Psychiatric Neurosurgery: Attitude and Barriers of Psychiatrists Toward Neurosurgical Interventions in Saudi Arabia

INTRODUCTION: Neurosurgical interventions such as deep brain stimulation (DBS), anterior capsulotomy and anterior cingulotomy have been utilized since the mid-20th century and continue to play a role in the management of treatment-resistant psychiatric disorders, particularly major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Despite growing evidence supporting their safety and efficacy, psychiatrist engagement with these interventions remains limited, and data from many parts of the world is lacking. OBJECTIVE: To evaluate awareness, attitudes, and perceived barriers among psychiatrists in Saudi Arabia toward neurosurgical interventions for treatment-resistant psychiatric conditions. METHODS: A survey based study was conducted between March and June 2024 targeting senior psychiatry residents and board-certified psychiatrists practicing in Saudi Arabia. The questionnaire assessed sociodemographic information, referral practices, perceived knowledge, attitudes, and barriers related to psychiatric neurosurgery. RESULTS: A total of 64 psychiatrists participated. While 68.8% agreed that neurosurgical interventions can be effective for selected cases, 79.7% had never referred a patient. Referral willingness was higher for OCD (60.9%) than MDD (31.3%). Key barriers included fear of irreversible complications (76.4%), lack of procedural knowledge (62.5%), and uncertainty about referral criteria (56.9%). Male gender and older age were significant predictors of referral behavior and positive attitudes. Despite the overall low referral rates, 32.8% expressed strong interest in learning more about these treatment options. CONCLUSION: Although modern psychiatric neurosurgery is supported by clinical evidence, its utilization among psychiatrists in Saudi Arabia is similar to that around the world. It remains limited due to knowledge gaps and safety concerns. Religious and cultural differences do not appear to play a significant role in psychiatrists' responses and attitudes toward psychiatric neurosurgery. Educational initiatives, interdisciplinary collaboration, and clearer referral criteria are essential to increase appropriate adoption and improve access for patients with severe, treatment-resistant psychiatric illnesses.