Predictors of pharmacotherapy outcomes for body dysmorphic disorder: a machine learning approach

Background Serotonin-reuptake inhibitors (SRIs) are first-line pharmacotherapy for the treatment of body dysmorphic disorder (BDD), a common and severe disorder. However, prior research has not focused on or identified definitive predictors of SRI treatment outcomes. Leveraging precision medicine techniques such as machine learning can facilitate the prediction of treatment outcomes. Methods The study used 10-fold cross-validation support vector machine (SVM) learning models to predict three treatment outcomes (i.e. response, partial remission, and full remission) for 97 patients with BDD receiving up to 14-weeks of open-label treatment with the SRI escitalopram. SVM models used baseline clinical and demographic variables as predictors. Feature importance analyses complemented traditional SVM modeling to identify which variables most successfully predicted treatment response. Results SVM models indicated acceptable classification performance for predicting treatment response with an area under the curve (AUC) of 0.77 (sensitivity = 0.77 and specificity = 0.63), partial remission with an AUC of 0.75 (sensitivity = 0.67 and specificity = 0.73), and full remission with an AUC of 0.79 (sensitivity = 0.70 and specificity = 0.79). Feature importance analyses supported constructs such as better quality of life and less severe depression, general psychopathology symptoms, and hopelessness as more predictive of better treatment outcome; demographic variables were least predictive. Conclusions The current study is the first to demonstrate that machine learning algorithms can successfully predict treatment outcomes for pharmacotherapy for BDD. Consistent with precision medicine initiatives in psychiatry, the current study provides a foundation for personalized pharmacotherapy strategies for patients with BDD.

Deciding on Optical Illusions: Reduced Alpha Power in Body Dysmorphic Disorder

Background: Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by excessive preoccupation with imagined defects in appearance. Optical illusions induce illusory effects that distort the presented stimulus thus leading to ambiguous percepts. Using electroencephalography (EEG), we investigated whether BDD is related to differentiated perception during illusory percepts. Methods: 18 BDD patients and 18 controls were presented with 39 optical illusions together with a statement testing whether or not they perceived the illusion. After a delay period, they were prompted to answer whether the statement is right/wrong and their degree of confidence for their answer. We investigated differences of BDD on task performance and self-reported confidence and analysed the brain oscillations during decision-making using nonparametric cluster statistics. Results: Behaviorally, the BDD group exhibited reduced confidence when responding incorrectly, potentially attributed to higher levels of doubt. Electrophysiologically, the BDD group showed significantly reduced alpha power at mid-central scalp areas, suggesting impaired allocation of attention. Interestingly, the lower the alpha power of the identified cluster, the higher the BDD severity, as assessed by BDD psychometrics. Conclusions: Results evidenced that alpha power during illusory processing might serve as a quantitative EEG biomarker of BDD, potentially associated with reduced inhibition of task-irrelevant areas.

O Impacto Psicossocial da Acne Vulgar / The Psychosocial Impact of Acne Vulgaris

A acne é uma afecção cutânea comum, que atinge cerca de 80% da população em alguma fase da vida. Além da parte estética, a acne abrange consequências psicológicas e sociais que podem afetar a qualidade de vida, saúde psíquica e a autoestima dos pacientes. O presente estudo de revisão narrativa bibliográfica, investigou os aspectos principais do impacto psicossocial em pessoas com acne vulgar. Constatou-se que vários danos são gerados para os acometidos por essa patologia, entre eles estão: ansiedade, fobia social, depressão, insegurança, timidez, sintomas obsessivos compulsivos e transtorno dismórfico corporal. Tendo em vista os resultados apontados, confirmou-se que o tratamento adequado e efetivo apresenta grande melhora no quadro dos pacientes. Diante dos malefícios que a acne promove para vida da população é necessário compreendê-la como uma doença e não apenas como uma disfunção estética. ---Acne is a common skin condition that affects about 80% of the population at some stage of life. In addition to the aesthetic part, acne includes psychological and social consequences that can affect the quality of life, mental health, and self-esteem of patients. The present study of a bibliographic narrative review investigated the main aspects of the psychosocial impact on people with acne vulgaris. It was found that several damages are generated for those affected by this pathology, including anxiety, social phobia, depression, insecurity, shyness, obsessive-compulsive symptoms and body dysmorphic disorder. In view of the above results, it was confirmed that the adequate and effective treatment presents a great improvement in the patients' condition. In view of the harm that acne causes to the population's life, it is necessary to understand it as a disease and not just an aesthetic dysfunction.

Self-worth Pada Individu Dengan Body Dysmorphic Disorder yang Menjalani Bedah Kosmetik

<p>Body dysmorphic disorder (BDD) is a psychiatry disorder related to body image. Individuals with BDD are found to have low self-worth, this is the cause of individuals with BDD to have cosmetic surgery. The purpose of this article is to determine the relationship of self-worth in individuals with BDD in performing cosmetic surgery. In this systematic review, there were 20 articles that met the criteria, there were 12 articles with the variable self-worth with BDD, 4 articles with the variable self-worth, BDD, and cosmetic surgery, and 4 articles with the variable BDD and cosmetic surgery. Based on the results of a systematic review, it was found that individuals with BDD have low self-worth, this low self-worth makes individuals with BDD perform cosmetic surgery.</p>

The Relationship Between Childhood Traumas with Social Appearance Anxiety and Symptoms of Body Dysmorphic Disorder: The Mediating Role of Sociocultural Attitudes Toward Appearance

Background: Body dysmorphic disorder (BDD) and social anxiety are two concepts related to body dissatisfaction. These concepts have been linked to sociocultural attitudes to appearances and painful experiences in interpersonal relationships. Objectives: The present study examines the relationship between childhood traumas with social appearance anxiety (SAA) and BDD through the mediating role of sociocultural attitudes toward appearance (SATA). Methods: This cross-sectional study was conducted on 415 university students in Tehran, Iran using the convenience sampling method in 2019 - 2020. Data were analyzed using SPSS version 24 and Amos version 21 software. Results: According to our results, while childhood traumas were not directly related to BDD (β = 0.059; SE = 0.31), SAA seemed to play a statistically significant mediating role (β = 0.17; SE = 0.005). Moreover, childhood trauma was related to SAA both directly (β = 0.24; SE = 0.001) and through the mediating role of SATA. In addition, SATA (β = 0.17; SE = 0.005) significantly predicted BDD (β = 0.27, P < 0.001). The assumed model was in good fit with the acquired data (CFI = 0.97, GFI = 0.95, NFI = 0.94, RMSEA = 0.046). Conclusions: Children who have had traumatic experiences may experience anxiety and self-doubt. Thus, childhood traumas are ostensibly related to signs of BDD and SAA through the mediation of sociocultural attitudes. Childhood traumas can also predict susceptibility to rejection in interpersonal relationships. However, no results have been found to mediate rejection sensitivity concerning trauma with BDD and SAA.

Is Every Patient of Hair Loss a Candidate for Hair Transplant?—Deciding Surgical Candidacy in Pattern Hair Loss

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Contemporary Supportive Therapy: A Review of History, Theory, and Evidence

Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.