Criteria for Ablative Neurosurgery

Treatment-refractory Depression

Inclusion criteria

1. Age > 20 years
2. Legal status: both formal and informal patients can be considered
3. Confirmation of diagnosis: the individual will fulfil ICD-10 criteria for one of the following:

   a) F32.2 Severe depressive episode without psychotic symptoms

   b) F32.3 severe depressive episode with psychotic symptoms

   c) F33.1 - F33.3 Recurrent depressive disorder, current episode moderate to severe

   d) F31.4 - F31.5 Bipolar Affective Disorder, current episode severe depression, with or without psychotic symptoms

4. Duration of illness: an absolute minimum of 3 years, with at least 2 years of unremitting symptoms despite treatment. Only in exceptional circumstances would a duration of illness less than 5 years be considered.
5. Consent: the patient must be capable of providing sustained, informed consent.

Exclusion criteria

1. Age < 20 years
2. Failure to fulfil ICD-10 criteria for F32.2, F32.3, F33.1-F33.3, F31.4-F31.5
3. Incapacity to give sustained, informed consent
4. A current diagnosis of substance misuse fulfilling criteria for ICD-10 F10-F19 'Mental and behavioural disorders due to psychoactive substance use'
5. A diagnosis of organic brain syndrome fulfilling criteria for ICD-10 F00-F09, including Alzheimer's disease, vascular, and other dementias
6. A diagnosis of disorder of adult personality fulfilling criteria for ICD-10 F60-F69
7. A diagnosis of pervasive developmental disorder fulfilling criteria for ICD-10 F84

Obsessive-compulsive Disorder (OCD)

Inclusion criteria

1. Age >20 years.
2. Legal status: both formal and informal patients can be considered.
3. Confirmation of diagnosis: individuals will normally fulfil criteria for a primary diagnosis according to ICD-10 F42.0-F42.9. Individuals with treatment-refractory obsessional and/or compulsive symptoms in the presence of other comorbid mental disorder (e.g. depression, schizophrenia) can be considered for surgery but additional criteria for adequacy of treatment will be applied.
4. Duration of illness: an absolute minimum of 3 years, with at least 2 years of unremitting symptoms despite intensive psychopharmacological and psychological treatment. Only in exceptional circumstances would a duration of illness of <5 years be considered.
5. Consent: the patient must be considered capable of providing sustained, informed consent.

Exclusion criteria

1. Age <20 years.
2. Failure to fulfil ICD-10 criteria for F42.0-F42.9.
3. Incapacity to give informed consent.
4. A current diagnosis of substance misuse fulfilling criteria for ICD-10 F10-F19,‘Mental and behavioural disorders due to psychoactive substance use’.
5. A diagnosis of organic brain syndrome fulfilling criteria for ICD-10 F00-F09, including Alzheimer’s disease, vascular and other dementias.
6. A diagnosis of disorder of adult personality fulfilling criteria for ICD-10 F60-F69.
7. A diagnosis of pervasive developmental disorder fulfilling criteria for ICD-10 F84.
8. Absence of an adequate therapeutic trial of psychological treatment methods.
9. Absence of adequate therapeutic trials of psychopharmacological treatment methods.

References

Matthews, K. & Eljamel, M. S. (2003) Status of neurosurgery for mental disorder in Scotland: Selective literature review and overview of current clinical activity. British Journal of Psychiatry, 182, 404-411.