Body dysmorphic disorder: the relationship to obsessive-compulsive disorder

Article Abstract:

Body dysmorphic disorder is a ''nondelusional preoccupation with an imagined defect in appearance'' by a person who is normal in appearance. Dysmorphophobia, a related term, refers to patients who have both delusional and nondelusional preoccupation with an imagined body defect. Such preoccupation is intense and very distressing to the patient. In its intensity, it is indistinguishable from the kind of preoccupation seen in obsessive-compulsive disorder (OCD). This is demonstrated in three case histories. The first concerns a medical student who was tormented by thoughts about losing his hair. His obsession with this defect generated an anxiety that interfered with his school performance. Treatment with clomipramine led to symptom relief, but side effects forced him to change to fluoxetine, with less complete symptom relief. The second case was that of a man who developed obsessive-compulsive behavior and became preoccupied with a small facial scar; he could not rid himself of the idea that he was grossly disfigured. Behavioral therapy and fluoxetine, with lithium added later, led to moderate improvement in OCD. The third case discussed was a man who was convinced of the persistence of a large acne blemish, which, in fact, had disappeared. Although he acknowledged that it was only to him that it remained visible, he was convinced of its existence and obsessed with it. His preoccupation and ritualistic behaviors improved after treatment with fluoxetine. A discussion of the diagnostic possibilities for these disorders is provided. In all cases, the patients were obsessively, but not delusionally, preoccupied with their imagined defects. Arguments are made for classifying their body dysmorphic disorder as a variant, rather than a coexisting condition, of OCD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Somatoform disorders, Identification and classification

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Psychometric assessment of depression in an elderly general medicine population: over- or underassessment?

Article Abstract:

Depression is believed to be undiagnosed in many elderly people. This disorder can be identified using a series of psychological tests. Although standardized tests can detect major depressive disorders, they may not detect minor depressive illnesses. Also, non-psychiatric physicians may not recognize depression in the elderly and cognitive impairment of the patient may cause difficulty in administering some tests. Many elderly patients undergo comprehensive psychological testing following referral by family members or personal physicians who are concerned about their functional deterioration. Three tests, the Geriatric Depression Scale (GDS), Mini-Mult MMPI, and the Brief Symptom Inventory (BSI) were given to 247 consecutive elderly patients to detect depression. Major depression was diagnosed in 58.5 percent of these patients and minor depression was diagnosed in 20.8 percent. The investigators believe that direct observation, patient and family interviews, and psychometric assessment are needed to detect depression in elderly depressed patients who may otherwise be undiagnosed. The MMPI is a lengthy test, and the BSI involves a series of multiple choice questions; both tests were difficult for the subjects. The GDS test was considered the easiest test to administer, since it has a simple yes-no format. Contrary to previous reports, depression is not overestimated in the elderly. Elderly patients often report physical rather than psychiatric complaints; further research is needed regarding self-recognition of depressive disorders in this group. Better methods of assessment are also needed to detect minor depression, since it may complicate a patient's recovery from other illnesses, or may lead to more serious depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Testing, Demographic aspects, Depression, Mental, Depression (Mood disorder), Depression in old age, Geriatric depression, Geriatric psychiatry

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Three cases of pharmacotherapy of obsessive-compulsive disorder in the elderly

Article Abstract:

Obsessive-compulsive disorder (OCD) is thought to occur in from 0.2 percent to 1.3 percent of men and women over the age of 65, with slightly more cases occurring in women than in men. Most often OCD is chronic, with an average onset at age 23. However, the incidence of new cases in older patients is currently 0.64 percent and increasing. While treatment of OCD with psychiatric drugs, particularly clomipramine and fluoxetine, has been shown to be efficacious, the use of drug therapy for treating OCD in the elderly has not been specifically addressed. Three cases are presented. In the first case, a 68-year-old woman who had suffered OCD for 30 years, treatment with 60 milligrams (mg) fluoxetine per day resulted in almost complete remission of symptoms within two months. The only side effect was an initial 10 pound weight loss. In the second case, a 72-year-old woman with a three-year history of OCD, recovered after six months of 40 mg fluoxetine per day and a behavioral program. In the third case, a 65-year-old man who had symptoms of OCD dating back to age 16, treatment with 25 mg clomipramine per day resulted in remission of symptoms, which continued at three-year-follow-up. This man had received numerous other treatments, all unsuccessful, over the years. These cases suggest that fluoxetine and clomipramine can be safely and effectively used for treating OCD in the elderly, even when there is a chronic history of OCD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy

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