The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery.

Adriel Barrios-Anderson,Steven Rasmussen,Nicole C R Mclaughlin,Morgan T Patrick,Richard Marsland,Wael F Asaad,Georg Noren,Benjamin D Greenberg

doi:10.3389/fnint.2022.802617

Abstract

Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.

Highlights

Affecting approximately 2.3% of the United States population, obsessive compulsive disorder (OCD) is defined by anxiety-inducing, intrusive thoughts and recurrent compulsive behaviors that manifest as an attempt to reduce obsession-induced anxiety (Rasmussen and Eisen, 1997; Ruscio et al, 2010; Rasmussen et al, 2018)
A recent cohort study found that 59% of patients with severe, treatment-resistant OCD treated with gamma knife Ventral Capsulotomy (VC) experience a significant reduction in OCD after one year (Lopes et al, 2014; Rasmussen et al, 2018)
All participants underwent Gamma Knife Radiosurgery (GKRS) except one who underwent VC using Laser Interstitial Thermal Therapy (LITT), a critical distinction since GKRS is an awake, non-invasive procedure, and LITT was conducted with general anesthesia

Summary

Introduction

Affecting approximately 2.3% of the United States population, OCD is defined by anxiety-inducing, intrusive thoughts (obsessions) and recurrent compulsive behaviors (compulsions) that manifest as an attempt to reduce obsession-induced anxiety (Rasmussen and Eisen, 1997; Ruscio et al, 2010; Rasmussen et al, 2018). Standard treatment for OCD includes psychopharmacologic and behavioral interventions, but approximately 10% of patients are severely impaired with medically-intractable illness (Greenberg et al, 2003; Shah et al, 2008). Neurosurgical intervention is recognized as an efficacious option for a subset of these patients (Greenberg et al, 2003; McLaughlin et al, 2016; Rasmussen et al, 2018). A recent cohort study found that 59% of patients with severe, treatment-resistant OCD treated with gamma knife VC experience a significant reduction in OCD after one year (Lopes et al, 2014; Rasmussen et al, 2018). Numerous studies and a recent meta-analysis have corroborated these findings and shown that VC improves associated depression, anxiety, functional outcome, and quality of life for patients (Sheehan et al, 2013; Lopes et al, 2014; Brown et al, 2016; Rasmussen et al, 2018; Kumar et al, 2019)

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Discussion

Conclusion