Japanese psychiatrists' perceptions of surgical treatment for treatment-resistant obsessive compulsive disorder: A nationwide survey.

Abstract

Aim: Surgical interventions such as deep brain stimulation (DBS) have demonstrated efficacy for severe treatment-resistant obsessive-compulsive disorder (TR-OCD) internationally, but surgical treatment has yet to be implemented in Japan. A nationwide survey of psychiatrists was conducted to clarify their perceptions of OCD surgery, and we analyzed the data with the aim of identifying factors associated with the acceptance of surgical interventions.

Methods: A web-based survey was conducted targeting board-certified psychiatrists in Japan. A total of 212 psychiatrists participated, responding to 10 multiple-choice questions assessing their awareness, perceived need, and expectations regarding DBS. Statistical analyses were performed to examine associations between key variables.

Results: Of the 212 respondents, 130 (61.3%) stated that surgical treatment options should be considered even after taking ethical and social issues into account. Perceived inadequacy of standard treatments alone for severe TR-OCD was strongly associated with perceived need for new treatment options, including surgical interventions and with justifiability of surgical treatment. Clinical experience with OCD showed a modest positive association with surgical acceptability. Awareness of overseas surgical treatment was associated with stronger recognition of treatment limitations and greater acceptance of surgical options. Additional stratified analyses suggested that awareness of overseas surgical treatment may influence how psychiatrists form their attitudes toward surgical intervention.

Conclusions: The survey results generally reflect positive attitudes among psychiatrists toward surgical treatment for TR-OCD. Psychiatrists' support for OCD surgery appears to be primarily associated with perceived unmet clinical needs and awareness of international surgical practices. Enhancing education, addressing ethical concerns, and generating domestic clinical evidence may facilitate the responsible introduction of surgical treatment for TR-OCD.