Neuropsychological outcome after deep brain stimulation in the ventral capsule/ventral striatum for highly refractory obsessive-compulsive disorder or major depression.

BACKGROUND: Deep brain stimulation (DBS) has shown promise as a treatment for severe, highly treatment-refractory obsessive-compulsive disorder (OCD) or major depressive disorder (MDD). We describe the neuropsychological outcome in 21 patients (10 OCD and 11 MDD) who received DBS in the anterior limb of the internal capsule/ventral striatum (VC/VS). METHODS: All patients completed a preoperative and postoperative neuropsychological battery. Average duration of DBS stimulation was 8.91 months (SD = 4.63) at the time of follow-up testing. Data were analyzed using practice-effect-corrected change scores. RESULTS: No significant cognitive declines were seen. There were significant improvements in prose passage recall after chronic DBS. The cognitive improvements were not related to change in severity of OCD, depression or global impairment. CONCLUSIONS: This preliminary study suggests that VC/VS DBS does not result in cognitive declines. The observations that verbal memory improved are consistent with current theories on the role of the VS in the memory, but require replication in larger studies.

Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions.

OBJECTIVE: To estimate the effectiveness of adherence-promoting psychological interventions for pediatric populations with chronic health conditions. METHODS: A meta-analysis was conducted on 70 adherence-promoting psychological intervention studies among chronically ill youth using a weighted least squares approach and random effect model. RESULTS: Medium effects sizes were found for the behavioral (mean d =.54, 95% confidence interval [CI] = 0.34-0.73, n = 10) and multi-component interventions (mean d =.51, 95% CI = 0.45-0.57, n = 46), while educational interventions displayed a small effect size with adherence (mean d =.16, 95% CI = 0.10-0.22, n = 23). Study designs incorporating pre-post comparisons yielded effect sizes approaching the medium range (mean d =.42, 95% CI = 0.36-0.48, n = 30). CONCLUSIONS: Behavioral and multi-component interventions appear to be relatively potent in promoting adherence among chronically ill youth. Recommendations for future research and methodological issues are presented.