的平均改善率在最后一次随访时为45%.
- 对症状的洞察力增加 (P=0.008) 预测了症状严重程度的变化,可能由抑郁症和焦虑症的初始减少中介. 将放在NAc的背部与更好的反应有关.
结论:
- 纳克的DBS对耐火性强迫症有临床效果,表明症状持续改善.
- 对症状的洞察力可能成为治疗反应的关键调解者.
- 辅助心理护理和代的DBS编程对于优化DBS治疗的强迫症患者的治疗结果至关重要.
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