Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T19:56:40.440Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  07 November 2014

Stefano Pallanti  and
Lorrin M. Koran
Get access Rights & Permissions [Opens in a new window]

Abstract

Body 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.

Type
Grand Rounds
Information
CNS Spectrums , Volume 1 , Issue 2 , November 1996 , pp. 54 - 57
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.American Psychiatric Association. Diagnostic and Statistical Manual ot Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Hollander, E, Phillips, KA. Body image and experience disorders: body dysmorphic and depersonalization disorders. In: Hollander, E, ed. Obsessive-Compulsive and Related Disorders. Washington, DC: American Psychiatric Press; 1993:17–48.Google Scholar
3.Phillips, KA, McElroy, SL, Hudson, JI, Pope, HG Jr. Body dysmorphic disorder: an obsessive compulsive spectrum disorder, a form of affective spectrum disorder, or both? J Clin Psychiatry. 1995;56(suppl 4):41–51.Google ScholarPubMed
4.Simeon, D, Hollander, E, Stein, DJ, Cohen, L, Aronowitz, B. Body dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder. Am J Psychiatry. 1995; 152:1207–1209.Google ScholarPubMed
5.Hollander, E, Wong, CM. Body dysmorphic disorder, pathological gambling, and sexual compulsions. J Clin Psychiatry. 1995;56(suppl 4):7–12.Google ScholarPubMed
6.Phillips, KA, McElroy, SL, Keck, PE Jr, Pope, HG Jr, Hudson, JI. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry. 1993;150:302–308.Google ScholarPubMed
7.Phillips, KA, McElroy, SL. Insight, overvalued ideation, and delusional thinking in body dysmorphic disorder: theoretical and treatment implications. J Nerv Ment Dis. 1993;181:699–702.CrossRefGoogle ScholarPubMed
8.Hollander, E, Liebowitz, MR, Winchel, R, Mumker, A, Klein, DF. Treatment of body dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry. 1989;146:768–770.Google ScholarPubMed
9.Brady, KT. Body dysmorphic disorder: the relationship to obsessive-compulsive disorder. J Nerv Ment Dis. 1990;178: 538–540.Google ScholarPubMed
10.Phillips, KA, McElroy, SL, Keck, PE Jr, Pope, HG Jr, Hudson, JI. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacol Bull. 1994;30:179–186.Google Scholar
11.Hollander, E, Cohen, L, Simeon, D, Rosen, J, DeCaria, C, Stein, DJ. Fluvoxamine treatment of body dysmorphic disorder. J Clin Psychopharmacol. 1994;14:75–77.Google ScholarPubMed
12.Warneke, LB. The use of intravenous chlorimipramine in the treatment of obsessive compulsive disorder. Can J Psychiatry. 1984;29:135–141.Google Scholar
13.Warneke, LB. Intravenous chlorimipramine in the treatment of obsessional disorder in adolescence: case report. J Clin Psychiatry. 1985;46:100–103.Google ScholarPubMed
14.Warneke, LB. Intravenous chlorimipramine therapy in obsessive-compulsive disorder. Can J Psychiatry. 1989;34: 853–859.Google Scholar
15.Fallon, BA, Campeas, R, Schneier, FR, et al. , Open trial of intravenous clomipramine in five treatment-refractory patients with obsessive-compulsive disorder. J Neuro-psychiatry. 1992;4:70–75.Google ScholarPubMed
16.Koran, LM, Faravelli, C, Pallanti, S. Intravenous clomipramine for obsessive-compulsive disorder. J Clin Psychopharmacol. 1994;14:216–218.Google ScholarPubMed
17.Sallee, FR, Pollock, BG, Perel, JM, Ryan, ND, Stiller, RL. Intravenous pulse loading of clomipramine in adolescents with depression. Psychopharmacol Bull. 1989;25:114–118.Google ScholarPubMed
18.Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Leischmann, R, Hill, C, Heninger, G, Charney, D. The Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), part II: development, use, and reliability. Arch Gen Psychiatry. 1989;46:1006–1011.Google Scholar
19.Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–296.Google Scholar