Evidence map›Paper›PMID 40830450›Full record

ArticleBMC psychiatry2025

Ethical considerations of deep brain stimulation for treatment refractory schizophrenia: surveying stakeholders.

Judith M Gault, Nicola Cascella, Nidal Moukaddam, Stephanie Lehto, Patrick Hosokawa, Paul S Appelbaum, Akira Sawa, Jocelyn Lippman-Bell, William S Anderson, Wayne Goodman and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Judith M GaultDepartment of Neurosurgery, University of Colorado Anschutz Medical Campus, E. 19th Ave. , Aurora, CO, 80045, Box 8601, USA. Judith.gault@cuanschutz.edu.
Nicola CascellaDepartment of Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
Nidal MoukaddamDepartment of Psychiatry, Baylor College of Medicine, Houston, TX, USA.
Stephanie LehtoDepartment of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Patrick HosokawaDepartment of Neurosurgery, University of Colorado Anschutz Medical Campus, E. 19th Ave. , Aurora, CO, 80045, Box 8601, USA.
Paul S AppelbaumDepartment of Psychiatry, Columbia University, New York, NY, USA.
Akira SawaDepartment of Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
Jocelyn Lippman-BellPhiladelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
William S AndersonDepartment of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
Wayne GoodmanDepartment of Psychiatry, Baylor College of Medicine, Houston, TX, USA.
Sameer A ShethDepartment of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Daniel KramerDepartment of Neurosurgery, University of Colorado Anschutz Medical Campus, E. 19th Ave. , Aurora, CO, 80045, Box 8601, USA.
John A ThompsonDepartment of Neurosurgery, University of Colorado Anschutz Medical Campus, E. 19th Ave. , Aurora, CO, 80045, Box 8601, USA.
Elyn R SaksUniversity of Southern California, Los Angeles, California, USA.
Rachel A DavisDepartment of Neurosurgery, University of Colorado Anschutz Medical Campus, E. 19th Ave. , Aurora, CO, 80045, Box 8601, USA.

Funding

Project 3P50MH136297 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Akira Sawa · 2024 to 2026
$12.8M
Leveraging ethical dissension among capacity, beneficence and justice in clinical trials of neurotherapeutics in the severely disabled: lessons from schizophreniaRF1MH121362 · NIMH · UNIVERSITY OF COLORADO DENVER · PI DAVIS, RACHEL A, GAULT, JUDITH MORSE · 2019 to 2019
$1.6M
NIH HHS MH121362NIMH NIH HHS P50 MH136297NIMH NIH HHS RF1 MH121362
6 · The paper itself

Abstract

introductionEthical 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.

methodsStakeholders 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.

resultsMost (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.

conclusionsDespite 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.

Indexed as

Deep Brain StimulationPsychotic DisordersSchizophreniaSchizophrenia, Treatment-ResistantAdultFemaleHumansMaleMiddle AgedParkinson DiseaseSurveys and QuestionnairesBeneficenceDeep brain stimulationEthicsJusticeObsessive–compulsive disorderParkinson’s diseaseSchizophreniaStakeholder opinions

Identifiers

PMID40830450
PMCPMC12362889

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.