Stereotactic Radiofrequency Thermocoagulation in Treatment-Resistant Obsessive–Compulsive Disorder with Comorbid Substance Abuse Disorder: A Prospective Single-Arm Study

Obsessive–compulsive disorder (OCD) and substance use disorder (SUD) are chronic psychiatric conditions characterized by compulsivity, functional impairment, and high treatment resistance. Shared neurobiological mechanisms suggest potential benefits of targeted neurosurgical interventions in treatment-refractory cases. To evaluate the safety, efficacy, and therapeutic impact of stereotactic radiofrequency thermocoagulation in patients with treatment-resistant OCD and comorbid SUD. This prospective single-arm interventional study included ۴۰ adults (۱۸–۶۵ years) diagnosed with OCD and comorbid SUD refractory to pharmacotherapy and cognitive–behavioral therapy. All patients underwent stereotactic thermocoagulation targeting the anterior limb of the internal capsule, subgenual cingulate, nucleus accumbens, and cingulate gyrus. Obsessive–compulsive symptoms (Y-BOCS), depressive symptoms (HAMD), insight (BABS), and functional disability (Sheehan Disability Scale) were assessed at baseline and at multiple postoperative intervals up to ۱۲ months. The mean age of participants was ۴۲.۳ ± ۱۲.۶ years, with ۵۷.۵% female. Y-BOCS scores decreased significantly from baseline to ۱۲ months (P < ۰.۰۰۱), reflecting marked and sustained symptom relief. HAMD and BABS scores also improved significantly across follow-up, indicating reduction in depressive symptoms and enhanced insight. Functional impairment in work, social, and family domains showed progressive improvement. Adverse events were infrequent and mild, including isolated cases of hemorrhage, infection, or frontal syndrome, while cognitive deficits were rare. Stereotactic radiofrequency thermocoagulation appears to be a safe and effective intervention for treatment-resistant OCD with comorbid SUD, yielding sustained reductions in symptom severity, depressive manifestations, and functional disability.

کلیدواژه ها:

Obsessive&ndash ، compulsive disorder ، Substance use disorder ، stereotactic thermocoagulation ، Treatment-Resistant ، neuroablation ، compulsivity