Delusionality and response to open-label fluvoxamine in body dysmorphic disorder.
BACKGROUND
Available data suggest that the delusional variant of body dysmorphic disorder (BDD), a type of delusional disorder, may respond to serotonin reuptake inhibitors (SRIs) and that delusionality (lack of insight) in BDD may improve with SRI treatment. However, this research has been hampered by the lack of a reliable and valid scale to assess delusionality.


METHODS
Thirty subjects (21 women, 9 men; mean age = 33.3 +/- 9.0 years) with DSM-IV BDD were prospectively treated with open-label fluvoxamine for 16 weeks. Subjects were assessed at regular intervals with the Brown Assessment of Beliefs Scale (BABS), the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS; a measure of BDD severity), and other instruments. The BABS is a reliable and valid 7-item, semistructured, clinician-administered scale that assesses current delusionality.


RESULTS
In this prospective, open-label study, 63% of BDD subjects responded to fluvoxamine. Delusional and nondelusional subjects had similar improvement in BDD symptoms. In addition, insight significantly improved in both delusional and nondelusional subjects. Baseline BABS scores did not contribute significantly to endpoint BDD-YBOCS scores in a regression analysis.


CONCLUSIONS
Degree of delusionality did not predict fluvoxamine response, and delusionality significantly improved. These findings are preliminary and require confirmation in controlled trials. The implications of these findings for other types of delusions requires investigation.
Phillips
K A
KA
Butler Hospital and the Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence RI 02906, USA.
McElroy
S L
SL
Dwight
M M
MM
Eisen
J L
JL
Rasmussen
S A
SA
D000328:Adult; D000553:Ambulatory Care; D003702:Delusions / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D016666:Fluvoxamine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012044:Regression Analysis; D015203:Reproducibility of Results; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors