title: Adjunctive antipsychotic in the treatment of body dysmorphic disorder - A retrospective naturalistic case note study.
abstract: OBJECTIVE
  A retrospective naturalistic case note study to determine the frequency, co-morbidity and treatment-response of body dysmorphic disorder (BDD).
  
  
  METHODS
  Records from 280 patients attending a highly specialised obsessive-compulsive disorder (OCD)/BDD service were analysed. The clinical outcome was measured either through scoring of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD/BDD, or textual analysis of case notes for evidence of symptomatic improvement, treatment tolerability, and premature disengagement.
  
  
  RESULTS
  A total of 32 patients (11.43%) were diagnosed with BDD. Of these, 28 (87.5%) had at least one co-morbidity. All patients were offered cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor (SSRI). Adjunctive low-dose antipsychotic was prescribed for 21 (66%) patients. Overall, 18/32 (56%) responded, and 7/32 (22%) disengaged prematurely. Patients offered antipsychotic, SSRI and CBT (n = 21) were compared with those offered SSRI and CBT only (n = 11). The treatment was well-tolerated. Whereas there was no significant inter-group difference in the clinical response rate, premature disengagement occurred less frequently in the antipsychotic-treated patients (9.5% versus 45%; Fisher's Exact Test P = 0.0318).
  
  
  CONCLUSIONS
  BDD frequently presents with co-morbidity, treatment-resistance and premature disengagement. Adjunctive antipsychotic was associated with significantly better treatment adherence, but responder rates did not differ significantly, possibly related to the small sample-size. A well-powered randomised controlled study is warranted, to determine clinical outcomes with adjunctive antipsychotic in BDD.
authors.affiliation: Highly Specialised OCD/BDD Service, Hertfordshire Partnership University NHS Foundation Trust, Mental Health Unit, Queen Elizabeth II Hospital , Howlands, Welwyn Garden City, Hertfordshire , UK.
authors.forename: Haroon
authors.initials: H
authors.lastname: Rashid
authors.forename: Akif A
authors.initials: AA
authors.lastname: Khan
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Fineberg
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000494:pharmacology*; D057215:Body Dysmorphic Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*
chemical_list: D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Body dysmorphic disorder; antipsychotic; selective serotonin reuptake inhibitor