Adjunctive antipsychotic in the treatment of body dysmorphic disorder – A retrospective naturalistic case note study

Abstract

Objectives. 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.

Key words::

• Body dysmorphic disorder
• antipsychotic
• selective serotonin reuptake inhibitor

Acknowledgements

We acknowledge kind assistance of the administrative staff in the HPFT OCD/BDD clinic, including Ms. Kim Fox, Ms Kiri Jefferies and Prof. T. Gale in the Research and Development Office.

Statement of interest

Consultancy

Dr Fineberg has consulted for Lundbeck, Glaxo-Smith Kline, Transcept, Novartis and Servier.

Research support

Dr Fineberg has received research support from Lundbeck, Glaxo-SmithKline, ECNP, Servier, Cephalon, Astra Zeneca, UK MRC, UK NIHR, and Wellcome Foundation.

Honoraria for lectures

Dr Fineberg has received honoraria for lectures at scientific meetings from Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, and Bristol-Myers Squibb.

Financial support to attend scientific meetings

Dr Fineberg has received financial support to attend scientific meetings from Janssen, Lundbeck, Servier, Novartis, Bristol-Myers Squibb, Cephalon, International College of OC Spectrum Disorders, International Society for Addiction, ECNP, BAP, WHO, and Royal College of Psychiatrists.