China Refractory Obsessive-Compulsive Disorder Deep Brain Stimulation Study

Inclusion Criteria:

1. Age between 18 and 60 years.

2. A primary diagnosis of OCD, defined according to the criteria of the Diagnostic andStatistical Manual of Mental Disorders, fourth edition (DSM-IV).

3. Chronic: disease duration of more than 5 years.

4. Severity: a score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) of more than 25 or one subscale score of more than 15 ; a score for severity of illness on theClinical Global Impression (CGI) scale of more than 4.

5. Disability: a score on the Global Assessment Functioning (GAF) scale of less than 45.

6. Refractory: a lack of response to drug therapy after adequate administration (definedas more than 12 weeks at the maximum tolerated dose) of at least threeserotonin-reuptake inhibitors, one of which had to be clomipramine. Adequate behaviortherapy, defined as 20 sessions of exposure and response prevention (ERP) with atherapist who has substantial expertise in OCD treatment.

Exclusion Criteria:

1. Schizophrenic disorder; bipolar disorder; substance abuse or dependence (except fordependence on nicotine), as assessed with the use of the Mini-InternationalNeuropsychiatric Interview (MINI 6.0.0).

2. Cluster A or B personality disorder according to DSM-IV criteria, as assessed with theuse of the Structured Clinical Interview II.

3. A current severe major depressive episode, determined according to DSM-IV criteria (asassessed with the use of the MINI 6.0.0) and defined by the Hamilton Depression RatingScale-17 (HAMD) score of more than 20 and a risk of suicide.

4. Abnormal cognitive status (measured by MoCA), abnormal findings on functional magneticresonance imaging (MRI) of the brain; and no contraindications to surgery oranesthesia.