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There were 5 follow-up assessments for ablative procedures and 6 follow-ups for VNS in this reporting period.

Forty-two referrals were received during the reporting period (18 men and 24 women); with a mean age of 46.8 years. A number were not considered to fall within the remit of the service and advice on further management was provided to the referrer.

There were 2 (4.8%) referrals from England, and 40 (95.2%) from Scotland.

Twenty-nine assessments were conducted during the 2009/10 financial year. Fourteen men and 15 women were seen, with a mean age of 49.5 years (range 20.3 – 85.2 years). Two assessments were conducted outwith the SLA.

Approximately 50% of patients had a diagnosis of unipolar major depression, and approximately 20% of patients had a primary diagnosis of obsessive-compulsive disorder. Other disorders made up the remaining 30% of assessments.

One Anterior Cingulotomy and one VNS implantation were performed during 2009/10. Both patients came from Scotland.

There were no deaths, no post-operative infections and no significant adverse events during the reporting year.

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.2 ± 3.4 weeks. This is slightly less than the previous year, but may reflect levels of activity. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as rescheduled appointments at the request of the patient.

There were no formal complaints.

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

Of the 5 patients who had undergone Anterior Cingulotomy and were followed up in 2009/10, two met criteria for response, and one met criteria for remission (categories not mutually exclusive). All patients undergoing ablative neurosurgery experienced variable degrees of symptom reduction.

Of the 6 patients who were reviewed following VNS, none met criteria for response or remission. Two patients had modest symptom improvement at follow-up. It is recognised that this is a very refractory population, and the service continues to collect very detailed outcomes from all patients.  

Members of the team continue to deliver presentations at a local and national level. Members of staff have been very active from a research perspective, publishing extensively in peer-reviewed journals, contributing to textbooks in psychiatry, and contributing to national clinical guidelines.

In addition, the service contributes to undergraduate and postgraduate teaching programmes (local and national) and individuals have supervised projects at an undergraduate and postgraduate (PhD) level.

Agreements, in principle, have been reached for our service to participate in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression, which will hopefully begin recruiting later in 2010. This will enable us to not only advance patient care but also to develop patient choice in this clinical area. Uniquely, in Dundee, we will have the opportunity to evaluate the outcomes for this DBS alongside those for other neurosurgical therapies.

Although neurosurgical activity in 2009/10 is less than that of 2008/09, it is recognised that such activity varies from one year to the next. In addition, the level of activity is dependent upon the nature of the patients referred, and it remains the situation that in many cases, further treatment recommendations are given before the patient may return for consideration for a neurosurgical intervention. Further, surgery rates for the next reporting period are predicted to be higher, with a number of patients already on the pathway for neurosurgery.

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AIS Annual Report 2009

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The Dundee Advanced Interventions (Neurosurgery for Mental Disorder) Service was first designated as a National Specialist Service in April 2006, and became fully staffed in the first quarter of 2007. We are therefore reporting on the second full year of service activity.

Twenty-five referrals were received during 2008/09. Twenty-two (88%) came from Scotland, 2 (8%) came from England, and 1 (4%) came from Northern Ireland.

Twenty-six assessments were performed. One patient did not attend for initial assessment. The source of assessments mirrored that of referrals, with 3 assessments being conducted outwith the Service Level Agreement (SLA) and was funded by referring NHS Trust in England/ Ireland).

Approximately 60% of assessments had a primary diagnosis of unipolar major depression. Approximately 20% had a diagnosis of Obsessive-Compulsive Disorder. Bipolar disorder, organic disorders, personality disorder, and other anxiety disorders made up the remaining diagnoses.

During 2008/09, 7 procedures (3 cingulotomies and 4 Vagus Nerve Stimulator implantations) were performed. Five procedures were funded outwith the SLA.

There were no deaths, no post-operative infections and no significant adverse events during the current year.

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 10.7 ± 6 weeks. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as rescheduled appointments at the request of the patient.

There were no formal complaints.

Patient satisfaction for both outpatient assessment and inpatient admission was consistently high, with the majority of patients rating their experience positively. The service was rated highly for quality of assessment. Inpatient experience was uniformly positive.

In the patients reviewed during 2008/09, six had undergone ACING (four as their second procedure) and five had undergone VNS. Response rates for VNS were 20%. This is believed to reflect the high levels of chronicity, disability and treatment-resistance within the patient group treated in Dundee. With respect to these clinical features, the VNS patients treated in Dundee were not comparable to those typically included in published studies where higher response rates have been described. Two out of 4 (50%) patients undergoing a second ACING for major depression achieved clinical remission.

Staff have delivered a range of presentations at national and regional meetings throughout the year. Invited presentations have also been given at postgraduate psychiatry meetings in Scotland.

The service continues to publish academic papers on NMD and related topics  and a number of AIS staff have been awarded grants for further research.

Dundee AIS continues to build links with local mental health services and a variety of third-sector organisations. In the last year, members of the team have visited tertiary-level inpatient OCD treatment services in London.

The service is optimistic about the possibilities for participation in international multi-centre trials of Deep Brain Stimulation (DBS) for both depression and OCD.

Although of the referral rate for assessments was lower this year than last, we continue to exceed our SLA recommended activity level. This reporting year has been busier with respect to neurosurgical activity and our engagement in post-operative care planning with referring services has continued to build and evolve.

New members of the team bring with them exciting possibilities for the service to build on its existing research portfolio and to ensure the delivery of best clinical practise in the delivery of complex and advanced interventions for chronic, refractory psychiatric illness.

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