Bupropion Augmentation in a Case of Compulsive Buying Disorder

Therapeutic management of buying/shopping disorder: A systematic literature review and evidence-based recommendations

The prevalence of buying/shopping disorder (B/SD) has been increasing in the last two decades, and this disorder has a substantial negative impact on general functioning and quality of life. Therefore, a systematic review of the studies dedicated to the efficacy and tolerability of therapeutic interventions, both psychological and pharmacological, might help clinicians to decide on the most evidence-based treatment for these patients. In order to further increase the clinical usefulness of the current review, GRADE-based recommendations were formulated, where enough evidence was found to support such an approach. A number of five electronic databases were searched for single case reports, case series, open-label and double-blind, placebo/active intervention-controlled trials, but other secondary reports (i.e., systematic reviews and meta-analyses) were also included in this analysis. Studies with unspecified designs or those that do not report either qualitatively or quantitively the evolution of B/SD core manifestations were excluded. All data included in the secondary analysis were evaluated using the Joanna Briggs Institute critical appraisal checklists. A total number of 24 manuscripts (i.e., 12 clinical trials, eight case reports, and four reviews) were included. Most of the reviewed studies were of moderate quality, representing a certain limitation of this review and preventing the formulation of high-validity recommendations. Psychotherapy, especially cognitive behavioral therapy (CBT) seems to be the main intervention supported by the current evidence, followed by the combination of antidepressants and CBT, and serotoninergic antidepressants as monotherapy. There is an obvious need to further develop good-quality trials with a more significant number of participants with B/SD and longer follow-up periods.

Obsessive-Compulsive Disorder in Older Adults: A Comprehensive Literature Review

We reviewed English-language articles concerning obsessive-compulsive disorder (OCD) in older adults. PubMed was searched using key words that included obsessive-compulsive disorder, geriatric, elderly, aging, and older. Of the 644 articles identified, we included 78 that were relevant to the topic. Articles that were excluded as irrelevant included studies that were not focused on OCD in older adults, animal studies, and older case reports if we identified similar more recent case reports. The literature contains very little information about the epidemiology, diagnosis, psychopathology, and treatment of OCD in older adults. Even though the diagnostic criteria for OCD are the same for older and younger adults, different manifestations and progression in older patients have been reported. While the domains and severity of symptoms of OCD do not change with age, pathologic doubt may worsen. The Yale-Brown Obsessive Compulsive Scale is used for diagnosing and evaluating illness severity, and the Obsessive-Compulsive Inventory-Revised is another valuable tool for use in older adults. Psychotherapy, specifically exposure and response prevention, is the first-line treatment for OCD because of minimal adverse effects and reported benefit. Although the US Food and Drug Administration has not approved any medications specifically for OCD in older adults, pharmacotherapy is a consideration if psychotherapy is not successful. Selective serotonin reuptake inhibitors have the fewest side effects, while the cardiovascular and anticholinergic side effects of tricyclic antidepressants are especially worrisome in older adults. OCD in older adults has received little attention, and further studies are needed.