title: The contemporary practice of psychiatric surgery: results from a survey of North American functional neurosurgeons.
abstract: BACKGROUND
  Deep brain stimulation (DBS) for psychiatric indications is becoming increasingly safe and effective. As a result, the treatment of these conditions by neurosurgeons is becoming more widespread and a larger part of the functional neurosurgeons' practice. Given the troubled history of the field and its current renaissance, it is important to evaluate current practices, to serve as a baseline for future comparison, and to gauge changing cultural attitudes towards invasive neuromodulation.
  
  
  OBJECTIVE
  The purpose of this study was to obtain a snapshot of the practice of the contemporary functional neurosurgeon engaged in psychiatric surgery. Current practices as well as attitudes towards the direction of the field and its future were also investigated.
  
  
  METHODS
  We designed an online survey and distributed it electronically to 299 functional neurosurgeons in North America identified by membership in the World Society for Stereotactic and Functional Neurosugery. Subsequent statistical and thematic analysis was performed on the data obtained.
  
  
  RESULTS
  Of 299 surveys sent out, 84 were completed (28%). Fifty percent of functional neurosurgeons are currently engaged in some form of psychiatric surgery, with DBS for obsessive-compulsive disorder and depression accounting for most cases. Most surgeons see psychiatric surgery as a growing field, with multidisciplinary teams and a greater engagement with psychiatry necessary for the expansion of the field. Opinions differed substantially on hypothetical scenarios dealing with surgical cognitive enhancement, with some in favour of it, citing patient autonomy and choice, and others drawing a clear distinction between pathologic and non-pathologic states.
  
  
  CONCLUSIONS
  Surgery for psychiatric indications is a growing field in the contemporary functional neurosurgeon's practice. Most neurosurgeons see the field continuing to grow and psychiatric surgery becoming a larger part of their daily practice, with the appropriate ethical and psychiatric oversight. Future editions of this survey and their results can be used to trace the development and growth of the field as technology and cultural attitudes continue to evolve.
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont., Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Lipsman
authors.forename: Daniel
authors.initials: D
authors.lastname: Mendelsohn
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D046690:Deep Brain Stimulation / Q000639:trends*; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D009493:Neurosurgery / Q000639:trends*; D009656:North America / Q000453:epidemiology; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016896:Treatment Outcome