Background

Deep brain stimulation (DBS) has been used for neuropsychiatric disorders in clinical and research settings for almost 50 years now. Recent evidence demonstrates some efficacy in treating obsessive-compulsive disorder and major depression in patients refractory to other treatment modalities beyond single case reports. This has led to a considerable surge of clinical and commercial interest in DBS for psychiatric indications. Because of the high vulnerability of psychiatric patients, the lack of extensive short- and long-term data about effectiveness and adverse effects and the haunting history of psychosurgery, this new field in psychiatry raises important and specific ethical issues that have only rarely been systematically addressed so far.

Objective and Methods

We here review an evidence-based systematic ethical analysis of psychiatric DBS using the criteria of beneficence, nonmaleficence, and autonomy.

Conclusions

These criteria can easily be applied to research and future clinical application of DBS in neuropsychiatric disorders. This will prepare the ground for ethically justified, empirically comprehensive DBS in this highly vulnerable population and allow stringent future societal discussions about its legitimation.

中文翻译：

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大脑中的电极——用深部脑刺激研究和治疗神经精神疾病的伦理标准

背景

近 50 年来，深部脑刺激 (DBS) 已用于临床和研究环境中的神经精神疾病。最近的证据表明，在治疗除单个病例报告之外的其他治疗方式难以治疗的患者的强迫症和重度抑郁症方面具有一定的疗效。这导致对 DBS 用于精神科适应症的临床和商业兴趣大幅增加。由于精神病患者的高度脆弱性、缺乏关于有效性和不良反应的大量短期和长期数据以及精神外科令人难以忘怀的历史，精神病学的这一新领域提出了重要而具体的伦理问题，而这些问题很少被系统地解决至今。

目的和方法

我们在此回顾了使用善意、无恶意和自主性标准对精神病 DBS 进行的基于证据的系统伦理分析。

结论

这些标准可以很容易地应用于 DBS 在神经精神疾病中的研究和未来临床应用。这将为在这个高度脆弱的人群中进行道德上合理的、经验上全面的 DBS 奠定基础，并允许未来就其合法性进行严格的社会讨论。