Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-18T14:12:13.722Z Has data issue: false hasContentIssue false

A Prospective Pilot Study of Levetiracetam for Body Dysmorphic Disorder

Published online by Cambridge University Press:  07 November 2014

Abstract

Introduction: Body dysmorphic disorder (BDD) is an often severe disorder, but few treatment studies have been conducted.

Objective: This pilot study explored the efficacy and safety of the antiepileptic medication levetiracetam for BDD.

Methods: Seventeen subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BDD participated in a 12-week open-label levetiracetam trial. Subjects were assessed at regular intervals with standard measures.

Results: In intent-to-treat analyses, scores on the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS), the primary outcome measure, decreased from 32.5±4.7 at baseline to 21.5±11.0 at endpoint (P<.001). Approximately 60% (n=9) of subjects were responders (≥30% decrease on the BDD-YBOCS). The mean time to response was 4.6±2.8 (range: 2-10) weeks. Scores also significantly improved on the Brown Assessment of Beliefs Scale, the Hamilton Rating Scale for Depression, the Global Assessment of Functioning Scale, and the Social and Occupational Functioning Assessment Scale. Scores did not significantly improve on the Quality of Life Enjoyment and Satisfaction Questionnaire, the Beck Anxiety Inventory, or the Social Phobia Inventory. The mean endpoint dose of levetiracetam was 2,044.1±1,065.2 (range: 250–3,000) mg/day, and it was relatively well-tolerated.

Conclusion: Randomized, double-blind placebo-controlled studies of levetiracetam for BDD are needed to confirm these preliminary findings.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2009

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

REFERENCES

1.Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry. 1991;148:11381149.Google Scholar
2.Faravelli, C, Salvatori, S, Galassi, F, et al.Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol. 1997;32:2429.CrossRefGoogle ScholarPubMed
3.Bienvenu, OJ, Samuels, JF, Riddle, MA, et al.The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48:287293.Google Scholar
4.Koran, LM, Abujaoude, E, Large, MD, Serpe, RT. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr. 2008;13:316322.Google Scholar
5.Rief, W, Buhlmann, U, Wilhelm, S, Borkenhagen, A, Brahler, E. The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med. 2006;36:877885.Google Scholar
6.Perugi, G, Giannotti, D, Frare, F, et al.Prevalence, phenomenology and comorbidity of body dysmorphic disorder (dysmorphophobia) in a clinical population. Int J Clin Pract. 1997;1:7782.CrossRefGoogle Scholar
7.Phillips, KA, Diaz, S. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997;185:570577.Google Scholar
8.Phillips, KA, Pagano, ME, Menard, W, Stout, RL. A 12-month follow-up study of the course of body disorder. Am J Psychiatry. 2006;163:907912.Google Scholar
9.Didie, ER, Menard, W, Stern, AP, Phillips, KA. Occupational functioning and impairment in adults with body dysmorphic disorder. Compr Psychiatry. 2008;49:561569.CrossRefGoogle ScholarPubMed
10.Phillips, KA, Quality of life for patients with body dysmorphic disorder. J Nerv Ment Dis. 2000;188:170175.Google Scholar
11.Phillips, KA, Menard, W, Fay, C, Pagano, M. Psychosocial functioning and quality of life in body dysmorphic disorder. Compr Psychiatry. 2005;46:254260.Google Scholar
12.Didie, ER, Walters, MM, Pinto, A, et al.Comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder. Ann Clin Psychiatry. 2007;19:181186.CrossRefGoogle ScholarPubMed
13.Frare, F, Perugi, G, Ruffolo, G, Toni, C. Obsessive-compulsive disorder and body dysmorphic disorder: a comparison of clinical features. Eur Psychiatry. 2004;19:292298.CrossRefGoogle ScholarPubMed
14.Veale, D, Boocock, A, Gournay, K, et al.Body dysmorphic disorder: a survey of fifty cases. Br J Psychiatry. 1996;169:196201.Google Scholar
15.Phillips, KA, Coles, M, Menard, W, et al.Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry. 2005;66:717725.Google Scholar
16.Phillips, KA, Menard, W. Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry. 2006;163:12801282.Google Scholar
17.Phillips, KA, Hollander, E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image. 2008;5:1327.Google Scholar
18.National Collaborating Centre for Mental Health. Obsessive Compulsive Disorder: Core Interventions in the Treatment of Obsessive Compulsive Disorder and Body Dysmorphic Disorder. National Clinical Practice Guideline Number 31. London, British Psychiatric Society and Royal College of Psychiatrists; 2006.Google Scholar
19.Hollander, E, Allen, A, Kwon, J, et al.Clomipramine versus desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry. 1999;56:10331039.Google Scholar
20.Phillips, KA, Albertini, RS, Rasmussen, SA. A randomized placebo controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry. 2002;59:381388.Google Scholar
21.Perugi, G, Giannotti, D, Di Vaio, S, et al.Fluvoxamine in the treatment of body dysmorphic disorder (dysmorphophobia). Int Clin Psychopharmacol. 1996;11:247254.CrossRefGoogle ScholarPubMed
22.Phillips, KA, Dwight, MM, McElroy, SL. Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry. 1998;59:165171.Google Scholar
23.Phillips, KA, Najjar, F. An open-label study of citalopram in body dysmorphic disorder. J Clin Psychiatry. 2003;64:715720.Google Scholar
24.Phillips, KA. An open-label study of escitalopram in body dysmorphic disorder. Int Clin Psychopharmacol. 2006;21:177179.Google Scholar
25.Allen, A, Hadley, SJ, Kaplan, A, et al.An open-label trial of venlafaxine in body dysmorphic disorder. CNS Spectr. 2008;13:138144.Google Scholar
26.Lynch, BA, Lambeng, N, Nocka, K, et al.The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A. 2004;101:98619866.CrossRefGoogle ScholarPubMed
27.Rigo, JM, Hans, G, Nguyen, L, et al.The anti-epilepetic drug levetiracetam reverses the inhibition by negative allosteric modulators of neuronal GABA-A and glycinegated currents. Br J Pharmacol. 2002;136:659672.Google Scholar
28.Simon, NM, Worthington, JJ, Doyle, AC, et al.An open-label study of levetiracetam for the treatment of social anxiety disorder. J Clin Psychiatry. 2004;65:12191222.CrossRefGoogle ScholarPubMed
29.Coles, ME, Phillips, KA, Menard, W, et al.Body dysmorphic disorder and social phobia: cross-sectional and prospective data. Depress Anxiety. 2006;23:2633.Google Scholar
30.Pinto, A, Phillips, KA. Social anxiety in body dysmorphic disorder. Body Image. 2005;2:401405.Google Scholar
31.Kelly, MM, Walters, C, Phillips, KA. Social anxiety and its relationship to functional impairment in body dysmorphic disorder. Behav Ther. In press.Google Scholar
32.Wilhelm, S, Otto, MW, Zucker, BG, Pollack, MH. Prevalence of body dysmorphic disorder in patients with anxiety disorders. J Anxiety Disord. 1997;11:499502.CrossRefGoogle ScholarPubMed
33.Buhlmann, U, Wilhelm, S, McNally, RJ, et al.Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectr. 2002;7:435436;441-443.Google Scholar
34.Gunstad, J, Phillips, KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003;44:270276.Google Scholar
35.Phillips, KA, Menard, W, Fay, C, Weisberg, R. Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics. 2005;46:317332.Google Scholar
36.Zhang, W, Connor, KM, Davidson, JRT. Levetiracetam in social phobia: a placebo controlled pilot study. J Psychopharmacol. 2005;19:551553.Google Scholar
37.Grunze, HC. The effectiveness of anticonvulsants in psychiatric disorders. Dialogues Clin Neurosci. 2008;10:7789.Google Scholar
38.Phillips, KA, Hollander, E, Rasmussen, SA, et al.A severity rating scale for body dysmorphic disorder. Psychopharmacol Bull. 1997;33:1722.Google Scholar
39.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York, New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
40.National Institute of Mental Health. Rating scales and assessment instruments for use in pediatric psychopharmacology research. Psychopharmacol Bull. 1985;21:839.Google Scholar
41.Eisen, JL, Phillips, KA, Baer, L, et al.The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry. 1998;155:102108.CrossRefGoogle ScholarPubMed
42.Miller, IW, Bishop, S, Norman, WH, Maddever, H. The modified Hamilton Rating Scale for depression: reliability and validity. Psychiatry Res. 1985;14:131142.Google Scholar
43.Connor, KM, Davidson JRT, Churchill, LE, et al.Psychometric properties of the Social Phobia Inventory (SPIN). Br J Psychiatry. 2000;176:379386.CrossRefGoogle ScholarPubMed
44.Shear, MK, Brown, B, Clark, DB. Anxiety disorder measures. In: Rush, AJ, First, MB, Blacker, D, eds. Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association; 2007:529558.Google Scholar
45.Brown, GK, Beck, AT, Newman, CF, Beck, JS, Tran, GO. A comparison of focused and standard cognitive therapy for panic disorder. J Anxiety Disord. 1997;11:329345.Google Scholar
46.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
47.Endicott, J, Nee, J, Harrison, W, Blumenthal, R. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull. 1993;29:321326.Google Scholar
48.Cohen, J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1988.Google Scholar
49.Phillips, KA, Albertini, RS, Siniscalchi, JM, Khan, A, Robinson, M. Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. J Clin Psychiatry. 2001;62:721727.Google Scholar
50.Rapaport, MH, Clary, C, Fayyad, R, Endicott, J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005;162:11711178.Google Scholar
51.Phillips, KA, Kaye, WH. The relationship of body dysmorphic disorder and eating disorders to obsessive-compulsive disorder. CNS Spectr. 2007;12:347358.Google Scholar
52.Mula, M, Pini, S, Cassano, GB. The role of anticonvulsant drugs in anxiety disorders. J Clin Psychopharmacol. 2007;27:263272.Google Scholar
53.Mazza, M, Martini, A, Scoppetta, M, Mazza, S. Effect of levetiracetam on depression and anxiety in adult epileptic patients. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:539543.CrossRefGoogle ScholarPubMed
54.Kinrys, G, Worthington, JJ, Wygant, L, et al.Levetiracetam as adjunctive therapy for refractory anxiety disorders. J Clin Psychiatry. 2007;68:10101013.Google Scholar
55.Kinrys, G, Wygant, LE, Pardo, TB, Melo, M. Levetiracetam for treatment-refractory posttraumatic stress disorder. J Clin Psychiatry. 2006;67:211214.Google Scholar