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February 2015

Toward Brain-Based Guidance of Clinical Practice

Author Affiliations
  • 1Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
  • 2Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
  • 3Department of Psychology, The Obsessive-Compulsive Disorder Team, Haukeland University Hospital, Bergen, Norway
JAMA Psychiatry. 2015;72(2):108-109. doi:10.1001/jamapsychiatry.2014.2552

The article by Banks and colleagues1 in this issue of JAMA Psychiatry is an elegant example of how the brain imaging field struggles to translate information on brain mechanisms at the group level to guide clinical practice for individuals. The authors describe the results of a small retrospective study in a subsample of 15 patients selected from a previously published2 series of 64 patients with severe treatment-resistant obsessive-compulsive disorder (OCD) undergoing dorsal anterior cingulotomy. Eight responders and 7 nonresponders to the cingulotomy were included in the analysis. The aim of the study was to establish preoperative brain imaging markers predicting a good response. Treatment response, defined as Yale-Brown Obsessive Compulsive Scale score reductions of 35% or more, was reached in 35% and 47% of the patients after 10.7 and 63.8 months of postoperative follow-up, respectively.2 These effects are modest and consistent with the results of other open-label studies on ablative interventions for refractory OCD, such as capsulotomy.3

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