Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders
Abstract Introduction Ethical concerns have been raised by both current and historically controversial neurosurgical interventions for treatment-refractory schizophrenia and schizoaffective disorder (TR-SZ). Considering advances in next-generation deep brain stimulation (DBS), initial success in tre...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12888-025-07128-0 |
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| author | Judith M. Gault Nicola Cascella Nidal Moukaddam Stephanie Lehto Patrick Hosokawa Paul S. Appelbaum Akira Sawa Jocelyn Lippman-Bell William S. Anderson Wayne Goodman Sameer A. Sheth Daniel Kramer John A. Thompson Elyn R. Saks Rachel A. Davis |
| author_facet | Judith M. Gault Nicola Cascella Nidal Moukaddam Stephanie Lehto Patrick Hosokawa Paul S. Appelbaum Akira Sawa Jocelyn Lippman-Bell William S. Anderson Wayne Goodman Sameer A. Sheth Daniel Kramer John A. Thompson Elyn R. Saks Rachel A. Davis |
| author_sort | Judith M. Gault |
| collection | DOAJ |
| description | Abstract Introduction Ethical concerns have been raised by both current and historically controversial neurosurgical interventions for treatment-refractory schizophrenia and schizoaffective disorder (TR-SZ). Considering advances in next-generation deep brain stimulation (DBS), initial success in treating a few cases of TR-SZ, and how challenging trial enrollment is, transparency and disseminating knowledge about DBS is important, as is input from involved groups. Here information was presented about DBS as an experimental treatment option for TR-SZ to stakeholders to gauge enthusiasm after consideration of potential risks and benefits. Methods Stakeholders were presented with information about DBS (total n = 629). Opinions about whether DBS should be an option for people with TR-SZ and acceptable response rates considering DBS risks were collected from research participants with SZ, treatment-refractory Parkinson’s disease (TR-PD) approved for DBS, caregivers for either SZ or TR-PD participants, and attendees at medical school presentations. In addition, the attendees were asked to decide whether DBS is appropriate for 4 cases who want DBS, one with PD, 2 with OCD and 1 with SZ. Chi-square, pairwise comparisons, and Duncan Multiple Range Test were performed with significance at p < 0.05. Results Most (83%) research participants and presentation audience members agreed that DBS should be an option for TR-SZ and 40% thought the potential benefits outweigh the risks of DBS with at least a 41–60% response rate. Audience approval of DBS was similar for the PD (30%), SZ (52%) and the OCD case with psychosis (56%), but there was a higher rate of approval (77%) for the OCD case whose compulsions involved self-harm. The majority (73–86%) of the audience thought that they would want to try DBS if they had TR-PD, TR-OCD, or TR-SZ. Conclusions Despite difficulty in recruiting patients for DBS clinical trials for TR-SZ, the consensus among 83% of stakeholders was that DBS should be an option for people with severe TR-SZ. Our approach to disseminate general knowledge then gather opinions among diverse stakeholders was to ensure the development of DBS clinical trials for the new indication TR-SZ is a relevant option despite the known difficulties in enrollment. These findings may help prevent disparities in access to advanced DBS therapeutics. |
| format | Article |
| id | doaj-art-00730209dcfe4d43b3e09ab03c62dd55 |
| institution | Kabale University |
| issn | 1471-244X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Psychiatry |
| spelling | doaj-art-00730209dcfe4d43b3e09ab03c62dd552025-08-24T11:42:49ZengBMCBMC Psychiatry1471-244X2025-08-012511910.1186/s12888-025-07128-0Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholdersJudith M. Gault0Nicola Cascella1Nidal Moukaddam2Stephanie Lehto3Patrick Hosokawa4Paul S. Appelbaum5Akira Sawa6Jocelyn Lippman-Bell7William S. Anderson8Wayne Goodman9Sameer A. Sheth10Daniel Kramer11John A. Thompson12Elyn R. Saks13Rachel A. Davis14Department of Neurosurgery, University of Colorado Anschutz Medical CampusDepartment of Psychiatry, Johns Hopkins UniversityDepartment of Psychiatry, Baylor College of MedicineDepartment of Psychiatry, University of Colorado Anschutz Medical CampusDepartment of Neurosurgery, University of Colorado Anschutz Medical CampusDepartment of Psychiatry, Columbia UniversityDepartment of Psychiatry, Johns Hopkins UniversityPhiladelphia College of Osteopathic Medicine Department of Neurosurgery, Johns Hopkins UniversityDepartment of Psychiatry, Baylor College of Medicine Department of Neurosurgery, Baylor College of MedicineDepartment of Neurosurgery, University of Colorado Anschutz Medical CampusDepartment of Neurosurgery, University of Colorado Anschutz Medical CampusUniversity of Southern CaliforniaDepartment of Neurosurgery, University of Colorado Anschutz Medical CampusAbstract Introduction Ethical concerns have been raised by both current and historically controversial neurosurgical interventions for treatment-refractory schizophrenia and schizoaffective disorder (TR-SZ). Considering advances in next-generation deep brain stimulation (DBS), initial success in treating a few cases of TR-SZ, and how challenging trial enrollment is, transparency and disseminating knowledge about DBS is important, as is input from involved groups. Here information was presented about DBS as an experimental treatment option for TR-SZ to stakeholders to gauge enthusiasm after consideration of potential risks and benefits. Methods Stakeholders were presented with information about DBS (total n = 629). Opinions about whether DBS should be an option for people with TR-SZ and acceptable response rates considering DBS risks were collected from research participants with SZ, treatment-refractory Parkinson’s disease (TR-PD) approved for DBS, caregivers for either SZ or TR-PD participants, and attendees at medical school presentations. In addition, the attendees were asked to decide whether DBS is appropriate for 4 cases who want DBS, one with PD, 2 with OCD and 1 with SZ. Chi-square, pairwise comparisons, and Duncan Multiple Range Test were performed with significance at p < 0.05. Results Most (83%) research participants and presentation audience members agreed that DBS should be an option for TR-SZ and 40% thought the potential benefits outweigh the risks of DBS with at least a 41–60% response rate. Audience approval of DBS was similar for the PD (30%), SZ (52%) and the OCD case with psychosis (56%), but there was a higher rate of approval (77%) for the OCD case whose compulsions involved self-harm. The majority (73–86%) of the audience thought that they would want to try DBS if they had TR-PD, TR-OCD, or TR-SZ. Conclusions Despite difficulty in recruiting patients for DBS clinical trials for TR-SZ, the consensus among 83% of stakeholders was that DBS should be an option for people with severe TR-SZ. Our approach to disseminate general knowledge then gather opinions among diverse stakeholders was to ensure the development of DBS clinical trials for the new indication TR-SZ is a relevant option despite the known difficulties in enrollment. These findings may help prevent disparities in access to advanced DBS therapeutics.https://doi.org/10.1186/s12888-025-07128-0Deep brain stimulationEthicsSchizophreniaObsessive–compulsive disorderParkinson’s diseaseStakeholder opinions |
| spellingShingle | Judith M. Gault Nicola Cascella Nidal Moukaddam Stephanie Lehto Patrick Hosokawa Paul S. Appelbaum Akira Sawa Jocelyn Lippman-Bell William S. Anderson Wayne Goodman Sameer A. Sheth Daniel Kramer John A. Thompson Elyn R. Saks Rachel A. Davis Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders BMC Psychiatry Deep brain stimulation Ethics Schizophrenia Obsessive–compulsive disorder Parkinson’s disease Stakeholder opinions |
| title | Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders |
| title_full | Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders |
| title_fullStr | Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders |
| title_full_unstemmed | Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders |
| title_short | Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders |
| title_sort | ethical considerations of deep brain stimulation for treatment refractory schizophrenia surveying stakeholders |
| topic | Deep brain stimulation Ethics Schizophrenia Obsessive–compulsive disorder Parkinson’s disease Stakeholder opinions |
| url | https://doi.org/10.1186/s12888-025-07128-0 |
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