Abstract
Gamma ventral capsulotomy (GVC) is a radiosurgical procedure which aims to create lesions in the ventral part of the anterior limb of the internal capsule (ALIC). It has been used as a treatment option for patients with intractable obsessive–compulsive disorder (OCD) who do not respond to several first-line treatments attempts. However, changes in personality disorder symptoms after GVC have not been investigated. The aims of this study are to investigate changes in personality disorder symptoms after GVC and to search for baseline personality disorder symptoms that may predict clinical response to GVC. Fourteen treatment-intractable OCD patients who underwent GVC completed the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) at baseline and one year after the procedure. Wilcoxon signed-rank test was performed to investigate personality disorder symptom changes before and after surgery. Linear regression models were utilized to predict treatment response, using baseline personality disorder symptoms as independent variables. We did not observe any quantitative changes in personality disorder symptoms after GVC, compared with baseline. Higher severity of obsessive-compulsive personality disorder symptoms at baseline was correlated with worse treatment response after GVC for OCD (β = −0.085, t-value = −2.52, p-value = 0.027). These findings advocate for the safety of the GVC procedure in this specific population of intractable OCD patients, in terms of personality disorder symptom changes. They also highlight the importance of taking into account the severity of obsessive–compulsive personality disorder symptoms when GVC is indicated for intractable OCD patients.
Highlights
Obsessive–compulsive disorder (OCD) is a chronic disease characterized by the presence of obsessions and/or compulsions that are highly distressing and may severely compromise social and occupational functioning in affected individuals [1]
In this study we had three main objectives: First, we aimed to verify the safety of Gamma ventral capsulotomy (GVC) with respect to changes in personality disorder symptoms obtained through the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II)
obsessive–compulsive disorder (OCD) subjects who underwent GVC presented a significant improvement in all clinical measures (Y-BOCS, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Global Assessment of Functioning (GAF))
Summary
Obsessive–compulsive disorder (OCD) is a chronic disease characterized by the presence of obsessions and/or compulsions that are highly distressing and may severely compromise social and occupational functioning in affected individuals [1]. Around 20% of OCD patients do not respond to first-line treatments [4] and less than 1% of OCD treatment seeking individuals do not respond to multiple interventions and have symptoms so severe and debilitating that they are classified as “intractable” [4, 5]. In these cases, Gamma ventral capsulotomy (GVC), a radiosurgical procedure which aims to create lesions in the ventral part of the anterior limb of the internal capsule (ALIC), has been used as a treatment option. Given that GVC is an ablative and irreversible procedure, studies that systematically evaluate personality disorder outcomes are highly important
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