Rechargeable Stimulators in Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Prospective Interventional Cohort Study.

BACKGROUND: From 1999 onwards, deep brain stimulation (DBS) has been proposed as an alternative to capsulotomy in refractory cases of obsessive-compulsive disorder (OCD). Although rechargeable implantable pulse generators (rIPGs) have been used extensively in DBS for movement disorders, there are no reports on rIPGs in patients with a psychiatric DBS indication, and even possible objections to their use. OBJECTIVE: We aim to evaluate rIPGs in OCD in terms of effectiveness, applicability, safety, and need for IPG replacement. METHODS: In this prospective before-after study recruiting from 2007 until 2012, OCD patients requiring at least one IPG replacement per 18 months were proposed to have a rIPG implanted at the next IPG depletion. OCD severity was the primary outcome. Ten patients were analyzed. RESULTS: Psychiatric symptoms and global functioning remained stable in the two years after as compared to the two years before rIPG implantation. Over the same period, the prescribed OCD medication doses did not increase and the DBS stimulation parameters were largely unaltered. Until the end of the follow-up (mean 4¾ years; maximum seven years), the DBS-related surgery frequency decreased and there were no rIPG replacements. During the first few weeks after implantation, two patients obsessively checked the rIPG, but afterwards there were no signs of compulsively checking or recharging the rIPG. Two patients experienced rIPG overdischarges (five occurrences in total). CONCLUSIONS: This is the first report on rIPGs in DBS for OCD patients. The use of rIPGs in this population appears to be effective, applicable, and safe and diminishes the need for IPG replacements.

Screening tools for body dysmorphic disorder in a cosmetic surgery setting.

OBJECTIVES/HYPOTHESIS: Body dysmorphic disorder (BDD) is a well-established psychiatric disorder characterized by a marked, distressing, and impairing preoccupation with an imagined or slight defect in appearance. Despite the growing interest in and awareness of aesthetic surgeons for BDD, diagnosing BDD during a preoperative consultation remains challenging. This review provides an overview of the existing screening tools for BDD and assesses their quality and feasibility in an aesthetic surgery population. STUDY DESIGN: Systematic review. METHODS: An electronic bibliographic search was conducted to identify all screening tools for BDD in a cosmetic setting. We investigated their development and validation processes and investigated whether the screening tool had a predictive value on subjective outcomes after treatment. RESULTS: We identified six different screening tools for BDD in a cosmetic setting. Only two of them were validated in a cosmetic dermatology setting: the Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV) and the Dysmorphic Concern Questionnaire (DCQ). Outside the dermatologic surgery setting, no screening tools were validated. For the BDDQ-DV, no influence on subjective outcome after cosmetic treatment was found. CONCLUSIONS: The limited availability of good screening tools for BDD in patients seeking aesthetic surgery stands in remarkable contrast to the estimated high prevalence of BDD in this setting. Among the currently used screening tools, the BDDQ-DV and the DCQ seem the most suitable for further research on prevalence of BDD in cosmetic surgery and the impact of BDD on treatment outcome.

High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty.

BACKGROUND: Nasal aesthetic deformities may be associated with significant body image dissatisfaction. The only diagnostic category in the current list of psychiatric disorders that directly addresses these concerns is body dysmorphic disorder. This large-scale study determined the prevalence of body dysmorphic disorder and its symptoms in patients seeking rhinoplasty and evaluated the clinical profile of these patients. METHODS: Two hundred twenty-six patients were given questionnaires including demographic characteristics, visual analogue scales for nasal shape, the Yale-Brown Obsessive Compulsive Scale modified for body dysmorphic disorder to assess severity of symptoms, a generic quality-of-life questionnaire, and the Derriford Appearance Scale 59, to assess appearance-related disruption of everyday living. Independent observers scored the nasal shape. RESULTS: Thirty-three percent of patients showed at least moderate symptoms of body dysmorphic disorder. Aesthetic goals (p < 0.001), revision rhinoplasty (p = 0.003), and psychiatric history (p = 0.031) were associated with more severe symptoms. There was no correlation between the objective and subjective scoring of the nasal shape. Yale-Brown scale modified for body dysmorphic disorder scores correlated inversely with the subjective nasal scoring (n = 210, p < 0.001), without relation to the objective deformity of the nose. Body dysmorphic disorder symptoms significantly reduced the generic quality of life (n = 160, p < 0.001) and led to significant appearance-related disruption of everyday living (n = 161, p < 0.001). CONCLUSIONS: The prevalence of moderate to severe body dysmorphic disorder symptoms in an aesthetic rhinoplasty population is high. Patients undergoing revision rhinoplasty and with psychiatric history are particularly at risk. Body dysmorphic disorder symptoms significantly reduce the quality of life and cause significant appearance-related disruption of everyday living. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.