Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: a neuropsychological study

J Affect Disord. 2010 Oct;126(1-2):198-205. doi: 10.1016/j.jad.2010.02.127. Epub 2010 Mar 29.


Background: For treatment-refractory Obsessive-Compulsive-Disorder (OCD) patients, anterior capsulotomy is a potential therapy. We investigated what kinds of cognitive deficits treatment-refractory patients have and how anterior capsulotomy modifies their clinical and cognitive profiles.

Methods: Ten treatment-refractory OCD patients were examined in two groups (operated and non-operated) with 5 participants in each group, matched for symptom severity, gender, age and education. The operated group was treated with anterior capsulotomy; the non-operated group was treated only with pharmaco- and psychotherapy. The Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) was used to measure OCD symptoms, and ten neuropsychological tests were used to measure cognitive functioning.

Results: In the operated group, the score of Y-BOCS score significantly decreased during the two-year follow-up period. Additionally, we found a significant increase in neuropsychological test scores on the Wechsler Intelligence Test (MAWI), California Sorting Test Part A (CST-A), Stroop Test Interference Score (STR-I), Verbal Fluency Test and Iowa Gambling Test. As a negative result, we observed intrusion errors in the Category Fluency Test. In the non-operated group significant improvement was found in Y-BOCS scores. At follow-up, we found significant differences between the operated and non-operated groups on three neuropsychological tests: Trail Making Test Part B, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Attention Index and RBANS Language Index, with better performance in the non-operated group.

Conclusions: Both treatment methods (i.e. anterior capsulotomy and pharmaco- and psychotherapy) seem effective in reducing OCD symptoms and cognitive deficits, but, importantly, to different degrees. The clinical and neuropsychological improvements were more impressive in the operated group.

MeSH terms

  • Adult
  • Analysis of Variance
  • Case-Control Studies
  • Cognition Disorders / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Internal Capsule / surgery*
  • Male
  • Neuropsychological Tests
  • Obsessive-Compulsive Disorder / surgery
  • Psychiatric Status Rating Scales
  • Psychosurgery / methods*
  • Statistics, Nonparametric
  • Treatment Outcome