Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study.
BACKGROUND
Research on the pharmacotherapy of body dysmorphic disorder (BDD) is limited. No placebo-controlled, continuation, maintenance, or discontinuation studies have been published. Only one augmentation study has been published.


METHODS
In this chart-review study of 90 patients with DSM-IV BDD treated for up to 8 years by the first 2 authors (K.A.P., R.S.A.) in their clinical practice, response to a variety of medications, including augmentation strategies, was assessed. The relapse rate with medication discontinuation was also determined.


RESULTS
All subjects received a serotonin reuptake inhibitor (SRI), with 63.2% (55/87) of adequate SRI trials resulting in improvement in BDD symptoms; similar response rates were obtained for each type of SRI. Discontinuation of an effective SRI resulted in relapse in 83.8% (31/37) of cases. Response rates to selective SRI augmentation were clomipramine, 44.4% (4/9) of trials; buspirone, 33.3% (12/36) of trials; lithium, 20.0% (1/5); methylphenidate, 16.7% (1/6); and antipsychotics, 15.4% (2/13) of trials.


CONCLUSIONS
These findings from a clinical setting suggest that a majority of BDD patients improve with an SRI and that all SRIs appear effective. Certain SRI augmentation strategies may be beneficial. The high relapse rate with SRI discontinuation suggests that long-term treatment is often necessary. These preliminary findings require confirmation in placebo-controlled efficacy studies and effectiveness studies.
Phillips
K A
KA
Butler Hospital and the Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI 02906, USA. Katharine_Phillips@brown.edu
Albertini
R S
RS
Siniscalchi
J M
JM
Khan
A
A
Robinson
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002065:Buspirone / Q000627:therapeutic use; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D002065:Buspirone; D008094:Lithium; D008774:Methylphenidate; D017367:Selective Serotonin Reuptake Inhibitors