Annual Report 2009

AIS Annual Report 2008-09

Download the Full Report (PDF, 1.0Mb)

1.1         Introduction

The Dundee Advanced Interventions (Neurosurgery for Mental Disorder) Service was first designated as a National Specialist Service in April 2006, and became fully staffed in the first quarter of 2007. We are therefore reporting on the second full year of service activity.

1.2         Activity








Vagus Nerve Stimulation



Anterior Cingulotomy







1.2.1        Referrals

Twenty-five referrals were received during 2008/09. Twenty-two (88%) came from Scotland, 2 (8%) came from England, and 1 (4%) came from Northern Ireland.

1.2.2        Assessments

Twenty-six assessments were performed. One patient did not attend for initial assessment. The source of assessments mirrored that of referrals, with 3 assessments being conducted outwith the Service Level Agreement (SLA) and was funded by referring NHS Trust in England/ Ireland).

Approximately 60% of assessments had a primary diagnosis of unipolar major depression. Approximately 20% had a diagnosis of Obsessive-Compulsive Disorder. Bipolar disorder, organic disorders, personality disorder, and other anxiety disorders made up the remaining diagnoses.

1.2.3        Procedures

During 2008/09, 7 procedures (3 cingulotomies and 4 Vagus Nerve Stimulator implantations) were performed. Five procedures were funded outwith the SLA.

1.3         Mortality Data

There were no deaths, no post-operative infections and no significant adverse events during the current year.

1.4         Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 10.7 ± 6 weeks. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as rescheduled appointments at the request of the patient.

1.5         Quality of Care

1.5.1        Formal Complaints

There were no formal complaints.

1.5.2        Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for both outpatient assessment and inpatient admission was consistently high, with the majority of patients rating their experience positively. The service was rated highly for quality of assessment. Inpatient experience was uniformly positive.

1.6         Best Value Healthcare – Clinical Audit and Outcomes

1.6.1        Outcome Data

In the patients reviewed during 2008/09, six had undergone ACING (four as their second procedure) and five had undergone VNS. Response rates for VNS were 20%. This is believed to reflect the high levels of chronicity, disability and treatment-resistance within the patient group treated in Dundee. With respect to these clinical features, the VNS patients treated in Dundee were not comparable to those typically included in published studies where higher response rates have been described. Two out of 4 (50%) patients undergoing a second ACING for major depression achieved clinical remission.

1.7         Teaching and Research Activities

Staff have delivered a range of presentations at national and regional meetings throughout the year. Invited presentations have also been given at postgraduate psychiatry meetings in Scotland.

The service continues to publish academic papers on NMD and related topics  and a number of AIS staff have been awarded grants for further research.

1.8         Service Developments and Future Plans

Dundee AIS continues to build links with local mental health services and a variety of third-sector organisations. In the last year, members of the team have visited tertiary-level inpatient OCD treatment services in London.

The service is optimistic about the possibilities for participation in international multi-centre trials of Deep Brain Stimulation (DBS) for both depression and OCD.

1.9         Summary and Conclusions

Although of the referral rate for assessments was lower this year than last, we continue to exceed our SLA recommended activity level. This reporting year has been busier with respect to neurosurgical activity and our engagement in post-operative care planning with referring services has continued to build and evolve.

New members of the team bring with them exciting possibilities for the service to build on its existing research portfolio and to ensure the delivery of best clinical practise in the delivery of complex and advanced interventions for chronic, refractory psychiatric illness.