Hollander E, Allen A, Kwon J, Aronowitz B, Schmeidler J, Wong C, Simeon D
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
Arch Gen Psychiatry. 1999 Nov;56(11):1033-9. doi: 10.1001/archpsyc.56.11.1033.
Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled treatment studies have been published.
Forty patients were enrolled and 29 were randomized into a 16-week, double-blind, crossover-design study of clomipramine, a potent serotonin reuptake inhibitor, and active control desipramine, a selective norepinephrine reuptake inhibitor. Outcome measures included specific ratings of body dysmorphic disorder severity, delusionality, and functional impairment.
Clomipramine was superior to desipramine in the acute treatment of body dysmorphic disorder symptoms as measured by assessment of patients' obsessive preoccupation with perceived body defects, repetitive behaviors in response to this preoccupation, and global ratings of symptom severity. Treatment efficacy was independent of the presence or severity of comorbid diagnoses of obsessive-compulsive disorder, depression, or social phobia. Likewise, clomipramine was equally effective regardless of whether the patients had insight or held their dysmorphic misperception with delusional intensity. Clomipramine was also superior to desipramine in improving functional disability.
Clomipramine is more effective than desipramine in the treatment of body dysmorphic disorder and is effective even among those patients who are delusional.
躯体变形障碍（过度关注想象中的或轻微的外表缺陷）是一种常见且致残的疾病，与妄想症状和自杀企图的高发生率相关。尽管初步研究表明血清素再摄取抑制剂可能对躯体变形障碍有效，但迄今为止尚未发表对照治疗研究。
招募了40名患者，其中29名被随机分配到一项为期16周的双盲交叉设计研究中，该研究比较了强效血清素再摄取抑制剂氯米帕明和选择性去甲肾上腺素再摄取抑制剂活性对照药地昔帕明。结果测量包括躯体变形障碍严重程度、妄想程度和功能损害的特定评分。
通过评估患者对感知到的身体缺陷的强迫性关注、对这种关注的重复行为以及症状严重程度的总体评分，氯米帕明在急性治疗躯体变形障碍症状方面优于地昔帕明。治疗效果与强迫症、抑郁症或社交恐惧症共病诊断的存在或严重程度无关。同样，无论患者是否有洞察力或是否以妄想强度持有其变形的错误认知，氯米帕明的效果都是一样的。氯米帕明在改善功能残疾方面也优于地昔帕明。
氯米帕明在治疗躯体变形障碍方面比地昔帕明更有效，甚至在那些有妄想的患者中也有效。
