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A register-based 13-year to 43-year follow-up of 70 patients with obsessive–compulsive disorder treated with capsulotomy
  1. Christian Rück1,2,
  2. Johan K Larsson1,
  3. David Mataix-Cols1,2,
  4. Rickard Ljung3
  1. 1 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2 Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
  3. 3 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Christian Rück; christian.ruck{at}ki.se

Abstract

Objectives Little is known about the long-term medical status of patients with severe obsessive–compulsive disorder (OCD) undergoing capsulotomy, a neurosurgical last-resort treatment. The present study used national registers to identify all operated patients with OCD in Sweden and evaluated their long-term medical status, including mortality, hospital admissions and psychotropic medication after capsulotomy for OCD.

Design Register-based long-term follow-up cohort study.

Participants We used the procedural and diagnostic codes in the Swedish National Patient Register to define the study population between 1970 and March 2013. Verification by manual review of medical records of the indication for surgery in those identified by the register yielded the final study cohort of 70 patients, followed 13–43 years after surgery. The sensitivity of the case selection method was 86%.

Outcome measures We studied hospitalisation 5 years before and after surgery. Mortality data were derived from the Causes of Death Register. The Prescribed Drug Register was used to study psychotropic drug utilisation.

Results By March 2013, 29 of the 70 patients were deceased. Their mean age at the time of death was 68 years (SD=14). Two patients had committed suicide and one had died of suspected suicide. Seventy per cent had been admitted to a psychiatric ward in the 5 years preceding surgery, and 84% in the first five postoperative years. Seventy-five per cent of those alive in 2012 were prescribed at least two psychotropic medications, often at high doses, the most common being antidepressants.

Conclusions Malignant OCD has a poor long-term prognosis. Patients who are candidates for surgery should be informed that, while OCD symptoms may be ameliorated with surgery, they should not expect long-term freedom from medication and psychiatric care.

  • neurosurgery
  • psychiatry
  • obsessive-compulsive disorder

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CR and RL had the original idea for the study and designed the study. CR, JKL and RL were responsible for the acquisition of the data. CR and JKL carried out the manual review of medical records to validate diagnoses. All authors carried out the statistical analysis and interpretation. CR drafted the manuscript, which was revised by all authors. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Regional Ethical Review Board Stockholm.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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