We present a case of acute onset of psychotic symptoms, without signs of hypomania, following DBS for intractable OCD in a patient with no prior history of psychosis or delusional beliefs. The patient was a male in his early 20s with a history of intractable OCD, receiving DBS of the ventral capsule/ventral striatum (VC/VS) implanted as part of a randomized clinical trial of DBS for OCD (NCT00640133). The study sought to investigate effectiveness of DBS as a treatment for intractable OCD, as preliminary data had shown promising therapeutic effects [1,2]. The patient’s OCD symptoms began at age 11, marked by exactness, thoroughness and perfectionism. His obsessions were accompanied by near constant doubt and a “need to know”, as well as, concerns about offending others, leading to excessive reassurance seeking. Prior to seeking DBS for OCD, he had received numerous conventional treatments without substantial symptom improvement, including trials of at least three serotonin reuptake inhibitors (SRI), one of which was clomipramine; all trials exceeded 6 months in length and were augmented with benzodiazepines (e.g., clonazepam). Dopamine antagonist augmentation was also tried. Cognitive behavior therapy, including exposure and response prevention, was tried over a period of many years, both in traditional weekly outpatient sessions as well as in a specialty residential treatment setting. At the time of his initial assessment for DBS, his OCD severity rated in the extreme range on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS; baseline score 1⁄4 33). He had a history of depression but was not in a depressive episode at the time of initial evaluation for DBS. The surgery to implant the DBS device was unremarkable, and placement was verified by imaging (Fig. 1). Active stimulation was delivered to contact 2 (left) and contact 3 (right), both monopolar; contact points were chosen following post operative titration for most acute affective effect and stimulus optimization. At the patient’s nine-month follow-up, his OCD symptoms had improved

中文翻译：

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非情感性精神病的案例，随后对强迫症的深部脑刺激中的非刺激反应延长

我们介绍了一例没有精神病史或妄想信念的患者，在 DBS 治疗顽固性强迫症后，精神病症状急性发作，没有轻躁狂的迹象。患者是一名 20 岁出头的男性，有顽固性强迫症病史，接受腹侧囊/腹侧纹状体 (VC/VS) 的 DBS 植入，作为 DBS 治疗强迫症的随机临床试验的一部分 (NCT00640133)。该研究试图调查 DBS 作为治疗顽固性强迫症的有效性，因为初步数据显示了有希望的治疗效果 [1,2]。患者的强迫症症状始于 11 岁，其特点是精确、彻底和完美主义。他的痴迷伴随着几乎不断的怀疑和“需要知道”，以及对冒犯他人的担忧，导致过度寻求安慰。在寻求 DBS 治疗强迫症之前，他接受了许多常规治疗，但症状没有明显改善，包括至少三种血清素再摄取抑制剂 (SRI) 的试验，其中一种是氯米帕明；所有试验的长度都超过 6 个月，并增加了苯二氮卓类药物（如氯硝西泮）。也尝试了多巴胺拮抗剂增强。认知行为疗法，包括暴露和反应预防，在传统的每周门诊和专业住院治疗环境中进行了多年的尝试。在他对 DBS 进行初步评估时，他的强迫症严重程度在耶鲁-布朗强迫症量表 (Y-BOCS；基线评分 1⁄4 33) 中处于极端范围内。他有抑郁症病史，但在 DBS 初始评估时并未出现抑郁发作。植入 DBS 装置的手术没有什么特别之处，并且通过成像验证了植入（图 1）。主动刺激传递到触点 2（左）和触点 3（右），均为单极；在术后滴定后选择接触点以获得最急性的情感效果和刺激优化。在患者的九个月随访中，他的强迫症症状有所改善