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DEEP BRAIN STIMULATION FOR OBSESSIVE-COMPULSIVE DISORDER

OCD is an anxiety disorder with a worldwide prevalence of between 1-3 %. Although its presentation may vary it is most commonly characterised by recurrent obsessions and /or compulsions.

Obsessions are persistent and anxiety provoking thoughts, images or impulses which dominate the thinking of an individual. Compulsions are recurrent mental acts or behaviours that often occur in relation to obsessional cues and can act to reduce the experience of anxiety or distress. While, historically, OCD was viewed as a chronic disorder which was intractable and non-responsive to treatment the prognosis has improved with the advent of psychological and pharmacological interventions.

Despite the availability of these treatments 20% to 30% of patients with OCD fail to improve and up to 10% develop a severe intractable form of the illness. For a small proportion of patients with treatment resistant OCD, deep brain stimulation (DBS) may be considered as a possible treatment. 
DBS involves the implantation of stimulation electrodes in highly localized brain regions with the aim of modifying brain activity. DBS has been extensively used in Parkinson's disease, chronic pain, intractable tremor and dystonia. DBS has a number of significant advantages over traditional lesional procedures as it is adjustable, controlled and reversible.

The Neuropsychiatry Unit was the first clinical service to offer DBS for OCD within Australia. All patients who proceed to surgery have met the requirements of the Psychosurgery Review Board. Comprehensive clinical data is collected during the admission and in regular follow-up appointments, which includes psychiatric measures (self-report, carer scales, clinician rated scales), functional assessments and cognitive assessments.

Preliminary data has been presented at the recent International Neuropsychological Society/Australiasian Society for the Study of Brain Impairment (INS-ASSBI) conference in Sydney as well as at the Australian and New Zealand Neuropsychiatry and Behavioural Neurology Conference. A research paper is in progress and we are planning to conduct follow-up cognitive assessments with our patients.
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