fluvoxamine and Body-Dysmorphic-Disorders

Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), skin picking disorder (SPD), and hair pulling disorder (HPD), which share core clinical features such as preoccupation or recurrent thoughts and/or repetitive behaviors. Repetitive behaviors in BDD and HD can be differentially characterized by the presence of cognitive components associated with preceding anxiety from those in SPD or HPD, which are only observed as motoric components that regulate emotions or alleviate tension. Thus, the validity of the OCRD category and specific interrelationships between each OCRD remain uncertain. In the present study, therefore, we presented a case of multiple comorbidities of OCRDs in order to discuss the nature of the OCRD category. Our patient was a 20-year-old female university student. At the age of 11 years old, she started picking at acne on her face. The psychopathological, and treatment features observed in this case indicated possible interrelationships among OCRDs, especially between cognitive and motoric OCRDs, which supported the clinical utility and continuous nature of this category.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Body Dysmorphic Disorders; Clonazepam; Combined Modality Therapy; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Hoarding Disorder; Humans; Obsessive-Compulsive Disorder; Psychotherapy; Self-Injurious Behavior; Skin; Trichotillomania; Young Adult

Body dysmorphic disorder (BDD) is a relatively common and severe disorder for which pharmacotherapy has been only minimally studied. BDD often appears to respond to selective serotonin reuptake inhibitors (SSRIs), but many patients do not respond or respond only partially. Investigation of SSRI augmentation strategies is therefore needed. We report a case of treatment-resistant BDD that was successfully treated with pharmacological augmentation of fluvoxamine with aripiprazole. The patient, a 43-year-old woman, had been taking a stable dose of fluvoxamine (400 mg/day) for 6 months when she was started on aripiprazole (10 mg/day). After 10 weeks of this treatment, her clinical condition improved markedly, as indicated by a significant decrease in the Body Dysmorphic Disorder Examination score. This case presents some preliminary evidence that addition of the atypical antipsychotic agent aripiprazole may be useful in patients with treatment-resistant BDD. However, results from controlled studies are needed to support this finding.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Body Dysmorphic Disorders; Drug Partial Agonism; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Piperazines; Psychiatric Status Rating Scales; Quinolones; Receptors, Dopamine D2; Selective Serotonin Reuptake Inhibitors; Treatment Outcome