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Psychiatric Neurosurgery: A Survey on the Perceptions of Psychiatrists and Residents

  • Josiane Cormier (a1) (a2), Christian Iorio-Morin (a3), David Mathieu (a3) and Simon Ducharme (a1) (a4)

Abstract:

Objectives: To evaluate the attitudes and perceptions of psychiatrists and psychiatry residents regarding neurosurgical procedures for treating psychiatric disorders and to identify potential barriers to patient referral. Methods: A survey consisting of 25 questions was created using SurveyMonkey and was distributed to psychiatrists and psychiatry residents in Quebec. The study was approved by the McGill University Health Center’s Research Ethics Board. Descriptive statistics and Friedman’s test were performed using SPSS software. Results: A total of 99 participants, including 64 residents and 35 psychiatrists, completed more than 75% of the survey and were included in data analysis. Overall, participants were significantly (p < 0.0005) more comfortable in referring patients suffering from treatment-resistant obsessive–compulsive disorder than from treatment-resistant major depressive disorder and preferred to refer patients for deep brain stimulation (DBS) rather than for anterior cingulotomy/capsulotomy (AC). Only 11.43% of psychiatrists had ever referred a patient for AC or DBS, and 34.69% of respondents felt that these procedures were dangerous. Lack of knowledge (82.83%) was viewed as the principal limiting factor, and 57.58% of respondents identified ≥6 different barriers to patient referral. The majority of participants (69.39%) were interested in improving their knowledge on psychiatric neurosurgery, and 82.65% felt that this subject should be included in the psychiatry residency curriculum. Conclusion: Overall, participants acknowledged having many limitations to referring patients for neurosurgical interventions. While informative conferences discussing neuromodulation/neuroablation could easily address many barriers, further studies are required to assess how these could change attitudes and patterns of referral.

Neurochirurgie psychiatrique: un sondage portant sur les attitudes et perceptions des psychiatres et résidents en psychiatrie. Objectifs: Évaluer les attitudes et perceptions qu’ont les psychiatres et résidents en psychiatrie à l’égard des procédures neurochirurgicales permettant de traiter les troubles psychiatriques et identifier les facteurs contraignants de l’aiguillage des patients. Méthodes: Un sondage contenant 25 questions a été élaboré au moyen de SurveyMonkey et a été distribué à des psychiatres et résidents en psychiatrie du Québec. L’étude a été approuvée par le Comité d’éthique de la recherche du Centre universitaire de santé McGill (CUSM). Pour analyser nos résultats, nous avons utilisé, de concert avec le logiciel SPSS, des statistiques descriptives ainsi que le test de Friedman. Résultats: Au total, 99 participants (64 résidents et 35 psychiatres) ont été inclus dans notre analyse de données. Dans l’ensemble, les répondants se sont montrés nettement plus enclins (p < 0,0005) à adresser des patients souffrant de troubles obsessionnels-compulsifs (TOC) réfractaires que des patients atteints de troubles dépressifs majeurs (TDM) réfractaires aux traitements standards. Ils ont aussi préféré référer des patients nécessitant une stimulation cérébrale profonde (SCP) plutôt qu’une cingulotomie ou capsulotomie antérieure. Seulement 11,43% des psychiatres avaient déjà adressé un patient au service de neurochirurgie pour qu’il reçoive l’un de ces traitements. Parmi les participants, 34,69% ont estimé ces procédures dangereuses. Un manque de connaissances a été perçu par les répondants (82,83%) comme étant le principal facteur contraignant à la référence des patients tandis que 57,58% d’entre eux ont identifié ≥ 6 différentes barrières à la référence. Une majorité des répondants (69,39 %) se sont dit intéressés à améliorer leurs connaissances en matière de neurochirurgie psychiatrique. En outre, 82,65% étaient d’avis que ce champ de pratique devrait être inclus dans le programme de résidence en psychiatrie. Conclusions: De façon globale, les répondants à notre sondage ont reconnu devoir faire face à plusieurs facteurs contraignants lorsqu’il est question d’adresser des patients en vue d’interventions neurochirurgicales. Bien que des conférences abordant les impacts de la neuro-modulation et de la neuro-ablation pourraient permettre de réduire certains stigmas liés à ces procédures neurochirurgicales, des études supplémentaires seront nécessaires afin d’évaluer si de telles conférences informatives seraient susceptibles d’apporter des changements au niveau des attitudes et perceptions des psychiatres et résidents en psychiatrie et, subséquemment, des patterns de référence en neurochirurgie.

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Corresponding author

Correspondence to: Josiane Cormier, CIUSSS de l’Estrie - CHUS - Hôpital Hôtel-Dieu, Département de psychiatrie, Bureau 5508, 580 rue Bowen Sud, Sherbrooke, Québec J1G 2E8, Canada. Email: josiane.cormier@usherbrooke.ca

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