Empirically defining treatment response and remission in body dysmorphic disorder

Abstract Background The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD. Method We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD–YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment. Results A BDD–YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) – Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD–YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI – Severity scale. Conclusion Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.

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Intravenous, Pulse-Loaded Clomipramine in Body Dysmorphic Disorder: Two Case Reports

CNS Spectrums ◽

10.1017/s1092852900002650 ◽

1996 ◽

Vol 1 (2) ◽

pp. 54-57 ◽

Cited By ~ 3

Author(s):

Stefano Pallanti ◽

Lorrin M. Koran

Keyword(s):

Body Dysmorphic Disorder ◽

Case Reports ◽

Controlled Trial ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Dsm Iv ◽

Surgical Treatments ◽

Delusional Disorder Somatic Type

AbstractBody dysmorphic disorder (BDD) is characterized by excessive preoccupation with an imagined or greatly exaggerated defect in appearance, and often by related rituals or pursuit of medical or surgical treatments. The frequent comorbidity of BDD with obsessive-compulsive disorder (OCD) and the phenomenological similarities between these two disorders suggest that they may be related. BDD reportedly responds to oral clomipramine (CMI).We present here two case studies of patients meeting DSM-IV criteria for BDD with comorbid delusional disorder, somatic type, to whom we administered pulse-loaded intravenous (IV) CMI (150 mg on day 1, 200 mg on day 2). After a 4.5-day drug holiday, both patients continued on oral CMI. As reflected in modified Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, both patients' BDD improved by about one third within 4.5 days of the second IV dose. Improvement continued over 2 months on oral CMI, and comorbid major depression present in one patient remitted. By the end of 8 weeks of oral CMI, the patients' modified Y-BOCS scores had decreased about 55%, and their social functioning had markedly improved.As in OCD, pulse-loaded, IV CMI may produce a much faster response than oral CMI or selective serotonin reuptake treatment and can be well tolerated. This treatment approach to BDD deserves further study in a prospective, randomized controlled trial.

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Body Dysmorphic Disorder

The British Journal of Psychiatry ◽

10.1192/bjp.169.2.196 ◽

1996 ◽

Vol 169 (2) ◽

pp. 196-201 ◽

Cited By ~ 354

Author(s):

David Veale ◽

Ann Boocock ◽

Kevin Gournay ◽

Windy Dryden ◽

Fozia Shah ◽

...

Keyword(s):

Body Dysmorphic Disorder ◽

Suicide Attempts ◽

Age At Onset ◽

Obsessive Compulsive ◽

Cross Sectional ◽

Compulsive Disorder ◽

Primary Disorder ◽

The Usa ◽

Axis I ◽

High Degree

BackgroundBody dysmorphic disorder (BDD) consists of a preoccupation with an ‘imagined’ defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD.MethodCross-sectional interview survey of 50 patients who satisfied DSM–IV criteria for BDD as their primary disorder.ResultsThe average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis I diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive–compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive–compulsive.ConclusionsBDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.

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Predictors of pharmacotherapy outcomes for body dysmorphic disorder: a machine learning approach

Psychological Medicine ◽

10.1017/s0033291721005390 ◽

2022 ◽

pp. 1-11

Author(s):

Joshua E. Curtiss ◽

Emily E. Bernstein ◽

Sabine Wilhelm ◽

Katharine A. Phillips

Keyword(s):

Machine Learning ◽

Precision Medicine ◽

Treatment Outcomes ◽

Treatment Response ◽

Partial Remission ◽

Body Dysmorphic Disorder ◽

Demographic Variables ◽

Support Vector ◽

Full Remission ◽

Feature Importance

Abstract Background Serotonin-reuptake inhibitors (SRIs) are first-line pharmacotherapy for the treatment of body dysmorphic disorder (BDD), a common and severe disorder. However, prior research has not focused on or identified definitive predictors of SRI treatment outcomes. Leveraging precision medicine techniques such as machine learning can facilitate the prediction of treatment outcomes. Methods The study used 10-fold cross-validation support vector machine (SVM) learning models to predict three treatment outcomes (i.e. response, partial remission, and full remission) for 97 patients with BDD receiving up to 14-weeks of open-label treatment with the SRI escitalopram. SVM models used baseline clinical and demographic variables as predictors. Feature importance analyses complemented traditional SVM modeling to identify which variables most successfully predicted treatment response. Results SVM models indicated acceptable classification performance for predicting treatment response with an area under the curve (AUC) of 0.77 (sensitivity = 0.77 and specificity = 0.63), partial remission with an AUC of 0.75 (sensitivity = 0.67 and specificity = 0.73), and full remission with an AUC of 0.79 (sensitivity = 0.70 and specificity = 0.79). Feature importance analyses supported constructs such as better quality of life and less severe depression, general psychopathology symptoms, and hopelessness as more predictive of better treatment outcome; demographic variables were least predictive. Conclusions The current study is the first to demonstrate that machine learning algorithms can successfully predict treatment outcomes for pharmacotherapy for BDD. Consistent with precision medicine initiatives in psychiatry, the current study provides a foundation for personalized pharmacotherapy strategies for patients with BDD.

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Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Molecular Psychiatry ◽

10.1038/s41380-020-00933-x ◽

2020 ◽

Author(s):

Hemmings Wu ◽

Marwan Hariz ◽

Veerle Visser-Vandewalle ◽

Ludvic Zrinzo ◽

Volker A. Coenen ◽

...

Keyword(s):

Clinical Trials ◽

Deep Brain Stimulation ◽

Obsessive Compulsive Disorder ◽

Brain Stimulation ◽

Brain Area ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Randomized Controlled ◽

Treatment Refractory ◽

Deep Brain

Abstract A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when “at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication.” The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.

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Memantine Augmentation Improves Symptoms in Serotonin Reuptake Inhibitor-Refractory Obsessive-Compulsive Disorder: A Randomized Controlled Trial

Pharmacopsychiatry ◽

10.1055/s-0043-120268 ◽

2017 ◽

Vol 51 (06) ◽

pp. 263-269 ◽

Cited By ~ 7

Author(s):

Atieh Modarresi ◽

Mehdi Sayyah ◽

Setareh Razooghi ◽

Kaveh Eslami ◽

Mohammadreza Javadi ◽

...

Keyword(s):

Treatment Response ◽

Controlled Trial ◽

Large Body ◽

Obsessive Compulsive ◽

Double Blind ◽

Compulsive Disorder ◽

Randomized Controlled ◽

Clinical Benefits ◽

The Mean ◽

To Receive

Abstract Introduction There is a large body of evidence on the clinical benefits of augmentation therapy with glutamate-modulating agents, such as memantine in reducing OCD symptoms. Methods A double-blind, placebo-controlled trial was conducted on SRIrefractory OCD patients. Thirty-two patients were randomized to receive either 20 mg/day memantine or placebo augmentation and were visited at baseline and every 4 weeks for 12 weeks. Results were measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Results The Y-BOCS total score was significantly reduced in the memantine group at the end of weeks 8 and 12, while no improvement was observed in the placebo group throughout the trial. A reduction of 40.9% in the mean Y-BOCS total score by week 12 in the memantine group resulted in 73.3% of patients achieving treatment response. The findings showed that a time to effect of 8 weeks was necessary to observe significant improvement in OCD symptoms, while treatment response was only seen after 12 weeks of memantine augmentation. Discussion Memantine is an effective and well-tolerated augmentation in severe OCD patients refractory to SRI monotherapy.

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A Retrospective Review of Clinical Characteristics and Treatment Response in Body Dysmorphic Disorder Versus Obsessive-Compulsive Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.v62n0114b ◽

2001 ◽

Vol 62 (1) ◽

pp. 67-72 ◽

Cited By ~ 30

Author(s):

Sanjana Saxena

Keyword(s):

Treatment Response ◽

Obsessive Compulsive Disorder ◽

Retrospective Review ◽

Clinical Characteristics ◽

Body Dysmorphic Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Empirically defining treatment response and remission in body dysmorphic disorder using a short self-report instrument

10.31234/osf.io/7rbhs ◽

2020 ◽

Author(s):

Oskar Flygare ◽

Long-Long Chen ◽

Lorena Fernández de la Cruz ◽

Jesper Enander ◽

David Mataix-Cols ◽

...

Keyword(s):

Treatment Response ◽

Body Dysmorphic Disorder ◽

Self Report ◽

Behaviour Therapy ◽

Obsessive Compulsive ◽

Appearance Anxiety ◽

Detection Analysis ◽

Remission Status ◽

Cognitive Behaviour ◽

Signal Detection Analysis

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cut-offs to define treatment response and remission in BDD using a brief self-reported instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive behaviour therapy for BDD, delivered via the internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale-Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤13 at post-treatment was the optimal cut-off in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.

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Body dysmorphic disorder

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.109.007716 ◽

2011 ◽

Vol 17 (2) ◽

pp. 142-149

Author(s):

Jennifer Ross ◽

Simon Gowers

Keyword(s):

Mental Health ◽

Clinical Trials ◽

Anorexia Nervosa ◽

Body Dysmorphic Disorder ◽

Healthcare Services ◽

Epidemiological Studies ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Health Community ◽

Physical Defects

SummaryBody dysmorphic disorder is a distressing and often disabling condition characterised by a preoccupation with imagined or slight physical defects in appearance. It has been recognised as a mental disorder for many years (and named body dysmorphic disorder since 1980), but epidemiological studies and clinical trials have been few. To a large extent, the disorder has been ignored by the mental health community, who often fail to elicit the diagnosis. This article reviews the diagnostic criteria for the disorder, its validity and its relationship to other disorders such as obsessive-compulsive disorder, anorexia nervosa, social phobia and somatisation disorders. The course of the illness, its aetiology and treatment approaches are discussed. As research is growing alongside an increase in patient presentations, body dysmorphic disorder requires a coherent response from healthcare services.

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Potential ethnic modifiers in the assessment and treatment of Alzheimer's disease: challenges for the future

International Psychogeriatrics ◽

10.1017/s104161020700511x ◽

2007 ◽

Vol 19 (3) ◽

pp. 539-558 ◽

Cited By ~ 29

Author(s):

Warachal E. Faison ◽

Susan K. Schultz ◽

Jeroen Aerssens ◽

Jennifer Alvidrez ◽

Ravi Anand ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Clinical Trials ◽

Genetic Variability ◽

Treatment Response ◽

Ethnic Groups ◽

Participation Rate ◽

Convincing Evidence ◽

Cognitive Enhancers ◽

Randomized Controlled

Objective: Despite numerous clinical trials, it is unknown whether ethnicity affects treatment response to cognitive enhancers in Alzheimer's disease (AD). There is convincing evidence of ethnic and genetic variability in drug metabolism. This article reviews the available data on ethnicity in clinical trials for AD to answer two questions: (1) what are the challenges to diagnose and treat AD across different ethnic groups, and (2) are there differences in response to pharmacologic interventions for AD across these different ethnic groups?Method: Available data from Alzheimer's Disease Cooperative Study (ADCS) randomized controlled clinical trials and from randomized controlled industry-sponsored trials for four cognitive enhancers (donepezil, galantamine, rivastigmine and sabeluzole) were pooled to assess the numbers of non-Caucasian participants.Results: The participation of ethnic minority subjects in clinical trials for AD was dependent on the funding source, although Caucasian participants were over-represented and non-Caucasian participants were under-represented in the clinical trials. Because of the low participation rate of ethnic minorities, there were insufficient data to assess any differences in treatment outcome among different ethnic groups. Strategies to improve diversity in clinical trials are discussed.Conclusion: Greater participation of ethnically diverse participants in clinical trials for AD would generate additional information on possible differences in metabolism, treatment response, adverse events to therapeutic agents, and could foster the investigation of genetic variability among ethnic groups.

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