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Attitudes Toward Neurosurgical Procedures for Parkinson's Disease and Obsessive-Compulsive Disorder

Received April 14, 1998; revised July 1, 1998; accepted August 11, 1998. From the Department of Psychiatry and Behavioral Sciences, Center for Medical Ethics and Health Policy, Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, and Veterans Affairs Medical Center and Huffington Center on Aging, Baylor College of Medicine, Houston, Texas. Address correspondence to Dr. Yudofsky, One Baylor Plaza, Rm. 115-D, Houston, TX 77030; e-mail: stuarty{at}bcm.tmc.edu

Similar neurosurgical procedures exist for Parkinson's disease (PD) and obsessive-compulsive disorder (OCD). Because PD is seen as a brain disease and OCD as a disease of the mind, neurologists and psychiatrists may be more aware of and more optimistic toward neurosurgery for PD than for OCD. A questionnaire was sent to randomized American Psychiatric Association and American Academy of Neurology members, and 569 of 1,188 eligible members (47.9%) responded. Some 82.8% of the psychiatrists and 27.4% of the neurologists were aware of neurosurgical procedures for OCD, whereas 84.7% of psychiatrists and 99.4% of neurologists were aware of neurosurgery for PD (P<0.001). Of psychiatrists, 74.1% would refer appropriate patients for OCD neurosurgery, 67.4% for PD neurosurgery (P=0.15); of neurologists, 25.6% would refer for OCD, 94.3% for PD (P<0.001). Specialty affected willingness to refer for OCD neurosurgery. Specialty and degree of contact with neurosurgeons affected willingness to refer for PD neurosurgery. There is poor physician awareness of neurosurgical options for OCD compared with PD, as well as a risk–benefit bias against OCD surgery by the neurologists surveyed.

Key Words: Parkinson's Disease • Obsessive-Compulsive Disorder • Neurosurgery • Psychiatrists, Surveys of

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