Table 2.

Possible indication and outcome criteria for psychosurgery for OCD

Suggested indication criteria
	Severity	Severe OC symptoms (Y-BOCS score >28)
	Chronicity	Symptoms of OCD with psychosocial impairment for at least 5 years
	Treatment resistant	Unresponsive to each of the subsequent pharmacological and psychological treatments
		More than 2 serotonin reuptake inhibitors
		≥2 augmentation strategies, such as the use of antipsychotic drugs (typical or atypical) or clomipramine, with adequate duration and dose
		≥20 h of OCD-specific Behavioral Therapy (i.e., ERP). Participation for shorter times may be permitted if nonadherence is due to symptom severity rather than to noncompliance
Outcome criteria [47]
	Response	Y-BOCS reduction ≥35% relative to the baseline score+CGI-I 1 (very much improved) or 2 (much improved)
	Partial response	Y-BOCS reduction 25%–35%+CGI-I ≥3 (minimally improved)
	Remission	Y-BOCS ≤12+CGI-S 1 (normal, not at all ill) or 2 (borderline mentally ill) ≥1 week
Suggested symptoms and adverse effects should be checked before and after the surgery
	Depression	HAM-D [48]
	Anxiety	HAM-A [49]
	Frontal lobe function	Neuropsychological tests (assess baseline intellectual function, change in broad range of cognitive domains, as well as change in behaviors subserved by the frontal lobe [e.g., apathy, disinhibition, and executive dysfunction])
		Frontal Systems Behavior Scale (self-report version) [50]
	Weight gain	Regular weight check
	Suicide ideation	Columbia-Suicide Severity Rating Scale (C-SSRS) [51]
	Quality of life	WHQOL [52]

OCD, obsessive-compulsive disorder; Y-BOCS, Yale-Brown Obsessive Compulsive Scale; ERP, exposure and response prevention; CGI-I, Clinical global impression-improvement; CGI-S, Clinical global impression-severity; HAM-D, Hamilton Depression Scale; HAM-A, Hamilton Anxiety Scale; WHQOL, The World Health Organization Quality of Life assessment