Annual Report 2010

AIS Annual Report 2009-10

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1               Activity








Vagus Nerve Stimulation



Anterior Cingulotomy






There were 5 follow-up assessments for ablative procedures and 6 follow-ups for VNS in this reporting period.

1.1.             Referrals

Forty-two referrals were received during the reporting period (18 men and 24 women); with a mean age of 46.8 years. A number were not considered to fall within the remit of the service and advice on further management was provided to the referrer.

There were 2 (4.8%) referrals from England, and 40 (95.2%) from Scotland.

1.2.             Assessments

Twenty-nine assessments were conducted during the 2009/10 financial year. Fourteen men and 15 women were seen, with a mean age of 49.5 years (range 20.3 – 85.2 years). Two assessments were conducted outwith the SLA.

Approximately 50% of patients had a diagnosis of unipolar major depression, and approximately 20% of patients had a primary diagnosis of obsessive-compulsive disorder. Other disorders made up the remaining 30% of assessments.

1.3.             Procedures

One Anterior Cingulotomy and one VNS implantation were performed during 2009/10. Both patients came from Scotland.

2               Mortality Data

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

3               Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.2 ± 3.4 weeks. This is slightly less than the previous year, but may reflect levels of activity. 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.

4               Quality of Care

4.1.             Formal Complaints

There were no formal complaints.

4.2.             Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

5               Best Value Healthcare – Clinical Audit and Outcomes

5.1.             Outcome Data

Of the 5 patients who had undergone Anterior Cingulotomy and were followed up in 2009/10, two met criteria for response, and one met criteria for remission (categories not mutually exclusive). All patients undergoing ablative neurosurgery experienced variable degrees of symptom reduction.

Of the 6 patients who were reviewed following VNS, none met criteria for response or remission. Two patients had modest symptom improvement at follow-up. It is recognised that this is a very refractory population, and the service continues to collect very detailed outcomes from all patients.  

6               Teaching and Research Activities

Members of the team continue to deliver presentations at a local and national level. Members of staff have been very active from a research perspective, publishing extensively in peer-reviewed journals, contributing to textbooks in psychiatry, and contributing to national clinical guidelines.

In addition, the service contributes to undergraduate and postgraduate teaching programmes (local and national) and individuals have supervised projects at an undergraduate and postgraduate (PhD) level.

7               Service Developments and Future Plans

Agreements, in principle, have been reached for our service to participate in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression, which will hopefully begin recruiting later in 2010. This will enable us to not only advance patient care but also to develop patient choice in this clinical area. Uniquely, in Dundee, we will have the opportunity to evaluate the outcomes for this DBS alongside those for other neurosurgical therapies.

8               Summary and Conclusions

Although neurosurgical activity in 2009/10 is less than that of 2008/09, it is recognised that such activity varies from one year to the next. In addition, the level of activity is dependent upon the nature of the patients referred, and it remains the situation that in many cases, further treatment recommendations are given before the patient may return for consideration for a neurosurgical intervention. Further, surgery rates for the next reporting period are predicted to be higher, with a number of patients already on the pathway for neurosurgery.